WVU Healthcare surgeon implants diaphragm pacemaker in quadriplegic pediatric patient

One of two centers in country to use device

MORGANTOWN, W.Va. – It all happened in a matter of seconds. In one second, Meg Throckmorton of Waynesburg, Pa., was a regular 16-year-old practicing for an upcoming dance competition. In the next second, she couldn’t feel her arms or legs and was struggling to breathe.

The trick – a standing back tuck – was one she had done a thousand times. Meg’s mom, Dolly, said it was her aerial trick of choice. To complete it, she was going to flip backwards from a standing position and use her hands to tuck her knees to her chest. But, somewhere between standing and landing the tuck, something went terribly wrong.

“There was one girl – who has done duets with Meg in the past – in the room with her at the time, and she said it was almost like Meg was suspended in the air and then she came down on her head,” Dolly said.

Meg was air lifted to WVU Healthcare’s Jon Michael Moore Trauma Center, where it was determined that she had suffered a high cervical spine injury. She was admitted to the pediatric intensive care unit (PICU) at West Virginia University Children’s Hospital. The next morning, she underwent neck surgery, which was performed by orthopaedic surgeon John France, M.D.

In addition to being quadriplegic as a result of the injury, Meg was unable to breathe on her own, which means she needed a ventilator to breathe for her.

Jennifer Knight, M.D., was the trauma surgeon on call the evening of Friday, April 13, when Meg arrived at WVU Healthcare and was brought in to consult on her case. She also is the same surgeon who was first in the state to implant a diaphragmatic pacemaker in an adult patient.

The device, NeuRx DPS, is currently being used in less than 35 cities nationwide, according to its manufacturer, Synapse Biomedical. WVU is the only center using the device in West Virginia.

An upper spinal cord injury breaks the connection between the brain and the diaphragm – the brain can no longer tell the diaphragm to contract. But for some people who suffer this type of spinal cord injury, a pacemaker for the diaphragm can be put into place to help them breathe. Just as a pacemaker for the heart helps to control the heartbeat, a diaphragmatic pacemaker stimulates the diaphragm to contract, allowing the patient to breathe.

The pacemaker is approved by the U.S. Food and Drug Administration for use in patients 18 years old and older. Meg is 16. Dr. Knight and others on her care team knew that she would greatly benefit from the pacemaker. The procedure won swift approval after an emergency assessment by WVU’s Institutional Review Board and from WVU Healthcare’s chief of staff, Michael Hurst, M.D., D.D.S. They determined that the two-year age difference did not put Meg at any significant risk.

Following surgery to implant the pacemaker on Friday, April 20, Meg returned to the PICU. When the device was turned on, she was able to spend a full 12 hours off the ventilator. Since the surgery, she has been able to come off the ventilator for periods of time every day. Though she is not yet off the ventilator completely, Knight said Meg will eventually get to that point.

Meg’s surgery makes West Virginia University’s medical center only the second in the country to use the device on a young patient, after Case-Western Reserve University in Cleveland. It is also the earliest the device has ever been implanted after injury.

“There are two reasons for that,” Knight said. “The first is that Meg was taken to a trauma center that does the procedure, and the second is that we started planning for the surgery almost immediately after she arrived. Everyone involved in Meg’s care worked very hard to make this happen as quickly as possible. And, it worked perfectly. Everyone did exactly what they were supposed to do to get it done.”

“They say you’ll go to the ends of the earth for your child, and when something like this happens, you don’t really have a choice,” Dolly said. “We are very thankful for the care Meg received, for as horrible as the situation was.”

Now, Meg will spend the next several weeks in Atlanta, Ga., at the Shepherd Center, a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury and brain injury. The Shepherd Center staff are trained to treat diaphragmatic pacemaker patients.

“She will live a pretty normal life with some limitations,” Knight said. “She’s a fighter, and her family is very strong.”