Those are the words of Barbara Stott of Columbus. It’s a statement she can make with full certainty. In August 2016, she aspirated following heart surgery, causing her lungs to fail. Fortunately for her, Mission Hospital had recently acquired an ECMO (extracorporeal membrane oxygenation) machine that assists heart and lung functioning.
Stott was placed in a medically induced coma and put on the ECMO machine for five days until her lungs could recover, making her the hospital’s first patient to receive the treatment. The process was a success, as Stott is here to testify: “I’m thankful for it. If not for the machine, I wouldn’t be here to say that.”
There are others who can now say the same – patients who, like Stott, would not be here if not for the technology and the around-the-clock care of the ECMO team at Mission. Ami Torrey, RN, lead nurse of the ECMO program at Mission Health, remains in close contact with the patients and families who have benefited from the machine, and said that each of them shares two things in common: they all have amazing stories of coming back from the brink of death, and they’re all eager to tell their stories to anyone who will listen.
Essentially, an ECMO machine does the work of a patient’s heart and lungs. “The two key components of the ECMO circuit are a blood pump and an oxygenator,” explained Daniel Mulloy, MD, a cardiothoracic surgeon at Asheville Heart, an affiliate of Mission Health. “The blood pump essentially replaces the work of the patient’s heart, and the oxygenator replaces the work of the patient’s lungs by delivering oxygen and removing CO2.”
Torrey describes the technology as one that creates a temporary artificial heart and lung. She said cannula (tubes) are placed into the patient’s neck, chest or groin to draw out and circulate blood. “The blood, once pulled from the body, is pumped through the oxygenator where carbon dioxide is removed and oxygen is added,” she said. “The oxygenated blood is warmed or cooled and returned back to the body through another cannula.”
Torrey said patients require such life-sustaining support when they have the following functioning problems in their heart or lungs:
- Lungs cannot provide enough oxygen to the body, even when given extra oxygen
- Lungs cannot get rid of carbon dioxide, even with help from mechanical ventilation
- Heart cannot pump enough blood to vital organs like the brain, heart, kidney and liver
- Heart and/or lung disease cannot be cured and the patient is deemed eligible for organ transplant, requiring them to be supported until a new heart and/or lung is available.
A patient can experience these conditions due to any number of reasons, including pneumonia or flu, lung injury, acute respiratory distress, myocardial infarction, heart failure or arrhythmias, surgery complications or aspiration, like Stott experienced.
The benefits of ECMO for these patients are profound. “It provides adequate blood flow for their brain and other organs to continue to function,” said Dr. Mulloy. “It also allows the patient’s heart to rest while on the machine. Depending on the cause of heart failure, the ECMO can be used until the patient’s own heart has recovered and improved, or it can buy time until a more permanent blood pump can be implanted into the patient’s chest.”
ECMO does not come without risks. Clotting, bleeding, risk of stroke, potential failure of other organs, infections, limb complications, need for blood transfusion and inability to wean off the support are all potential dangers of being on the machine. But in almost every case in which the technology is recommended, the patient has nothing left to lose.
“ECMO is an end-stage, lifesaving technique used for people who would not survive without it,” said Dr. Mulloy. “Patients on ECMO are the sickest patients in the hospital and would have a near 100 percent mortality rate otherwise. Therefore, it is a very useful tool that allows cardiothoracic surgeons to save lives of patients who would otherwise die with more conventional methods of cardiac and respiratory support. Fortunately, we’ve had very good outcomes here at Mission, with about 70 percent of patients placed on ECMO surviving.”
Torrey points out that the technology is only a stand-in until real healing can take place. “ECMO therapy has helped save patients’ lives at Mission,” she said. “However, it doesn’t treat the patient’s disease or injury; it only provides support and valuable time to heal. It’s Mission Health’s exceptional multidisciplinary team that works together to treat the underlying disease or injury that heals these patients.”
A Lifesaver for WNC Patients
The technology behind ECMO has been in use for more than 50 years in the form of heart-lung bypass machines that are used in operating rooms during open-heart surgery. The ECMO machine is a miniaturized, portable version that can be brought to a patient’s bedside to support them for a longer period, extending to several days, weeks or months.
This convenience has only become available to Mission patients in the past two years, and it is currently the only system available to patients in western North Carolina. “Our program strives to have processes, procedures and systems in place that promote excellence and exceptional lifesaving care for patients in our region,” said Torrey.
Naturally, Stott doesn’t remember anything from her time on the machine. But her survival is a testament to its effectiveness. In addition, reports from her family and her experience with follow-up care made her grateful she was at Mission to undergo the treatment. So grateful, she brought in German chocolate cakes for the ECMO staff this past Christmas.
“I cannot praise the hospital enough,” Stott said. “The doctors and nurses all took such great care of me and were with me around the clock. I’m not just thankful for the machine, but all the people who knew how to work it and made sure I was doing okay.”
As for what it was like to be Mission’s first ECMO patient, Stott said: “I feel like a celebrity, but they’re the ones who should get the attention.”
Ami Torrey, RN, is lead nurse of the ECMO program at Mission Health.
Daniel Mulloy, MD, is a cardiothoracic surgeon at Asheville Heart, an affiliate of Mission Health.