Tickle-Me ECMO

When I was a medical student at my old alma, we didn't have ECMO, but I had heard the horror stories. (ECMO = extracorporeal membrane oxygenation - basically a machine that takes place of the lungs and/or heart depending on how you use it). How hard it was to manage, how complex it is, and what terrible shape the patients are in...I am here today to tell you that everything they say is true ;P...seriously though, only a couple of my attendings knew how to use it during rounds today and the rest were asking questions like first year residents...and the first year residents (ie me and my crew) were just blown away.

We had this little girl who was delivered close to term, but as un-luck would have it, she inhaled a large amount of meconium (baby poop in utero). As you can imagine, having feces coating the inside of your lungs isn't the best way to start out in life. I don't know all the particulars, but as is common with these kids she had a pneumothorax (the left lung popped)...then the other popped (uh oh - do they call that being up meconium creek without a paddle?..drum roll). They tried placing chest tubes, which would have fixed the pneumo's...but she was still being unlucky at the time. She continued to get worse and her heart started to crap out as a side effect of all the problems with her lungs. So my attending opted to just bypass those two organs completely with the magic ECMO machine.

It was pretty wild, we would round once a day on this kid, although none of us residents had her. They would pimp us to death with questions on expected lab values, "what-if" scenarios, and all kinds of other stuff (with a good 20 person croud standing around..real fun). I remember standing there the first day in total awe of that machine and simultaneously in awe of that little girl...really in awe of all human beings.

This machine probabaly weighs over a 1000lbs, I tried counting all the tubes, ports, and monitors but it was futile - there is just a crap ton of them...I think that thing had monitors for it's monitors. It has a dedicated person also just to sit there and watch it, making adjustments when needed. All these doodads, ect. and it all comes down to two tubes, one filled with bright red (oxygenated blood) and one filled with dark red (deoxygenated blood) going into and out of this tiny tot. All the while this little girl is laying there resting her little lungs and worn out heart, slowly getting better, slowly using the machine less and less, until eventually they would pull her off of this monstrocity.

First off, I was in awe of how complex this machine was, how big it was, and the skill it took to operate it. However, my second reason for being in awe was a way more impressive thought. It takes a 1000lb+ machine with innumberable wires, tubes, monitors, and human operators (probably costing around 50K per case, not to mention what the machine costs) to do what a 6 lb, little girl (usually) can do without thinking...WOW!

We've advanced so far in science and technology, it starts to seem as if the impossible is right around the corner...like we can do anything, but when you look at it like that...we still have a very long way to go.

Newbie Doc

Update: She got pulled off of it a couple hours after writing this and she is doing great. Very cool.

Update: A couple of weeks later, I walked into a patient's room to talk to a nurse who had another patient of mine, she was feeding this cute little baby, who must have been a feeder/grower (one of the uncomplicated ones)...only as I walked out of the room and gazed up at the patient's name on the door did I realize it was this same baby, who had almost died.  It's amazing that we could bring her back from the edge like that, she looks as if she was born perfectly normal...if I had known this when I wrote this post, I would have named it "The Miracle Machine" because for this little one it truly was just that.