NewYork-Presbyterian Hospital/Columbia University Medical Center has officially opened the Center for Acute Respiratory Failure, which offers, among other services, expertise in using lung bypass technology to help adult patients whose lungs are rapidly shutting down.
The Center's launch coincides with publication of a review article in today's New England Journal of Medicine that details how the technology, extracorporeal membrane oxygenation (ECMO), can take over the function of the lungs in adults with acute respiratory distress syndrome (ARDS) to give severely damaged lungs time to rest and heal.
ARDS, which can be caused by injury or disease, affects more than 140,000 individuals a year, and mortality may be very high, especially in those with the most severe forms of the disease, according to the NEJM article. It was written by Dr. Daniel Brodie, a pulmonary critical care specialist, and Dr. Matthew Bacchetta, a thoracic surgeon, who are co-directors of the new Center.
NewYork-Presbyterian/Columbia is already one of the largest centers in the world for respiratory as well as cardiac failure in adults. Recent growth is largely due to the use of ECMO, which functions as an artificial lung, heart or both. The ECMO Program has improved the techniques used for delivering ECMO in adults. These improvements include reducing side effects that have been associated with the use of ECMO in adults, and development of a mini-ECMO unit that can be used to transport critically ill patients to the Center.
"The evidence is accumulating that, at the very least, referring patients with severe respiratory failure to a center capable of performing ECMO is beneficial for these patients. The Center for Acute Respiratory Failure is exactly such a center," says Dr. Brodie, who is an assistant professor of medicine at Columbia University College of Physicians and Surgeons.
While ECMO is used at other centers, very few hospitals in the world treat as many adult patients with ECMO. NewYork-Presbyterian/Columbia treats about 70 a year, and that number is growing. More unusual in the U.S. is the team's ability to travel to area hospitals, place patients on their adapted ECMO unit, and transport them to the Center, he says. "This allows us to bring patients into our center who would otherwise be too sick to be transported by ambulance so that they can receive ECMO and other advanced respiratory care," says Dr. Brodie, who credits Dr. Bacchetta, assistant professor of surgery at Columbia University College of Physicians and Surgeons, for the success of the ECMO transport program.
The first such patient they transported on ECMO, in 2008, was a 27-year-old woman who was being treated at another New York hospital. Severe lung inflammation caused her lungs to fill with blood and her oxygen levels plummeted. By the time the ECMO team was called, she had had two cardiac arrests, according to Dr. Brodie. "The only chance she had was to be put on ECMO," he says. She thrived.
Another patient was transported from Connecticut following a motorcycle accident that fractured his ribs and leg, and severely damaged his lungs. His kidneys and lungs stopped working. He recovered with ECMO.
Albany is the farthest the physicians have traveled to put patients on ECMO and bring them back to the Center. However, preparations are being put in place for air transport on ECMO from around the region and internationally.
The majority of patients treated with ECMO at the Center are referred to NewYork-Presbyterian/Columbia by other hospitals. One such patient is a woman who developed malaria after she returned from a missionary trip to Uganda. She had a rare and severe response to malaria that resulted in ARDS. She was on ECMO for nine days, and she recovered.
Most patients in respiratory distress are placed on ventilators, which move air in and out of the lungs. The forces involved in mechanical ventilation itself can harm the lungs. ECMO uses instead a mechanical pump that draws the blood from the body, gives it oxygen, and passes it back into the body, allowing the lungs time to heal.
Although ECMO has been available for decades, it has been considered an option of last resort in adults, used sparingly because it had high risks of bleeding, infection and stroke. However, advances in the technology of ECMO have greatly reduced the risks and made ECMO an important option for selected patients with respiratory failure.
The Center offers other procedures that can be life-saving in patients with lung failure. One is embolectomy, a surgery that directly removes clots from the lungs of patients with severe acute pulmonary embolism. In rare cases, clots in the lungs can develop into chronic blockages that cause abnormally high pressures in the blood vessels of the lung, a disease referred to as Chronic Thromboembolic Pulmonary Hypertension (CTEPH), which is very difficult to treat. However, the team at NewYork-Presbyterian/Columbia provides the complex surgical intervention to treat it, which is called Pulmonary Thromboendarterectomy. "We are one of the few centers in the U.S. that does this procedure," Dr. Bacchetta says.
Dr. Brodie reports receiving consulting fees and travel expenses from Maquet Cardiovascular, makers of the ECMO machine, serving on its cardiovascular advisory board, and anticipating possible receipt of grant support from the company. Dr. Bacchetta reports receiving consulting fees and travel expenses from Maquet Cardiovascular, anticipating possible receipt of grant support from the company, and discussing with Avalon Laboratories a possible instructional video for which he would not be paid.
Source: NewYork-Presbyterian Hospital/Columbia University Medical Center