Doctors Use High Technology ECMO to Save a Life
Eric White began New Year’s Day 2016 as many did, feeling a little tired and rundown from celebrating the evening before. Within 24 hours, the previously healthy 39-year-old would be fighting for breath — and his life.
A healthy Eric White stands in the middle of care team members Cara Mlodzik, RN; Kevin Miller, MD; Misty Sieracki, RN; Tristan Huie, MD; Stephanie Wilson, MD; Kathy Owens, RN, BSN; Ken Lyn-Kew, MD; and Theresa Bone, RN, BSN.
“I figured I’d lie on the couch for a couple of days and be fine,” Eric said. Instead of getting better, he got worse. “Walking across the apartment became really laborious,” he said. When that simple act left him breathless, his concern rose to “just above panic level.” At 8 a.m., Jan. 2, he texted his brother, Shaun, and asked him to take him to urgent care. When Shaun arrived, he instead decided to take Eric to National Jewish Health | Saint Joseph Hospital — a decision that most likely saved his brother’s life.
“If he hadn’t come when he did, he probably would have died,” said Kenneth Lyn-Kew, MD, head of critical care medicine at National Jewish Health and part of the team of physicians, nurses, family medicine residents and others who cared for Eric at the hospital.
Eric, a fit and active merchant sailor, was so ill that within hours of arriving in the Emergency Department, he was moved into the Intensive Care Unit (ICU). By the time Ben Mendoza, MD, an internist with Midtown Inpatient Medicine, received his first call about Eric, a tube had already been inserted so he could be placed on a ventilator to help him breathe. “He had only been there for one or two hours. Something didn’t seem right,” Dr. Mendoza said.
Concerned about pneumonia and having difficulty delivering oxygen to his airway, Dr. Mendoza quickly involved the pulmonologists at National Jewish Health.
Your Son Might Not Make It Through the Night
“His pneumonia was so bad, he was drowning in his own secretions,” said Vipin Malik, MD, a pulmonologist at National Jewish Health who responded to Dr. Mendoza’s call. An X-ray revealed that one of Eric’s lungs had ceased to function, and the other was functioning at 10 percent. He was suffering from acute respiratory distress syndrome (ARDS) resulting from a Group A Strep Pneumonia bacterial infection. The condition, which killed Muppets® creator Jim Henson, was aggressively attacking Eric’s lungs and other organs.
“It was difficult to oxygenate him, and traditional mechanical ventilation was not enough to provide adequate oxygenation,” Dr. Malik said. He called Kevin Miller, MD, a cardiothoracic surgeon at Saint Joseph Hospital, to discuss treatment with extracorporeal membrane oxygenation (ECMO), also known as cardiopulmonary bypass.
Realizing that his patient’s “chances of survival were minimal,” Dr. Malik also called Eric’s parents and explained that their son was extremely sick and might not make it through the night.
A Rare Technology for a Rare Illness
ECMO is not a routine procedure. In the rare instances when it is employed, it is typically used on children. The procedure is a last resort when more conventional oxygenation methods are not an option.
With his lungs and heart failing, Eric was being cared for by nationally recognized leaders in respiratory and cardiac care. He could not have been in a better place, or in better hands. Though it is uncommon to see ECMO used outside an operating room, Dr. Miller successfully placed a tube in Eric’s femoral vein and created a circuit enabling the machine to provide cardiac and respiratory support, giving him time to fight his infection.
ECMO in place, Dr. Malik stayed at Eric’s bedside for 10 hours straight. A resident, nurses and perfusionists, who constantly monitored the ECMO machine, were also there around the clock. “The entire team did a marvelous job,” Dr. Malik said.
'Riding a Dragon'
Though his oxygen was improving, doctors struggled to get Eric’s heart rate under control through medications. “It was really a very tough case,” said Dr. Malik. “We rarely see patients who get this sick so fast.”
Stephanie Wilson, MD, an internist with Midtown Inpatient Medicine, who also took care of Eric, was optimistic. “I’m not normally like this, but I had a sense he was going to make it,” she said. Standing at the foot of his bed, she thought, “I feel like we can help him. I feel like we can save him.” Eric began to stabilize, but his physicians were acutely aware of the risks associated with the unpredictable procedure they were using to keep him alive.
“ECMO is like riding a dragon,” said Michael Schwartz, MD, a pulmonologist at National Jewish Health who also played an integral role in Eric’s care. “Everything we do has benefits and side effects.”
A Life-Saving 'Road Trip'
After an odds-defying couple of weeks during which Eric was relatively stable, his progress was almost undone by a complication with his feeding tube that caused life-threatening bleeding. “Many people might have assumed ‘this guy’s so sick, he’s going to die. “We never say never,” said Tristan Huie, MD, a pulmonologist at National Jewish Health, who was caring for Eric when he began to bleed profusely.
Ultimately, Dr. Huie decided Eric’s best chance at survival was a “road trip” to the hospital’s Interventional Radiology unit, where physicians stopped the bleeding and again saved his life. As he stabilized and continued to improve, Eric faced a new challenge: getting off ECMO before additional complications occurred.
Off Life Support and On His Own
On Jan. 26, Dr. Miller removed the ECMO machine. For the first time since Jan. 2, Eric breathed on his own. And he continued to improve. “We were just elated with the outcome,” said Dr. Schwartz. “It was a team effort.”
“It took an amazing amount of teamwork,” agreed Misty Sieracki, a nurse at National Jewish Health | Saint Joseph Hospital. Though she sees critically ill patients almost every day, Eric’s case struck a chord. “He’s near my age, so it hits close on a personal level,” she said. “He just got this random illness. It could have happened to any of us.”
'They Were Amazing'
“Misty, Kathy, Liz, Cara and Theresa were just super-cool and fun,” Eric said of the nurses who took care of him. “They did everything.” In addition to removing stitches, cleaning him up, joking with him, answering questions and managing expectations, they even took his dad to a yoga class. “They were amazing with my family and friends.”
Eric’s physicians echoed his praises. “The nurses were excellent,” said Dr. Lyn-Kew. “You can have the world’s best doctor, but if you don’t have great nursing, the patient may not survive.” The admiration is mutual. “I love the physicians that work for the pulmonology group,” Misty said. “It’s really fun to learn about these respiratory illnesses. The National Jewish Health team is part of us.”
Today, Eric has almost completely recovered. “I’m not as strong as I was, but I’m getting there,” he said. “I’m like a normal person now.”
Some might describe Eric’s dramatic recovery as a medical miracle, but he views it through a more factual lens. “I got sick. I got better because a lot of smart and caring people took care of me,” he said. “Sometimes the ball bounces your way.”