‘Artificial lung and heart’
FOR SEVERAL years South African doctors have been saving lives of those with heart disease using the so-called “artificial”, or mechanical hearts, to help restore normal blood flow in and out of the heart.
But a new life-support technology that takes over the function of both the heart and lungs, has revolutionised how cardiac and respiratory failures are now treated that medics are calling it an “artificial lung and heart”.
The extracorporeal membrane oxygenation (Ecmo) – which acts as a “temporary bridging medical intervention” for patients whose lungs and heart are unable to provide adequate amount of oxygen to their bodies – pumps the blood from the heart and oxygenates it before it returns it to the organs.
It is used on patients with heart failure and those with severe lung disease which are difficult to treat such as pulmonary embolism, severe pneumonia and infections.
Dr Nic Schlapobersky, a specialist physician from Netcare Christiaan Barnard Memorial Hospital, who went for special training at one of the biggest Ecmo centres in the world at Pitié-Salpêtrière Hospital in Paris last year, said Ecmo, which acts similarly to a dialysis machine, is used as a last resort or “rescue” medical intervention on patients who are not responding to conventional treatments for lung and heart failure.
It is solely a life-sustaining intervention, and can be used as a shortterm treatment that can be used for a few days and no longer than two months.
Traditionally used overseas since the 1980s to treat only paediatric lung complications, Ecmo was first used on adults after 2009 following the H1N1 outbreak, which left many with serious lung complications.
While this kind of treatment is well established in the first world countries, it is relatively new in South Africa and only two private hospitals are using it so far – the Netcare Milpark Hospital in Joburg and Netcare Christiaan Barnard Memorial Hospital in Cape Town.
The Cape Town hospital was also the first one to use a mechanical heart – otherwise known as Heart-Ware Ventricular Assist System (HVAD) a few years ago. This is a small device implanted into the heart and is designed to restore a normal blood flow into and out of the heart. It draws the oxygenated blood from the left ventricle of the heart and propels it into the aorta for distribution into the body. The
device keeps the patient well while awaiting a heart transplant.
Just like the dialysis machine, which purified the blood outside the body or extracorporeally, Ecmo oxygenated blood outside the body, but at a much faster rate, pumping six litres of blood per minute.
Schlapobersky said: “The process itself is quite a complicated one, and can only be done by a multidisciplinary team of specialists such as physicians and cardiothoracic surgeons. Even nurses who look after Ecmo patients have to go for special training,” he said. Schlapobersky works with two other cardiothoracic surgeons, Dr Willie Koen and Dr Loven Moodley, and an Ecmo nurse Mila Kondziolka.
Using Ecmo, doctors remove blood from the patient using large cannulas (catheters). The blood goes through a machine or artificial lung, which adds oxygen and takes away carbon dioxide and returns that blood back to the patient through another cannula.
Schlapobersky said: “The machine is basically a bridge between the heart and lungs when they are very sick and unable to do their own jobs. It bridges the patient by breathing for them while their lungs are still recovering… until they are able to breathe on their own again or while a patient is still waiting for a heart transplant or a mechanical heart. Ordinarily these patients would die as there are no more treatment options available for them.”
While the multimillion-rand Ecmo is an intensive care unit (ICU) machine it can also be used as a mobile machine to stabilise sick patients who are either too sick to breathe on their own or trauma patients who have breathing difficulties. This mobile device is used in facilities where Ecmo is unavailable.
One such patient, who was recently saved by the mobile device, which is used in an ambulance, is Jenes Jakobsen, 56, of Hout Bay in Cape Town. Jakobsen, who suffered deep vein thrombosis (blood clotting in the veins) following surgery in another Cape Town hospital, had less than 48 hours to live when doctors at Netcare Christiaan Barnard Memorial Hospital received a call from another hospital to rescue him.
Jakobsen, who confesses to have a hazy memory of what happened to him 24 hours after the surgery, said that according to the doctors and his wife’s account, “I was half dead when the Ecmo crew came to save me”.
After getting attached to the Ecmo machine, he became stable immediately and was transferred back to Netcare Christiaan Barnard Memorial Hospital where he remained attached to an ICU Ecmo machine for seven days to allow his lungs to recover.
“I was so sick that I regained conscious three days after being put on Ecmo. I’m so grateful to the Ecmo technology, the doctors, nursing staff and everyone who prayed for me while I was sick. If it wasn’t for this technology and all the expertise I wouldn’t be here today,” he said.
Schlapobersky said Ecmo services were so crucial in the medical field that his team was in the process of establishing a centre of excellence for other hospitals with very sick patients by providing Ecmo services.