Barnes-Jewish Hospital | Washington University Physicians

IN DEPTH

featured stories.

art

ECMO: Saving lives during the pandemic

By Emily Dovolis Thomson, MHA

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.

A complex intervention

According to Cambridge University, the first successful use of ECMO happened in Russia in 1929, when extracorporeal perfusion—pumping blood outside of the body—was used to sustain life in a dog. Following this initial accomplishment, specialists spent decades enhancing perfusion by developing a device that could exchange carbon dioxide for oxygen in blood. It wasn’t until the 1950s, though, with the invention of the heart-lung machine, that specialists began to use ECMO regularly and successfully in people.

In 1979, Robert Bartlett, MD—now known as the father of ECMO—and a team of clinicians used ECMO to save the life of a newborn. Born with nonfunctioning lungs, baby Esperanza was kept on an ECMO system for six days, giving her lungs time to fully develop.

However, during the 10 years following this successful use, the treatment was primarily used for pediatric patients, in good part because the need for ECMO intervention was more readily recognizable. In adults, too often the lungs sustained irreversible damage before the need for intervention was recognized. Because of this and other factors, the mortality rate for adults on ECMO was 90%. But in 1989, the new Extracorporeal Life Support Organization (ELSO) began to support and advocate for ECMO as medicine made advances that positively affected outcomes for adults.

These changes allowed ECMO to play an important role during the outbreak of H1N1 influenza in 2009. The virus caused extreme inflammation of the lungs, resulting in respiratory failure and profound lung damage. ECMO served a lifesaving role, treating some adults affected by the H1N1 virus whose lungs needed time to recover and repair.

ECMO and COVID-19

Like H1N1, the SARS-CoV-2 virus that causes COVID-19 infiltrates the lungs through the mucus membrane, potentially spreading infection and inflammation. In severe cases, the virus affects the upper and lower areas of the lungs, causing pneumonia that drowns the lungs’ alveoli sacs with fluid.

These sacs, situated at the end of the lung’s bronchi branches, exchange oxygen for carbon dioxide molecules. When the alveoli become flooded with fluid, they are unable to perform; the lungs, and then the body, begin to fail.

Some people with COVID-19 are given antiviral drugs, such as remdesivir, to prevent lung complications. And specialists may use a ventilator machine to help the lungs perform more effectively. Those with particularly severe COVID-19 disease, however, may have lung damage so severe that a ventilator cannot be used. In these cases, says Muhammad Faraz Masood, MD, a Washington University cardiothoracic surgeon at Barnes-Jewish Hospital, “the lungs become stiff and less compliant to air exchange.” Healthy lungs, he adds, expand and retract like balloons; COVID-19 can transform them into hard, leather-like pouches. “In very advanced stages of lung failure, ventilators are not able to sustain gas exchange, and we use ECMO to intervene.”

WHEN A PATIENT UNDERGOES EMCO FOR LUNG FAILURE, WE WANT TO MAKE SURE THAT THE REST OF THE BODY'S ORGANS ARE HEALTHY ENOUGH TO SUPPORT HEALING. WE USE EMCO TO BUY THE TIME THE BODY NEEDS TO RESTORE ITSELF.

MUHAMMAD FARAZ MASOOD, MD, A WASHINGTON UNIVERSITY CARDIOTHORACIC SURGEON AT BARNES JEWISH HOSPITAL

However, Masood notes, not every person with life-threatening COVID-19 can be treated with ECMO. “We evaluate a patient carefully to determine whether ECMO can be beneficial,” he adds. Masood and fellow Washington University cardiothoracic surgeons Akinobu Itoh, MD, PhD, and Kunal Deepak Kotkar, MD, collaborated with other university specialists to develop the criteria used at Barnes-Jewish Hospital to determine eligibility. In addition to meeting other criteria, patients must be 70 years of age or younger, have a body mass index (BMI) below 45 and have no history of chronic organ failure or irreversible cardiac or pulmonary disease. “When a patient undergoes ECMO for lung failure, we want to make sure that the rest of the body’s organs are healthy enough to support healing,” Masood says. “We use ECMO to buy the time the body needs to restore itself.”

Because the criteria for ECMO qualification is strict—and because the equipment involved in the treatment is complex and the number of specialists it takes to manage an ECMO process is high—ECMO programs in the United States are scarce. In fact, currently there are only about 260 ECMO programs in the country, most of them located in cities with large hospital systems or academic medical centers. The ECMO program at Washington University School of Medicine and Barnes-Jewish Hospital is led by Masood, Itoh and Kotkar.

The complexity of the ECMO process means that the care team, made up of specialists in their fields of medicine, carefully coordinate their activities. Jane Goetz, RN, a critical care nurse in the cardiothoracic intensive care unit at Barnes-Jewish Hospital and a member of the ECMO team, says, “Whether it is cannulating a patient in preparation for ECMO, repositioning to help ensure lung function, or waking someone for the first time after ECMO, the process of caring for these patients really does take an entire village.”

Members of the cardiothoracic surgery team and the intensive care team have built relationships grounded in trust and respect. “We all work together toward the goal of a patient’s recovery,” Goetz says. For example, it took a team of at least 50 specialists working over a nine-week period to care for a recent patient with COVID-19 at Barnes-Jewish Hospital. “Some people with COVID have had a long, hard road to recovery,” says Goetz. “But thanks to ECMO—and the specialists who have provided care—we’ve seen people get a new chance at life.”

ECMO and the future

In 2019, Barnes-Jewish Hospital logged 3,000 hours of ECMO care for patients. Since March 2020 and the beginning of the SARS-CoV-2 pandemic, the hospital has recorded 30,000 hours of ECMO care.

Masood notes that ECMO often is used as a “last resort” option, a treatment for the sickest of the sick. He would like to see that change. As more clinicians become familiar with ECMO, he says, they may begin to see it as a viable option in a wider range of situations, resulting in an even greater potential to save lives. And frequency of use may improve the treatment itself, as well as expand the situations in which it is used. “If we were to use ECMO earlier in the treatment process, that would mitigate its reputation as the device of last chance,” Masood says. “And we likely would improve its rate of success while offering an effective way to care for people who are critically ill.”


SAVING LIVES DURING THE PANDEMIC

SAVING LIVES DURING THE PANDEMIC

PHOTOGRAPHY BY GREGG GOLDMAN

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.

Read More
MAKING ROOM FOR DADS

MAKING ROOM FOR DADS

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.

Read More
ECMO: Saving lives during the pandemic

ECMO: Saving lives during the pandemic

By Emily Dovolis Thomson, MHA

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.

Read More
WHOLE GENOME SEQUENCING FOR CANCER CARE

WHOLE GENOME SEQUENCING FOR CANCER CARE

BY Andrea Mongler

Three billion is such a large number that it’s hard to fathom. To put it in perspective:

  • 3 billion seconds is about 95 years
  • If you took 3 billion steps, you could walk around Earth at its equator more than 45 times
  • Stacking 3 billion pennies would result in a tower nearly 3,000 miles tall

Three billion also happens to be the number of DNA building blocks, or base pairs, that make up a human genome. And nearly every single cell in our bodies contains two copies of those 3 billion base pairs.

Read More
SAVING LIMBS TAKES TEAMWORK, TIME AND TENACITY

SAVING LIMBS TAKES TEAMWORK, TIME AND TENACITY

By Stephanie Stemmler

Noah was just six years old when he walked up behind someone mowing the lawn who didn’t know he was there. In an instant, as the lawnmower was backed up, Noah’s foot was caught underneath it, sharp blades cutting through skin, muscle and bone in his foot and toes. “They told us at the hospital that his foot might have to be amputated,” says Hingst. “We were in total shock.”

Read More
Addressing the Donor Organ Shortage

Addressing the Donor Organ Shortage

BY CONNIE MITCHELL
ILLUSTRATION BY ABIGAIL GOH

They would fill St. Louis’ Busch Stadium more than twice, take every seat in 261 jumbo jets and fill each bed in Barnes-Jewish Hospital 85 times over. They are the more than 108,000 Americans waiting for an organ transplant. And for too many, a donor organ won’t arrive in time.

Read More
MEETING THE CHALLENGES OF PANCREATIC CANCER

MEETING THE CHALLENGES OF PANCREATIC CANCER

BY STEPHANIE STEMMLER

Every few years, as he pursues breakthroughs for one of the world’s most notoriously difficult cancers to treat, William Hawkins, MD, says he feels like the first man who walked on the moon. “When you have an idea, and you test it in the laboratory, and you find a new insight that no one else has known previously, that’s cool,” he says. “It pushes the frontier of cancer research that much closer to effective treatments for my patients. It really is like boldly going where no one has gone before.”

Read More
MENTAL HEALTH AND THE GENDER GAP

MENTAL HEALTH AND THE GENDER GAP

BY ANDREA MONGLER
ILLUSTRATION BY ABIGAIL GOH

Whether it’s monthly menstrual cycles, pregnancy, childbirth or menopause, women’s bodies change a lot over a lifetime. But often, these life changes aren’t just physical. They can affect women’s mental health, too, in ways large and small.

Read More
ADDRESSING DISPARITIES IN CANCER PREVENTION AND CARE IN RURAL COMMUNITIES

ADDRESSING DISPARITIES IN CANCER PREVENTION AND CARE IN RURAL COMMUNITIES

BY KELLY OMAN
PHOTO BY GREGG GOLDMAN

Though people living in rural communities across the United States may be less likely to get cancer, they are more likely than people living in suburbs and cities to die from it. That’s what is known as a health disparity, a term that can sound rather abstract. The problem, however, is anything but.

Read More
TREATING ADDICTION: PREGNANCY AND OPIOIDS

TREATING ADDICTION: PREGNANCY AND OPIOIDS

BY JEN MILLER
PHOTOS BY JAY FRAM

When Jeannie Kelly, MD, MS, a Washington University maternal-fetal medicine specialist at Barnes-Jewish Hospital, first arrived on the medical campus in St. Louis in 2016, she had already seen how opioid use can devastate a community. “I finished my training in Boston, where the opioid epidemic was exploding,” she says. While working there, Kelly saw addiction and overdoses. She was aware of the difficulties and dangers for pregnant women addicted to opioids, and the great risks to their babies. And she wanted to help.

Read More
RACIAL DISPARITY AND INFANT MORTALITY: WHEN DOING EVERYTHING RIGHT ISN’T ENOUGH

RACIAL DISPARITY AND INFANT MORTALITY: WHEN DOING EVERYTHING RIGHT ISN’T ENOUGH

BY ANDREA MONGLER
ILLUSTRATION BY ABIGAIL GOH | PHOTOS BY JAY FRAM

Every year in St. Louis, the infants who die before their first birthday could have one day populated 12 kindergarten classrooms. That’s according to Flourish St. Louis, an infant mortality reduction initiative supported by the Missouri Foundation for Health.

Read More
THE PRESENT AND FUTURE OF DEPRESSION CARE

THE PRESENT AND FUTURE OF DEPRESSION CARE

BY HOLLY EDMISTON
PHOTOS BY JAY FRAM

Most of us have confessed, at one time or another, to feeling depressed. But often what we really mean is: I’m sad. Or maybe, I’m tired. Or bored. Actual depression, also known as major depressive disorder, is more than sad feelings. People living with this disorder may experience, among other symptoms, changes in appetite, suicidal thoughts, difficulty sleeping or oversleeping and a feeling of hopelessness.

Read More
FERTILITY PRESERVATION: WHY, HOW AND WHEN

FERTILITY PRESERVATION: WHY, HOW AND WHEN

BY ANDREA MONGLER
PHOTOS BY JAY FRAM

A little girl has just been diagnosed with cancer, and her parents are facing a new and terrifying reality. Whys and what-ifs dominate their thoughts, and a feeling of helplessness threatens to overwhelm them. They would suffer the disease for her if they could, but they can’t. They would do anything for this to be over, for her to be OK.

Read More
COMPASSION REQUIRES RESILIENCE

COMPASSION REQUIRES RESILIENCE

BY PAM MCGRATH
ILLUSTRATION BY ABIGAIL GOH | PHOTOS BY JAY FRAM

Taking care of sick people is hard. Whether you’re staying home with a kid who has a fever, spending the weekend with a friend and her broken ankle or helping a parent age at home, the task, though done with love and concern, can take a toll.

Read More

What is Trending: