ECMO provides life-saving support for patients with critical illnesses

"The University of Iowa doctors and nurses knew what they were doing, and I'm really glad they did."

Mike Durant doesn’t call in sick.

So when the crew he supervises at a soybean processing plant in Emmetsburg, Iowa, heard that Mike wasn’t coming to work on April Fools’ Day, they assumed it was a joke.

It turned out to be no laughing matter. In fact, Mike came close to not returning to work ever again.

But thanks to a specialized therapy at University of Iowa Hospitals & Clinics called extracorporeal membrane oxygenation (ECMO), Mike is back to work and grateful for around-the-clock care he received.

In the days leading up to April 1, 2016, Mike often found himself short of breath. He figured it was the drug he’d recently begun taking for a kidney condition but soon realized this was more than a medication side effect.

“I’d get up from my chair and couldn’t move, I was so exhausted,” says the 44-year-old who lives near the northwest Iowa town of Whittemore. “I knew I had to do something.”

Mike visited his doctor’s office and was sent to the emergency department at the Emmetsburg hospital. When tests revealed that his blood oxygen level was dangerously low, Mike was taken by ambulance to Mercy Medical Center–North Iowa in Mason City.

An ultrasound showed that Mike had blood clots blocking the right and left pulmonary arteries leading to both of his lungs. These are the blood vessels that carry blood from the heart to lungs, where tiny air sacs add oxygen to the blood (and help remove carbon dioxide) before the blood returns to the heart and is pumped out to the rest of the body.

A clot or blockage in one of the pulmonary arteries is known as a pulmonary embolism, and this explained Mike’s shortness of breath and fatigue. In short, his body was not getting the oxygen-rich blood it needed. Left untreated, it was a life-threatening condition.

Blood-thinning medications often are used to dissolve a pulmonary embolism, but Mike’s clots were extensive, and his condition had worsened considerably. He was transferred by helicopter to University of Iowa Hospitals & Clinics for advanced care.

Jonathan Simmons, DO; Mohammad Bashir, MBBS

“Mr. Durant’s blockages were substantial. As a result, his heart was struggling since it couldn’t push the blood into the lungs, and blood could not be oxygenated,” says Mohammad Bashir, MBBS, a cardiothoracic surgeon with UI Heart and Vascular Center. “In his case, medication alone was not enough.”

Bashir and other UI medical specialists determined that an embolectomy—the surgical removal of a blood clot—was the best course of action.

Just as the surgery was underway, however, Mike went into cardiac arrest.

He was quickly placed on a heart-lung bypass machine, which allowed the surgical team to continue the operation. The clot-removal procedure went well, but Mike’s heart remained very weak and his blood pressure was extremely low. His heart likely would stop again—perhaps fatally—if he was taken off the bypass system.

Enter ECMO, which for Mike was a life-saving solution. Similar to a bypass machine but smaller and designed for use outside of the operating room, ECMO therapy does the work of the heart and lungs by circulating blood through an artificial lung—removing carbon dioxide and adding oxygen—and returning it to the bloodstream.

ECMO also allows a patient’s heart and lungs to rest and heal, notes Jonathan Simmons, DO, a critical care physician and member of the ECMO team at UI Hospitals & Clinics.

“ECMO is a supportive mechanism. It provides valuable healing time critically ill patients sometimes need,” Simmons says. “Without ECMO, Mr. Durant most likely wouldn’t have made it out of the operating room.”

Fortunately for Mike, the ECMO team at the UI has medical staff with the experience and expertise to handle any challenge—cardiothoracic surgeons who are available around the clock for emergency implantation; intensive care specialists who oversee the patient’s ECMO therapy and any potential complications that might occur; and nurses, perfusionists, and respiratory therapists who help ensure 24/7 bedside care.

“It’s definitely a collaborative effort, and it needs to be,” Simmons says. “With ECMO, we’re talking about patients who are really struggling, which means the potential for things to suddenly ‘go wrong’ is high. Not many ECMO programs have 24/7 bedside specialists like we do, and that’s really important. It helps the patient get the very best care possible. In fact, it saves lives.”

Mike spent five days on ECMO in the hospital’s Cardiovascular Intensive Care Unit. After ECMO support was removed, he spent several additional days recovering in intensive care before being transferred to a general inpatient unit.

Twenty-two days after arriving at UI Hospitals & Clinics, Mike was cleared to go home.

Next came physical therapy, a slow but gradual process of regaining Mike’s strength.

“When I first got home, I needed help just lifting my legs out of the car,” Mike says. “I’m not walking as fast as I used to, but I’m getting there. I’m healing up good.”

Mike also is back to work—an important milestone on his road to recovery.

Looking back, he considers himself “very lucky.”

“I was unconscious for about half the time I was in the hospital, including the entire ECMO run, so it all still seems kind of unreal to me,” Mike says. “I could’ve just as easily died, so it really does make you stop and think.

“The University of Iowa doctors and nurses knew what they were doing,” he adds, “and I’m really glad they did.”

ECMO at Iowa

The ECMO (extracorporeal membrane oxygenation) program at UI Hospitals & Clinics is a highly coordinated team endeavor.

Patients who require ECMO typically are critically ill with complex and severe respiratory and/or cardiovascular health problems. ECMO requires 24/7 bedside monitoring. The Iowa team—cardiothoracic surgeons, heart and lung specialists, intensive care physicians and nurses, perfusionists, respiratory therapists, and others—ensure that ECMO patients receive the highest quality heart-lung bypass care and follow-up as needed.

Key points about the ECMO program at Iowa:

• Recognized in 2016 with a Gold Level Award for Excellence in Life Support from the Extracorporeal Life Support Organization (ELSO)—one of only 31 such programs in the world, and the only one in Iowa
• One of the few programs in the nation that serves patients of all ages—adult, pediatric, and neonatal patients
• The UI is an ECMO training center, providing weeklong sessions and hands-on training to medical professionals from across the country and around the world
• One of a handful of programs in the United States with an ECMO “sled,” developed in collaboration with ELSO, that allows for transporting patients on ECMO via ambulance or fixed-wing aircraft. The transport system, approved by the Federal Aviation Administration, provides an opportunity to better serve smaller hospitals across Iowa and the upper Midwest with limited or no ECMO capabilities.