Otherwise known as Extracorporeal Membrane Oxygenation. Daniela Lamas investigates the fortunes of the medical process that “siphons blood out of the body and runs it through a machine that temporarily assumes the lung’s work—oxygen in, carbon dioxide out—and gives the injured lung time to heal,” avoiding the problems associated with respirators. The backstory:
Building on the principles of the heart-lung bypass machine used in cardiac surgeries, the first ECMO machines for lung failure came about in the nineteen-seventies. In an early, publicized case, a young man in California was dying after having injured his lung severely. His doctors put him on ECMO—the machine was the size of a car—for three days. He survived and his story was published in the New England Journal of Medicine, in 1972. The ensuing enthusiasm led to a medical trial in the seventies with the goal to test whether patients with lung failure did better with ECMO or with a respirator alone. In both groups, more than ninety per cent of patients died. The excitement about ECMO for adults with lung failure “fell back to earth,” Daniel Brodie, who directs the medical ECMO program at Columbia University Medical Center, told me.
But lately there’s been an ECMO “revival” – aided by much improved technology – and it began with a butt augmentation gone awry:
In the fall of 2008, a twenty-seven-year-old woman was admitted to the Allen Hospital after receiving silicone injections to enhance her buttocks. The silicone had leaked into her vessels and travelled to her lungs, causing massive bleeding. Even with a respirator at its highest settings forcing air into her lungs, she was, literally, drowning in her own blood. The doctor caring for the young woman called Brodie, who suggested ECMO. “By all accounts, she was surely going to die. We felt we had nothing to lose by trying, and everything to gain,” Brodie said. She survived. “When it worked, even we were a bit surprised. That one case may not have changed a lot of minds, but it certainly opened them up to the ever-so-faint possibility this wasn’t crazy.”
Then, in 2009, the H1N1 virus swept the globe and left some previously healthy people with severely injured lungs—a condition called acute-respiratory-distress syndrome. For patients whose oxygen levels still teetered despite the highest settings on the respirator, doctors started turning to ECMO. In the same year, a smaller ECMO apparatus that could get patients up and walking—older versions required patients to remain supine and sedated—won approval from the Food and Drug Administration. The coincidental timing—a new pandemic, a new machine—“opened the floodgates,” said Jose Garcia, a cardiac surgeon at Massachusetts General Hospital. “We’re redefining death, to the point that somebody we thought for sure was dead two or three years ago, well, they’re not dead anymore.”
