"We hoped the ventilator would allow us to get him well enough that he wouldn't need to be put on a heart-lung machine," Gazit says. "But 24 hours later, we knew that wouldn't be the case, and we had to make the decision to go forward with the heart-lung machine called ECMO (extracorporeal membrane oxygenation). We knew that his chances of survival were getting smaller and smaller."
ECMO gives the heart and lungs time to recover and respond to medical treatment prior to a lung transplant. However, it comes with a high rate of complications, including bleeding, blood clots, infection and stroke, and carries a high mortality rate in patients who go on to have a lung transplant. Complications become more severe the longer a patient is on the machine, especially after 10-14 days, Gazit says.
After 16 days on ECMO, Owen's heart had recovered but his lungs had not. Since there were no lungs available for transplant, Owen's physicians knew they didn't have a lot of time. So the team, led by Charles B. Huddleston, MD, professor of surgery and a cardiovascular surgeon at St. Louis Children's Hospital; Stuart C. Sweet, MD, associate professor of pediatrics and a lung transplant surgeon; Gazit; and R. Mark Grady, MD, associate professor of pediatrics and director of the pediatric pulmonary hypertension program, decided to put Owen on the artificial lung, even though it had never been used on a child so young.
After getting emergency approval from the U.S. Food and Drug Administration and from Washington University's Institutional Review Board, Huddleston moved Owen from ECMO to the artificial lung in an innovative procedure without the need for a cardiopulmonary bypass.
The Novalung artificial lung is a small box about the size of a lunchbox that is attached through a shunt created between the main pulmonary artery and the left atrium of the heart.
"This case was very interesting and cha
|Contact: Beth Miller |
Washington University School of Medicine