Alaysha Victorian rests quietly in an infant hospital bed, surrounded by tubes and blinking metal boxes that signal her vital signs.
The most crucial machine performs the work of her heart and lungs. It allows 4-month-old Alaysha–a Toledo, Ohio, baby who has never spent a day outside hospitals–to rest while it removes a portion of her blood, then pumps it back, enriched with oxygen.
The device is used when nothing else works. It buys time to allow the body to rebuild itself.
Patients come to the University of Michigan Medical Center in Ann Arbor from as far as Florida and Nebraska for ECMO, as the machine is called. The alphabet letters stand for extra corporeal membrane oxygenation.
Last week, in a theme issue of the Journal of the American Medical Association devoted entirely to the University of Michigan Medical School on its 150th anniversary, a report describes how a university team pioneered ECMO and created an international registry to educate others.
ECMO has its highest survival rate among patients with respiratory failure, particularly newborns, reports Dr. Robert Bartlett, one of ECMO’s developers.
Of the first 1,000 patients with respiratory failure treated with ECMO since 1980, when data started to be collected, the survival rate is 88 percent among infants; 70 percent among children, and 56 percent among adults. The survival rate among patients with cardiac problems was 48 percent for children and 33 percent for adults. Without ECMO treatment, these gravely ill patients have little chance for recovery.
“What we’ve learned is that . . . if we keep people alive for days or weeks, their heart or lungs will recover from whatever the acute illness was,” said Bartlett. “With this safety net available . . . we have a little more freedom to try new treatments.”
Some day there may be no need for the machine because doctors will better know how to treat the problems, in part because of what they learned while using ECMO, Bartlett said.
For instance, it was discovered that lung failure in infants is caused by low oxygen levels in the blood, a problem triggered by the spasm of pulmonary arteries. Once doctors realized that, they began to give nitric oxide to babies to relax the pulmonary arteries.
The origin of the machine dates to the 1960s, when researchers such as Bartlett sought to improve heart-lung machines used in open-heart surgery. Those machines take over the work of the heart and lungs so that doctors can operate on a non-beating heart. They can only be used for a few hours and the longer a person is on the machine, the more the risk of complications.
ECMO avoids the need to open the chest, as is required with a heart-lung machine. It employs tubes attached to large blood vessels in the neck and leg, an artificial lung that takes over the exchange of oxygen and carbon dioxide, monitoring equipment, and intravenous doses of blood thinners to prevent clotting.
Most patients return to normal lung function within a year.
Bartlett first used ECMO in 1975. Since then it has been used on hundreds of patients, including babies like Alaysha, a preemie with a respiratory virus; burn patients like some of the Ford Rouge workers after last year’s explosion, and people awaiting organs.
Most major children’s hospitals have ECMO. There are machines at Children’s Hospital of Michigan in Detroit and Spectrum Health in Grand Rapids.
But while it’s well-known in the pediatric community, “there’s still enough of a problem that doctors don’t always refer patients” for ECMO care, said University of Michigan ECMO coordinator Robin Chapman. The machine’s cost is $35,000 to $50,000, but around-the clock monitoring and training are larger barriers to its wider use in adult patients. Most insurance covers use of the device.
The University of Michigan has 10 ECMO machines, including three portable units.
ECMO physicians and technicians counsel families that “if it’s very clear we are simply prolonging the process of dying, we stop.” The work builds bonds among the team and survivors. Each year, the University of Michigan hosts an ECMO picnic reunion, drawing more than 500 people. “We’ve watched many of the kids grow,” Bartlett said. “Some have gotten to be good friends.”
