Reeve Gets Surgery to Try to Stop Using Respirator

Times Staff Writer

Actor Christopher Reeve has undergone an experimental surgery that doctors believe will enable him to breathe without a respirator for the first time since he broke his neck in a 1995 horseback-riding accident.

Physicians at University Hospitals of Cleveland used minimally invasive surgery to implant tiny electrodes that control his breathing by stimulating the muscles of his diaphragm with a pacemaker-like device.

Using the device, the star of the movie "Superman," who is paralyzed from the neck down, is able to breathe without a respirator for 15 minutes at a time.

At a Thursday news conference, Reeve said it was a relief to escape the constant noise, especially when the respirator was first turned off. "All you could hear was me breathing through my nose -- regular rhythmic breathing from my nose for the first time in nearly eight years," he said.

With the respirator turned off, Reeve is also able to talk and detect odors. When the medical team brought him a cup of coffee, he recalled, "I actually woke up and smelled the coffee."

Dr. Raymond Onders, who performed the experimental procedure, said the team is now working to strengthen the muscles of Reeve's diaphragm, which have not been used for eight years. "We're strengthening it to go 24 hours a day, seven days a week, but that will take a little time," he said. "Our goal now is hours at a time."

About 200 to 300 spinal cord injury patients in the United States might be eligible for the procedure once it is approved, Onders said.

Before the experimental procedure, Reeve was able to breathe using his neck muscles to force air into his lungs for as long as 12 minutes, but only with great effort.

The procedure works because most breathing is controlled by the diaphragm. When the diaphragm contracts, it creates a vacuum in the chest cavity, drawing air in. When it relaxes, the air escapes.

Although the procedure used on Reeve is fairly new, the idea is not. Physicians have used a surgical procedure called a thoracotomy in which the chest is opened and electrodes are attached to the phrenic nerves, which control the diaphragm. That open-chest procedure entails substantially more risk and requires a long hospital stay for recuperation. Attaching the electrodes directly to the nerves, furthermore, runs the risk of damaging them. If they are damaged, the patient will never be able to breathe without a respirator again, Onders said.

In his 1999 book, "Still Me," Reeve called the open-chest operation "a drastic and dangerous procedure." He wrote: "After the implantation you have to stay in intensive care for months of constant monitoring. The risks are enormous. Batteries fail. Phrenic nerves can be damaged by the constant electrical impulses. The procedure frees you from the ventilator, but the outcome can be fatal."

The new procedure was developed by Onders and Dr. Anthony DiMarco of University Hospitals in association with biomedical engineers at Case Western Reserve University. Because surgeons used a slender tubular endoscope to perform the surgery in a minimally invasive manner, only an overnight hospital stay was required. And because the electrodes were implanted in muscles near to, but not touching, the phrenic nerves, there is little chance of damage.

"The worst-case scenario is that, if it doesn't work, I just pull the wires out," Onders said. "Even if this doesn't get him off the ventilator, there should be no other long-term problems."

Reeve is the third patient to undergo the procedure. The first was 38-year-old Tom Conlan of Medina, Ohio, who was paralyzed in a 1998 swimming accident. He received the implant three years ago but had to undergo a second procedure to correct minor problems, Onders said.

The second implant did not work because the surgeons discovered during the surgery that the patient's phrenic nerves, which control the diaphragm, had already been damaged. They revised their procedure to test Reeve's phrenic nerves before scheduling the surgery.

The Feb. 28 operation lasted 4 1/2 hours.

Reeve, who had left Ohio to recuperate at his home, returned to Cleveland on Sunday and has been working with doctors 12 hours a day to learn how to use the device. "He has a lot of other muscle stimulators and other devices, and we have to check to make sure there is no interference," Onders said. Reeve breathes with the device about 15 minutes of every hour.

"He's made tremendous progress in four days," Onders said. The team has permission from the Food and Drug Administration to use the procedure in 35 patients, but Onders said that they have sufficient funds currently to perform it in only five.

Reeve said he is grateful for the operation, but he emphasized that he hopes it will benefit others as well. "My recovery doesn't mean anything if it doesn't translate into better care for other patients," he said.

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