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As a seasoned card player, Jess Harris knows a good hand when he sees one.
When it came to heart failure, however, the deck was stacked against him.
"My survival chances were less than 50 percent," says the 72-year-old resident of Mason City, Iowa. "Yet here I am!"
Getting from where he was late last year-with heart failure so severe he could only walk a few steps at a time-to where he is today-on the road to recovery-wasn't easy. The retired tax consultant and emergency medicine technician needed special help in the form of a procedure called extracorporeal membrane oxygenation (ECMO).
First used in 1971 and often associated with treating newborn infants with respiratory failure, ECMO allows sick or injured hearts or lungs the opportunity to rest and get better.
In Harris's case, the experts with UI Heart and Vascular Center at University of Iowa Hospitals and Clinics viewed ECMO as a last-ditch effort to give his heart a temporary boost so he could survive the surgical implantation of a cardiac stent.
"A mechanical heart pump was a consideration but the required surgery would have been too risky," says cardiologist Phil Horwitz, MD, who led the cardiac treatment team.
Cardiologist John Chase, MD, who evaluated Harris and recommended him for ECMO, noted that the procedure is not a cure. "ECMO is generally used for acute, reversible cardiac or respiratory failure when the risk of death despite conventional treatment is high (50 to 100 percent)," he explains. "The results focus on survival."
ECMO is performed by draining venous blood from the large catheter placed in a vein to the ECMO circuit, removing carbon dioxide and adding oxygen through an artificial lung, and pumping the re-warmed blood back into the circulatory system via a vein (VV ECMO) or artery (VA ECMO).
What begins as poorly oxygenated dark red blood becomes well oxygenated bright red blood.
The entire process requires vascular access catheters, connecting tubing, a servo-regulating blood pump, a gas exchange device, a heat exchanger, and various measuring and monitoring devices. It takes a highly trained team of specialists to monitor the system and make sure the patient is progressing as expected.
Supported by ECMO, Harris's heart recovered well enough that he could tolerate the all-important surgical implantation of a life-saving stent.
"Everything came together as we hoped and Mr. Harris is doing very well," says William Lynch, MD, a cardiothoracic surgeon and medical director of the ECMO Program.
After recovering from that procedure, Harris underwent extensive rehabilitation at Manor Care Health Services in Cedar Rapids, then received a pacemaker implant at Mercy Medical Center-North Iowa, in Mason City.
"I'm feeling pretty good right now," Harris says. "The people who took care of me were absolutely great!"
For more information, patients and family members may call UI Health Access toll-free and ask for Shanna Seigel, RRT, CHT, ECMO program coordinator. Seigel can also be reached at 319-384-9707, or via e-mail at shanna-seigel@uiowa.edu.
For consultation or referral, physicians should contact UI Consult.
Two types of ECMO
- Veno-arterial (VA ECMO) for cardiac failure patients usually requires two catheters, one in a large vein and one in a large artery
- Veno-venous (VV ECMO) for respiratory failure patients usually involves one catheter through the neck
ECMO at UI
- 103 pediatric patients treated since the program's start in 1994
- Three adults treated since the adult program began last year
- 29 ECMO team members specially trained to manage the pump at the patient's bedside
ECMO survival rates
- 77% for neonatal respiratory failure
- 56% for pediatric respiratory failure
- 53% for adult respiratory failure
- 43% for pediatric cardiac failure
- 32% for adult cardiac failure
-Michael Sondergard
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