Extra corporeal membrane oxygenation (ECMO) has been used since 1971 to treat infants with respiratory failure. More recently the procedure has become available for adults. William Lynch, MD, cardiothoracic surgeon and medical director of the adult EMCO services at University of Iowa Hospitals and Clinics, has these comments:
Explain what ECMO does or how it works.
It's been available since the early 1970s and in a lot of ways it's very similar to cardiac pulmonary bypass, or the heart-lung machine that we use in the operating room to support patients during open heart surgery. More than 30,000 patients have been treated with this technology in the last 30 years, and the majority of those have been infants or babies who've had either respiratory failure or cardiac failure.
The job of the lungs and the job of the heart are something that we need every second of our life, and if those organ systems are struggling, then ECMO technology is something that can be used to support a patient for a handful of hours for procedures or up to more than 30 days, if necessary.
How long does a patient remain on an EMCO machine?
It depends on the patient and why we're treating or supporting the patient with ECMO. For infants, for example, if they're experiencing lung failure, it often times takes a good two to four weeks for the baby's lungs, to recover. With this technology, it's feasible to support a patient like that, babies for example, for four to six weeks. The same strategy holds for adults, we can, usually successfully, use it for two to four weeks. Four weeks is close to the limits of successful support for an adult. Complications arise for a lot of different reasons, and some of these complications outlive the benefit of the ECMO treatment.
Which patients benefit from adult ECMO?
With the adult support, there are probably fewer than 30 centers in the U.S. that offer support for adults. We started this in this past year. And like infants, one of the primary reasons to use it is for respiratory failure. But also for adult heart failure patients as a way to provide support for brief periods of time if that patient were a potential heart transplant patient, for example.
But it's also a way to support a patient who has significant heart disease that needs to have a high risk procedure done in the cath lab. Doing these procedures in the cath lab can sometimes cause the heart problem to be even worse, and to be able to support the patient with the machine while they're having these high risk procedures has proven to be a very successful way to use this sort of technology.
Can ECMO actually cure some adult patients?
No, the technology is to support patients, or to do the job of the heart or the lungs while either the heart or the lungs are trying to improve. Or again, as we mentioned in the cath lab, if the worry is that the heart function might deteriorate during the procedure, it's a great way to do the job of the heart and protect the heart from a complication related to the catheterization.
So it doesn't in and of itself cure things but a lot of the things that we do in the hospital are not curative; when we have people who are sick in the intensive care unit, the majority of the technology that we use there is to support patients, give people a chance to heal and that's what ECMO is shown to be very successful in doing in some of the sickest patients that we have. We can take patients who have what we consider to be a 90 percent mortality disease and we can offer these patients a treatment that has more than half of these patients surviving. So it seems to be a successful strategy, a good use of technology to try to help people have a chance to get better.
If a patient or family member want to learn more about adult EMCO, who would they contact?
They can reach me through my office in the Department of Cardiothoracic Surgery at 319-353-6451 and the other is through our ECMO service at 319-384-9707. |
