It’s 1982, and a man is having a heart attack. An ambulance rushes him to the emergency department, where he’s given a nitroglycerin tablet and a drug called nifedipine.
The treatment doesn’t seem to work, and the man’s heart sustains serious damage. An emergency physician delivers the news to the man’s family: “He might not survive the night. We’ll keep him comfortable, but there’s nothing else we can do.”
For years, this scene was a common one, played out again and again in emergency departments across the nation. Physicians did their best to care for heart attack patients—but their best too often wasn’t enough. That’s because nifedipine and other drugs used at the time simply weren’t effective.
In the fall of 2021, Curiosus writer and Barnes-Jewish Hospital administrative fellow Emily Dovolis Thomson, MHA, talked with Muhammad Faraz Masood, MD, Washington University cardiothoracic surgeon, and other members of a specialized team about a life-saving procedure called ECMO, or extracorporeal membrane oxygenation. Often used to treat the sickest of the sick, ECMO sustains life when the body no longer can. During the days of the SARS-coV-2 pandemic, ECMO, which performs the functions the heart and lungs can no longer manage, has become a valuable tool in saving lives.
This photo essay suggests the level of expertise required to care for patients undergoing ECMO, an intervention with many moving parts. It takes a dedicated team to manage the complexities.
BY Connie Mitchell
“It was a lonely experience.” That’s how Dave Barylski remembers the long hours at his babies’ bedsides. Twins, the girls were born in April 2019 weighing just more than 1 pound each after birth at 22 weeks of gestation. Barylski and his partner, Bethany Watkins, practically lived in the newborn intensive care unit (NICU) at St. Louis Children’s Hospital for seven months—and he was often the only father in the unit. “I was lucky that my job offered paternity leave and extended family leave so I could be there, but being a dad in that situation, I had to piggyback off the services that are usually focused on moms,” he says. “I was the only father there during lunches and in the support groups that were clearly aimed at moms’ needs.
In an ice rink measuring 200 feet by 85, 10 of the 12 players on a professional hockey team skate at speeds of up to 20 miles per hour, vying for a frozen, vulcanized rubber puck that, when forcefully shot, can reach 100 miles per hour. Players collide with each other, get rammed into the rink’s wood or fiberglass walls and steel goal posts, skate on razor-sharp blades and swiftly maneuver hockey sticks measuring up to 63 inches in length. What could possibly go wrong?
Just a few decades ago, cardiac surgeons, engineers and scientists were working on new technology that would revolutionize open-heart surgery. Specifically, they were developing a device that would act as a patient’s heart and lungs, keeping the body’s blood supply circulating while the heart underwent complex repairs. At Barnes Hospital, now Barnes-Jewish, a solution to the problem arrived in 1956: the Gibbon-Mayo heart-lung pump.
A little boy is cured of cancer. A woman finds relief after months of pain. A man gets the new lung he needs to breathe easy and keep living. A baby goes home from the hospital—healthy after a frightening early birth and a stay in the newborn intensive care unit. With its cutting-edge technologies and lifesaving advances, the field of medicine is full of stories like these. This is apparent every day in health-care systems across the country and around the world.
A first-of-its kind device, called IpsiHand, will soon be available to people working to recover hand and arm movement after a stroke. And it works by using a technology called BCI, short for brain-computer interface. In fact, it is the first stroke-rehabilitation device that relies on BCI. The device is not yet available to patients, but its developer, a Washington University startup called Neurolutions Inc., is preparing to bring the device to market.
The new drug sotorasib reduces tumor size and shows promise in improving survival among people with lung tumors caused by a specific DNA mutation, according to results of a global phase 2 clinical trial. The drug is designed to shut down the effects of the mutation, which is found in about 13% of people with lung adenocarcinoma, a common type of non-small-cell lung cancer. Non-small-cell lung cancer makes up over 80% of all lung cancers. And more than 200,000 new cases of non-small-cell lung cancer are diagnosed annually in the United States.
In a phase 2 clinical trial, researchers at Washington University School of Medicine and the University of Chicago demonstrated that symptoms of depression can improve rapidly following a single, one-hour treatment with inhaled nitrous oxide.
Research suggests nursing mothers who receive a COVID-19 vaccine may pass protective antibodies to their babies through breast milk for at least 80 days following vaccination.
The beeping vibrato of pressure monitors, mechanical rhythm of the blood pump, low hum of the oxygenator and metronomic beat measuring heart rate: These are the sounds that emanate from a complex circuit of pumps, tubes, filters and monitors called ECMO, or extracorporeal membrane oxygenation. ECMO moves blood outside of the body through cannulae, or tubes, to an oxygenator that provides a gas exchange in the blood, removing carbon dioxide and replacing it with oxygen. The oxygenated blood is then warmed to the appropriate temperature and returned to the body using rhythms that mimic a beating heart.
When disease or trauma prevent the body from performing these life-sustaining rhythms, ECMO can take over.
In mid-March 2020, Marta Perez, MD, left her Florida-based private practice in obstetrics and gynecology to return to Washington University School of Medicine and Barnes-Jewish Hospital. Perez had completed her obstetrics and gynecology residence at those institutions, and now her husband, Michael Chomat, MD, was finishing a pediatric cardiology fellowship at the School of Medicine and St. Louis Children’s Hospital, and about to begin a pediatric intensive care fellowship.
Perez welcomed the move because it provided her with the opportunity to change the focus of her career. Rather than continuing in private practice, she wanted to return to academic medicine and focus exclusively on obstetrics. Now, working as an academic laborist, she serves as a hospital-based obstetrician who helps women deliver their babies and teaches residents and medical students about obstetrics.
Two factors in the timing of the move to St. Louis would prove to be extraordinary—for the world and for Perez. First, by early spring 2020, the scope and severity of a new coronavirus became evident worldwide, resulting in a pandemic. And second, Perez had learned she was pregnant with her first child, about to face many of the challenges and uncertainties her pregnant patients were facing.