Mission of Mercy Falls Short in Effort to Save Infant’s Life

A 2-day-old baby girl died Thursday at a Santa Ana hospital minutes after a special Air Force medical team from San Antonio, Tex., dramatically rushed in with a special infant heart-lung bypass machine that might have saved her life.

The condition of the infant, the first child born to a Santa Ana couple, had worsened overnight, prompting doctors at Western Medical Center to call for the Texas team to perform the procedure called “extra corporeal membrane oxygenator,” or ECMO.

Closer hospitals--in Pasadena, San Francisco, San Diego, Salt Lake City and Denver--equipped and staffed to perform the procedure were too busy to take the infant.

But the baby’s neonatologist, Dr. Richard Meidell, said that despite the baby’s death there is hope the technology and expertise will be more readily available in the near future.

“We’re only touching the tip of the iceberg,” Meidell said as the Air Force team prepared to return to Wilford Hall Air Force Medical Center, considered a pre-eminent hospital for infants requiring the ECMO heart-lung bypass treatment.

To Offer Treatment

Childrens Hospital of Orange County--where some of the original ECMO research was conducted--is expected to begin offering the ECMO treatment within a few months, said Dr. Barbara Towne, a CHOC pediatric surgeon. The hospital is now acquiring the equipment and training team members in the highly technical, extremely intense procedure, she said. She estimated that 10 to 20 infants from Orange County will undergo the treatment every year. Meidell said Childrens Hospital of Los Angeles will also be offering the treatment soon.

The ECMO treatment was pioneered in Orange County in the early 1970s by then-UC Irvine physician Robert Bartlett. He first used ECMO in 1973 but the infant did not survive, said Dr. Devin Cornish, leader of the Wilford Hall team. The first infant who survived after the ECMO procedure was treated by Bartlett in 1975, Cornish said. The ECMO treatment was performed at UCI Medical Center and CHOC, which was then affiliated with the university. But when Bartlett departed for the University of Michigan about eight years ago, he took the program with him, Meidell said.

Cornish said that while about 20 hospitals throughout the nation now have the technology and training for the ECMO procedure, he expects to see the number expand to about 100 within five years.

Meidell said that heart-lung bypass machines have been used for adults for about 30 years but that it has been only in the last 10 years that doctors have developed the technology and expertise to perform the same procedure on the tiny, fragile blood vessels and organs of sick newborn babies.

The baby girl who died Thursday suffered from persistent pulmonary hypertension of the newborn, a condition in which the blood vessels to the lungs fail to open up to receive blood from the heart, Meidell said. It afflicts about one newborn out of every 1,000 and is a common cause of respiratory distress among full-term newborns, he said.

Meidell explained that while in the womb, a baby’s lungs naturally do not function because the fetus receives oxygen from the mother through the placenta.

At birth, though, the blood vessels to the lungs are supposed to open up so that the blood is pumped from one ventricle of the heart into the lungs, where it is infused with oxygen and then travels back to the heart, to be pumped throughout the body, resulting in a pink, healthy baby, he said.

But in babies with persistent pulmonary hypertension of the newborn, that does not happen. The baby’s heart and lungs usually are well-formed, but the “systems become deranged,” the blood vessels to the lungs do not open and the baby turns blue, he said.

About 90% of the babies afflicted with the condition respond to conventional treatment--placement on a ventilator--that can be provided at most hospitals. If the ventilator fails to open the lungs, medication is given, he said.

But about 10% of the babies fail to respond to the ventilator or drugs, and their last resort is ECMO, Meidell said. Without ECMO, 90% of these babies will die, he said. For those treated with the ECMO procedure--only about 1,000 babies nationwide in the last 10 years--the success rate has been 90%, he said.

Bypass Heart and Lungs

The ECMO treatment involves the insertions of two catheters into the heart, one through an artery and the other through a vein in the neck. Doctors withdraw the baby’s blood through one catheter, infuse it with oxygen, remove carbon dioxide and adjust the blood’s acidity, and then pump it back into the baby’s body through the second catheter, entirely bypassing the heart and the lungs.

The treatment is intensive and usually lasts several days before the baby is weaned off the machine and its body takes over, Meidell said.

ECMO carries its own risks, so it is important that only babies with a good chance for surviving the rigors of treatment are selected for the procedure, he said. Premature babies and infants under five pounds cannot undergo the treatment.

Even before the ECMO team from San Antonio--which flew to El Toro Marine Corps Air Station at a cost to the Air Force of $50,000--arrived at Western Medical Center Thursday, Meidell said he did not know whether the 2-day-old girl would be strong enough to take the treatment. Had she been hooked up to the machine, she would have been flown back to the Texas hospital, still attached to the bypass equipment, once her condition had stabilized.

The baby had been delivered by Caesarean section after a fetal monitor showed that she was in “a little distress,” Meidell said. But at birth, the baby was “crying, screaming, pink,” signs that her lungs were working well and delivering oxygen to the blood, he said.

Condition Worsened

Within the next 12 hours, however, the vessels to her lungs shut down, he said. The baby was put on a ventilator and appeared to be stable until 3 a.m. Thursday, when her condition worsened and Meidell frantically tried to find a hospital equipped and staffed to provide the ECMO treatment.

ECMO is still relatively new, and the numbers of babies treated with it are still small, but doctors will learn more as additional hospitals provide the treatment, Meidell said. For example, he said, ECMO is now a treatment of last resort, but in time “our ability to determine when to go for it (sooner) might be better.”

CHOC’s Towne said ECMO, while a risky treatment, can be used to prevent or overcome the lung-scarring complications that can result from long-term use of a ventilator. Studies performed on ECMO-treated infants have shown few complications, she said.

“It’s not only a lifesaving treatment, but a baby may end up with fewer complications than with standard therapy. It’s not something for every child with respiratory problems,” Towne said, “but properly used, this modality can not only save lives, but result in normal children with normal lives.”