Friday, August 8, 2014

Magic in the making


David Oliver, a well-known magician from Weymouth, awaited a double lung transplant in the spring of 2013, close to death. When he arrived at the MGH, he had to undergo ambulatory extracorporeal membrane oxygenation (ECMO), which took over his lung function until his successful transplant six weeks later.

ECMO is a therapy that oxygenates and removes carbon dioxide from the blood – outside a patient’s body – sometimes allowing a damaged heart and lungs time to recover. The MGH Transplant Center was the first team in Boston to perform a lung transplant for an ECMO-supported patient and currently is the only medical center in New England that accepts referrals from other hospitals for long-term ECMO care.

“In the past, ECMO equipment was quite bulky – about the size of a small refrigerator – and patients would average five to 10 days hooked up to the machine,” says Jose Garcia, MD, surgical director of the Cardiothoracic Transplantation and Artificial Heart and Lung Program. “An ambulatory ECMO setup is about the size of a toaster and, more importantly, is portable. Patients can be supported on ECMO for months, prolonging their chances of success.”

In 2009, Garcia was a member of the first team to use ambulatory ECMO in the U.S. Since joining the MGH, he has overseen more than a dozen patients experiencing ambulatory ECMO as a bridge to transplantation.

“Traditional ECMO requires a patient to be sedated, often times paralyzed with medications,” says Todd Astor, MD, medical director of the MGH Lung and Heart-Lung Transplant Program.The patient becomes bedridden, deconditioned and debilitated. As a result, the patient is more likely to develop complications such as pneumonia and other infections.

Ambulatory ECMO takes a completely mobile approach, allowing patients to get up, walk around, and actually rehabilitate while they are waiting for an organ to become available for transplant. This waiting period is unpredictable at best, but the portable nature of the device prolongs what previously was a risky proposition for those on the transplant list.

“It was certainly a strange experience to feel your heart pumping, and look down and see the blood travelling through the tubes into a machine and back, knowing it would go directly into your heart,” says Oliver.

“I would have visitors and I would joke with them, ‘Let’s have a contest to see who can hold their breath the longest.’ I could do it for 10 minutes! It was surreal.”

Read more articles from the 08/08/14 Hotline issue.


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