A New Mexico woman and a young Flagstaff schoolteacher are alive today thanks to The University of Arizona Medical Center's world-class expertise in ECMO – a complex medical technology for patients in extreme heart failure.
Both patients were near death at hospitals in La Cruces, N.M., and in Flagstaff this past year when UAMC's ECMO team was called in by local physicians for help.
In both cases, cardiothoracic surgeon Dr. Jess Thompson, perfusionist Chris Mogan and 4NW ECMO nurse specialists Kathy Swanson and Jeanne Scott traveled to the hospitals, placed the patients on the ECMO device, and in a complicated medical transport, escorted them back to UAMC.
After weeks at the University Campus, both women recovered fully under the watchful care of cardiothoracic surgeon Dr. Cristy Smith, and pulmonologist and critical care specialist Dr. Yuval Raz, the surgical and medical directors, respectively, of the hospital's ECMO team for adult patients.
"No other facility in the Southwest, and very few medical centers in the nation, have the capability or would attempt to transport a patient on an ECMO machine," said Thompson, an assistant professor of the UA department of surgery Division of Cardiothoracic Surgery. "It's pretty amazing. We literally swooped in front the sky and were able to resuscitate the patients back to life."
ECMO – ExtraCorporeal Membrane Oxygenation – serves as a temporary life support system for patients who have heart or lung failure or both. To initiate ECMO, a surgeon inserts tubes into the patient's large blood vessels. With the help of blood thinners to prevent clotting, the system pumps blood from the patient to the membrane oxygenator, or artificial lung, and returns it back into the patient. The membrane oxygenator removes carbon dioxide from the blood and rejuvenates it with oxygen, exactly as healthy lungs would do.
"If it hadn't been for ECMO, I'd be in the grave right now," said Julia Bendixen of Las Cruces, N.M., who suffered a heart attack on her 23rd wedding anniversary on May 19.
Her husband drove her to a local hospital where she underwent what should have been a routine coronary bypass. Instead, her surgeons were unable to re-start her heart. She had a dreaded "stone heart," a rare complication that is almost always fatal.
"My surgeon later told me he called all these different specialists, but they couldn't help me. Tucson was the last resort," she said. "The plan was to put me on ECMO to buy me time for a heart transplant."
She remembers nothing of the heart attack, her surgery or the medevac flight to Arizona. When she regained consciousness at UAMC, she thought maybe she'd been in a car accident.
Ultimately, Bendixen did not require a heart transplant. ECMO allowed her heart to heal itself. Today she is back at work and in perfect health.
"I had the best doctors and nurses in the world at UAMC. They took excellent care of me, and they have my deepest gratitude," she said.
Initially, ECMO was exclusively a therapy for critically ill newborns, but in recent years ECMO has been used on desperately ill older patients to keep them alive until their organs recover, or they have a mechanical device implanted that assists with the heart's function, or they undergo a heart or lung transplant.
Tucsonan middle-schooler Addison Rerecich – the "Pink Ninja" to hundreds of Facebook followers who avidly monitored her progress – was on the ECMO device at UAMC for a record-breaking 93 days before undergoing a double-lung transplant in 2011.
Since 2006, UAMC has orchestrated last-ditch ECMO transports of eight adult patients and two children, making it one of only a handful of institutions worldwide to be able to provide this service to both adults and children, Thompson said.
Not only is University Campus the only Tucson hospital with ECMO, it also holds a rare Award for Excellence in Life Support from the international Extracorporeal Life Support Organization and has just won full accreditation as a heart failure center by the Society for Cardiovascular Patient Care.
Managing a patient on ECMO requires highly specialized skills, said pediatric intensivist Dr. Robyn Meyer, director of the hospital's ECMO pediatric program. The device must be monitored 24 hour a day and requires an organized multi-disciplinary team of experts, including cardiac surgeons, cardiologists, pulmonologists, pharmacists, pathologists, certified perfusion technologists, critical care specialists and nursing staff.