Specialized life-support system keeps children alive
Edmonton team trains others on use of life-saving equipment
A specialized life support system in Edmonton, and expertise in using it, is keeping the most sick children and a growing number of adults alive in Western Canada.
Children in Brazil, Hawaii and Colombia are also reaping the benefits as a team of local experts travel to those countries to teach doctors, nurses and respiratory therapists how to keep alive those with lung and heart failure weeks and months longer by using an extracorporeal membrane oxygenation machine, or an ECMO machine.
Once attached to a severely ill patient whose heart, lungs or kidneys are failing after a heart surgery or infection, the ECMO machine — combined with a dialysis machine — temporarily takes over the oxygenation, cleansing and circulation of the blood normally done by the lungs, kidney and heart. That gives the organs a rest, from a few days to a few weeks, to heal.
In Edmonton, approximately 30 patients are hooked up to the machine each year, 20 who come out of heart surgery and face heart failure without immediate intervention. The other 10 have complex infections, such as those with pneumonia who are in septic shock because their bodies aren’t properly cleaning the toxins out of the blood.
That was the case with Alice Halinda, a 12-year-old in Grade 7 at Lorne Akins Junior High School in St. Albert, who became sick in March with a strange rash on her face, tendinitis-like pain in her feet, blisters on her fingers and joint pain her parents thought were all related to playing guitar and adolescent hormones. Physiotherapy and acne medication didn’t help, and when Alice’s fever and extreme fatigue became worse and prolonged, she ended up in emergency at the Stollery Children’s Hospital. Three days of more conventional treatment didn’t level out her low blood pressure. She would die without being hooked up to the ECMO system, doctors said.
With the complex machine, patients such as Alice have a 50-50 chance of survival.
“It was harrowing (to see Alice hooked up with tubes), also harrowing because the machine itself, I wanted to destroy it every time I saw it,” said mother Angela Halinda. “It was saving her life, but at the same time, it could also take it.”
But Angela and Alice’s father didn’t hesitate.
“It was an easy decision because I had such faith in all those intensivists,” Angela said of the Stollery team. While a patient is on the extracorporeal membrane oxygenation system, one nurse is needed to look after the patient, and another specialist to look after the machinery. Physicians are also key to the care. “It was terrifying. It was the darkest period of my life.”
But Alice stabilized immediately. Doctors were able to drain as much as 20 litres of fluid from Alice’s body they had originally given her to try boost her low blood pressure.
“It was a brilliant reversal,” Angela said. “It allows the body to rest and extra energy to fight what it’s combating.” Alice’s illness, it turned out, was a flare-up associated with undiagnosed lupus, an autoimmune disease where the body’s immune system becomes overactive and attacks healthy tissue.
“I don’t know how we lucked out, but it saved my daughter’s life,” said Angela of the ECMO system, which was first offered here in 1989. “It is a boon for Edmonton.”
Edmonton’s expertise and training program has also been key to saving infants and children in Winnipeg, Regina, Saskatoon and Calgary. While those centres don’t have the staffing or the influx of such patients to sustain an entire ECMO system, professionals across the Prairies have come here since 2009 for training. Forty such trainees were here this week to learn how to temporarily hook up their patients to their limited supply of machines until an Edmonton transport team brings them to Alberta’s capital for complex care.
Before that option, many would die, said Dr. Laurance Lequier, the pediatric intensivist director in charge of the extracorporeal life support system at the Stollery.
Lequier and his team even designed a transport version of the machine that isn’t available elsewhere. The team has transported 28 patients to Edmonton since 2005, or about four each year.
“It’s not a huge number of patients, but it’s the sickest group of patients we have,” Lequier said.
A heart-lung bypass machine does similar work when someone is undergoing openheart surgery, but it’s only safe to use for a few hours as it empties the heart of blood. The bypass machine is needed so that the heart doesn’t pump and bleed while a hole is sutured or a new valve put in place. Using it longer can cause clotting and other dangerous complications.
The extracorporeal membrane oxygenation machine, at a cost of about $100,000 plus $5,000 in equipment for each patient, is much more gentle on the blood, Lequier said, and allows the organs to beat or breathe slightly while most of the hard work is done by the machines. Using it allows doctors to give high doses of medication that would shut the patient’s body down if it was hooked up to a regular breathing machine accompanied by blood pressure treatment.
“We’ve had to do things that are very innovative,” Lequier said.
Four ECMO machines are available in Edmonton, although another four can be found in an emergency such as the H1N1 crisis in 2009. At one point, Edmonton had three pediatric and three adult patients with H1N1 on the machines, plus another two children who had just had heart surgery and needed extra time to heal. While the machine has largely been used on children, it’s becoming more available to treat adults as well.
“We’re able to save some of these kids because of this technology,” Lequier said.