Grateful for the Breath of Life : A Once-Radical Technique Now Routinely Saves Severely Ill Newborns
Karen Stare can still recall how terrified she was 12 years ago after her first child was born prematurely with a life-threatening respiratory disease and placed on a then-radical support system.
“She was this big,” Stare said, gesturing about eight inches, “and all red. Both tubes were coming out of her neck. She was on a respirator and had an umbilical catheter.
“She was such a fighter. . . . They had to pin her down with safety pins.”
Sunday, Stare’s daughter Erica, a bright sixth-grader from Anaheim, stood by her side, smiling appreciatively at the familiar family story and at the doctor who made it possible.
They were among about a dozen families with similar stories who came to a reunion at Children’s Hospital of Orange County to see Dr. Robert Bartlett, a former UC Irvine surgeon who in 1975 developed ECMO (extra corporeal membrane oxygenation), now a standard treatment for the most severe respiratory problems of newborns, such as meconium aspiration syndrome, hyaline membrane disease or diaphragmatic hernias.
Ranging in age from toddlers to preteens, the children roamed outside on the grass, preoccupied by farm animals brought in for them to pet.
Since Bartlett pioneered the method at CHOC 15 years ago, about 5,000 children nationally have been successfully treated with ECMO, including 106 in Orange County. The first 40 children to receive the treatment and follow-up studies were from Orange County.
The heart/lung device is important because it allows a newborn’s lungs to rest and heal while minimizing the risks associated with the long term use of respirators.
Now a professor of surgery at the University of Michigan, Bartlett explained that his technique improved on the heart/lung machine, developed in the 1940s, that first allowed open heart surgery to be performed. That machine pumped air into blood drawn out of the patient and then returned it--a procedure that was safe for only a few hours.
Many researchers were interested in prolonging the time a patient could successfully be hooked up to the machine and widening its application. “But our team made it work,” Bartlett said.
By introducing a membrane into the process, he said he was able to eliminate the mixing of oxygen and blood, and create a cardiopulmonary bypass system that could be used for days or even weeks at a time.
The innovation was initially greeted with skepticism, Dr. Bartlett said. “The feeling was that it was inappropriately heroic,” he said.
Now, the survival rate of those treated with ECMO nearly equals the 90% of newborns who used to die as a result of serious respiratory ailments, according to Dr. Barbara Towne, pediatric surgeon and ECMO administrator at the children’s hospital. While the labor-intensive procedure is expensive--the Stares’ hospital bills reached $103,000--it is often cheaper than the costs of the longer hospital stays needed for treatment without ECMO, Towne said.
The original patients were followed carefully to see if the procedure, which includes tying off some veins and arteries in the neck, resulted in any brain damage. About 20% of those suffer some sort of damage, but it is due to the lack of oxygen caused by their original problem, Towne said.
According to recent studies, at least 75% of the original 40 Orange County children treated with ECMO are likely to lead normal, healthy lives.
On Sunday, Bartlett greeted the children from the original group fondly, recalling the details of his or her birth.
Karen Espolt of Fontana watched her 17-month-old daughter Hannah, a recent user of the system, as she giggled and tried to feed a cookie to her father, David. Hannah was born with her internal organs outside her body--a genetic birth defect repaired by operations. She had also suffered a stroke.
“We didn’t think she’d be this normal and this happy,” said Espolt, who had to quit working to care for her daughter. “It’s worth it,” she said. “I think every parent here would tell you that.”
