Alvin Hackel, anesthesiologist and pioneer in newborn care, pediatric specialization, dies at 91

Alvin Hackel, MD, professor emeritus of anesthesiology and of pediatrics at the Stanford School of Medicine, died Sept. 23 in Boise, Idaho. He was 91.

Hackel invented new ways to ensure critically ill infants received the medical care they needed. He was a leader in efforts to have pediatric anesthesiology recognized as a distinct subspecialty, with training focused on the needs and physiology of young patients.

“Dr. Hackel played a significant role in establishing the profession of pediatric anesthesiology as a distinct discipline centered on children,” said Lloyd Minor, MD, dean of the Stanford School of Medicine and vice president for medical affairs at Stanford University. “He will be remembered for his advocacy, energy and innovative thinking that saved countless young lives.”

In particular, Hackel solved two key problems for newborns requiring a move to specialty hospitals. In the 1960s and ’70s, community physicians who needed to find a bed in a neonatal intensive care unit often spent hours making phone calls to locate an opening. Even once they had secured a place to send the patient, moving the ill, fragile baby could be dangerous.

Working with a Stanford professor of mechanical engineering, Hackel invented the first incubator that could be used to transport ill newborns by ambulance or air. He also founded the dispatch center and information-sharing system still used across Northern California to quickly locate vacant NICU beds.

“Al made huge contributions to how we get patients here to our hospital, and he made that possible for every institution in Northern California and across the entire country,” said David Stevenson, MD, the Harold K. Faber Professor in Pediatrics and senior associate dean of maternal and child health, who learned from Hackel how to perform critical-care procedures for newborns.

“He’s an iconic figure in pediatric anesthesia,” said Anita Honkanen, MD, former chief of pediatric anesthesiology, whose career was strongly shaped by Hackel’s mentorship. “He really understood the peculiar vulnerabilities of children, their radically different physiology, and the concerns that children and families bring to the operating room experience.”

Safely moving babies

Hackel was born May 15, 1932, in Los Angeles to Jewish parents who had immigrated to the United States from Poland. He grew up in the city’s Fairfax District and attended Stanford University, where he earned his undergraduate degree in 1954 and his medical degree in 1957.

After medical school, Hackel did his residency training in pediatrics at New York University’s Bellevue Medical Center, completing it in 1960. While at Bellevue, he met Jacqueline Mandelbaum, and they married and had two children, daughter Jamie and son Steven. They divorced in the early 1970s. In 1973, Hackel married Brenda Diane Long and they had a son, Daniel.

Throughout the 1960s, Hackel completed residency training in anesthesiology and fellowship training in cardiac pathology and cardiovascular surgery. He served two years in the U.S. Navy, stationed in Long Beach, California, as a pediatrician.

“In the 1960s, he was one of very few anesthesiologists in the country who were really well trained in and familiar with pediatrics,” said Elliot Krane, MD, the former and founding chief of pediatric anesthesiology and a professor emeritus of pediatrics and of anesthesiology, perioperative and pain medicine.

In 1969, Hackel was hired as an assistant professor of anesthesia and of pediatrics at the Stanford University School of Medicine and Hospital. (At the time, there was no children’s hospital.) He cared for patients of all ages and he assisted Norman Shumway, MD, with early heart transplants.

Although Hackel enjoyed caring for all patients, he gravitated most toward babies. “It was a natural thing for him to work in pediatric anesthesia, and preemies became the focus,” said his son Steven. “Preemies aren’t just born at Stanford, so he became very interested in how to get those kids to places where they could receive adequate care.”

Hackel began collaborating with Robert Moffat, professor of mechanical engineering at Stanford University, to develop a battery-powered transport incubator that did everything needed to keep the infant safe. It included oxygen ventilation, monitors for the baby’s heart rate, fluid intake and blood pressure, and a stabilizer that would keep the unit steady to prevent injury during sudden changes of speed or altitude in an ambulance or aircraft.

The incubators used radiant heat warmers to keep babies at a comfortable temperature, “a principle adapted from the Apollo space program,” according to a 1972 press release from the Stanford University Medical Center’s news bureau. The incubator helped transport tiny patients from as far away as Hong Kong.

In the early 1970s, Hackel worked with Philip Sunshine, MD, professor of pediatrics, emeritus, to set up programs to improve care for babies throughout Northern California. As part of that work, Hackel established a dispatch center to locate available NICU beds across a 200,000-square-mile region covering the northern half of the state. The region had 250 NICU beds in 10 hospitals, but at any time only a handful were vacant. The dispatchers checked in by phone once every eight hours with each hospital to receive updates on available beds, then used the information to help match babies to beds, cutting the time needed from hours to about 20 minutes.

This system formed the foundation for a more technologically advanced version that still exists today, Stevenson said. “For us in neonatology, it was an absolutely key feature of how we developed relationships with physicians in neonatology across the region.”

Hackel also helped secure state funding for the dispatch program. “I remember him saying it was going to be a separate line in the state budget,” his son Steven said. “It was a big deal for him.”

Hackel enjoyed trying out early versions of technology we now take for granted, such as mobile phones. “In the 1970s, he had this crazy Dick Tracy suitcase-sized phone that we had in the car,” his son said.

Teacher, mentor and friend

Hackel was an excellent mentor and a strong advocate for his field, his colleagues said.

As one of Stanford Medicine’s first three neonatology fellows, Stevenson learned from Hackel how to perform procedures in the NICU such as starting arterial lines in preemies. Before neonatology became its own field, anesthesiologists were responsible for such procedures. “He was very careful and very patient, teaching trainees like us who knew nothing about how to do these things in really tiny people,” Stevenson said.

Early in her career, on Hackel’s advice, Honkanen launched a quality improvement program using simulation as a way of teaching medical teams to respond to operating room emergencies.

“He didn’t know a lot about simulation, but he recognized that it could have a significant role in helping people deal with crises in the perioperative setting, especially in pediatrics,” Honkanen said. “I have a particularly fond spot in my heart for Al because he helped get that going for me.”

I never saw him get angry or lose his temper, even in frustrating situations.

“He was a very gentle physician, teacher and mentor,” Krane said. “I never saw him get angry or lose his temper, even in frustrating situations. He was also very, very good with parents and children.”

In the 1980s, Hackel invited about a dozen anesthesiologists from around the country — including Krane, then at the University of Washington in Seattle — to establish pediatric-specific fellowship training for anesthesiologists. Their efforts resulted in the subspecialty being formally recognized by the American Board of Anesthesiology.

Hackel loved the Stanford community and formed strong friendships with many colleagues, his son said. When he and Brenda were married, Sunshine and his wife hosted the wedding in their home. Shumway was often a guest at Hackel’s birthday parties, and the entire Hackel family was close with the family of Bob Moffat, Hackel’s collaborator on the transport incubator.

Hackel and his wife enjoyed attending Stanford football and basketball games. “I don’t think he missed a Big Game until he moved to Idaho when he retired,” Steven said. Hackel also loved cycling in the hills around Palo Alto and the Santa Cruz Mountains.

“He was a really avid cyclist and loved his Kestrel, the first carbon fiber bicycle frame,” Krane said, adding that Hackel and his wife loved to ride their tandem bike. “He was a mentor and role model for me in that way as well.”

After they retired, Hackel and his wife moved to Sun Valley, Idaho. “They loved the outdoor life there,” Steven Hackel said. They also enjoyed being ushers at the symphony and were leaders in the local Jewish community, he said.

In 2006, Hackel received the Robert M. Smith Award from the American Academy of Pediatrics, given annually to honor an individual who has made outstanding contributions to pediatric anesthesiology. The award recognized his work in establishing guidelines for air and ground transport of babies and children, as well as guidelines for the pediatric perioperative anesthesia environment.

Hackel is survived by his wife, Brenda Hackel, daughter Jamie Hyams, sons Steven Hackel and Daniel Hackel, and four grandchildren. Donations in his memory can be made to the Wood River Jewish Community: https://www.wrjc.org/donate.