Q: The news has reported a few stories about a life-saving technology called ECMO. Is that available for children, too?
A: Absolutely. In fact, ECMO (Extracorporeal Membrane Oxygenation) has been used to support babies with life-threatening heart and lung problems for about 30 years. It is a machine that sits at the bedside and is connected to the child by cannulas inserted into large veins and arteries. A pump pulls blood from the patient through the cannulas and across a specially designed membrane for oxygenation. The pump can take over the function of the heart, while the membrane acts like a lung. A child can stay on ECMO for a couple of days or a couple of months, depending on the indication. This provides time needed for organs to recover from illness. Occasionally, organs do not recover, in which case ECMO can become a bridge to a heart or lung transplant.
Our patients have included a newborn with Persistent Pulmonary Hypertension of the Newborn (PPHN), who went on the day she was born and came off 10 days later, on Father’s Day. Another newborn born with a congenital lung problem went on at age 5 days and stayed on for 5 weeks before coming off in good condition. There was a teenager with Influenza myocarditis who needed to be stabilized on ECMO and then transported to a heart transplant center in another state. And there was an 8-year-old with newly diagnosed cancer who developed rapid respiratory failure and needed to be supported on ECMO in order to get through her first round of chemotherapy.
Typically, ECMO is used in conditions that affect the heart or lungs. In 1994, a new cause of heart/lung failure requiring ECMO came to light, Hantavirus Pulmonary Syndrome (HPS). HPS is endemic to the Four Corners area and initially caused 100 percent mortality. It mostly affects young to middle-aged adults, often in good health, causing rapid, life-threatening heart and lung disease. To date, the only way to survive HPS is with ECMO support. A series of HPS patients from 1994-2000 had a 66 percent survival rate, a vast improvement from the prior 0 percent survival rate.
The original history of ECMO dates back 75 years. In 1944, researchers discovered that blood became oxygenated as it passed through an artificial cellophane membrane. In 1953, this was combined with perfusion support for the first successful open heart operation, and by 1970, it was possible to support infants undergoing cardiac surgery. The next evolution was finding a way to use ECMO safely for days to weeks, to support diseased lungs that can take weeks to recover. The first success was in 1972, in an adult. However, overall survival rates remained low and ECMO fell out of favor for adults. However, in 1975, a baby, “Esperanza,” was born at the University of Michigan with respiratory failure due to PPHN. She was put on ECMO as a last chance, and survived. There had been a handful of prior attempts in newborns, with 100% mortality due to bleeding complications. Ezperanza became the first successful case of ECMO for newborn respiratory failure.
Over the next 40 years, both ECMO technology and intensive care practices improved. CMO has been standard care for infants and children with heart and/or lung failure since 1990. It came to New Mexico in 1991. Dr. Mark Crowley (Division Chief, Pediatric Critical Care, UNMH) and his associates at the time consulted with experts in the field and started the ECMO program. It has consistently served the New Mexico population ever since, currently supporting between 10-15 children per year, including babies as small as 2K. Each case is a multi-disciplinary effort, entirely dependent on the expertise of surgeons, intensivists, neonatologists and specially trained nurses. Because it is so resource intensive and requires specially trained personnel, it is not available in every hospital. But each region will have designated ECMO centers.
ECMO is a life-saving therapy, but it does have inherent risks, such as clot formation, air bubble formation and bleeding. Survival rates vary by diagnosis – cardiac issues 62 percent, respiratory issues 84 percent (50-95 percent). Fortunately, families tend to view post-ECMO life favorably, with most parents considering their child to be in good health, with few physical limitations. So we will continue to offer this therapy to children and work toward better technology and even better outcomes.
Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send your questions to her at firstname.lastname@example.org.