A Life-Saving Collaboration at Mount Sinai

A young woman who underwent a high-stakes liver transplant at The Mount Sinai Hospital in May is now safely back home thanks to an extraordinary collaboration between Stephan Mayer, MD, Director of the Institute for Critical Care Medicine, and Sander Florman, MD, Charles Miller, MD, Professor of Surgery and Director of the Recanati/Miller Transplantation Institute, and their teams.

When Ayana Richardson, 24, arrived at Mount Sinai Urgent Care last spring, she suffered from brain swelling caused by acute liver failure, a condition that carries a high mortality rate. Overnight, Dr. Mayer, an expert in resuscitating patients suffering from massive severe brain injury, and his team kept her alive by cooling her, administering large doses of hypertonic saline, and inserting an intracranial pressure monitor into her brain.

Dr. Mayer, who joined Icahn School of Medicine at Mount Sinai in February as the Founding Director of the Institute for Critical Care Medicine, helped pioneer the life-saving technique of therapeutic hypothermia in which a patient’s body is cooled to minimize brain injury due to lack of oxygen or severe swelling.

The next morning, Ms. Richardson was in a state that resembled clinical brain death, but Dr. Mayer believed she might still have a chance to recover neurologically. He stayed in close contact with Dr. Florman. Hours later, a CT scan showed no irreversible injury. Preserved blood flow to the brain was documented by ultrasound, and her brain stem reflexes returned after her sedation was stopped. Serendipitously, a donor liver became available.

“There is no question that Stephan’s expertise helped us bridge the gap and for the patient to remain a candidate for liver transplant,” says Dr. Florman. “He was able to use his techniques to treat brain swelling to buy us enough time to find a donor. Luckily, it came a short period of time later, and we were able to save her life.”

Dr. Mayer says, “Great outcomes like this are only possible with teamwork and collaboration. She was as sick as any human being could be, and she was treated in three different departments within Mount Sinai within the span of 36 hours. It’s unbelievably gratifying when things work out.”

Both Dr. Florman and Dr. Mayer commended the outstanding work of the entire medical staff involved in saving Ms. Richardson’s life. “It was a tremendous team effort,” says Dr. Florman, “and it reflects the incredible expertise of Mount Sinai in so many areas.”

Nearly a dozen of Ms. Richardson’s family members waited at Mount Sinai while the transplant took place.

“From the bottom of my heart, I don’t even think there are words that can express how I feel about Mount Sinai,” says Ayana’s mother, Pamela Richardson. “The entire team, up until discharge, was the most professional, caring, and understanding team I have ever met.”

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