The NewYork-Presbyterian Hospital and Columbia University Medical Center officially opened the Center for Acute Respiratory Failure, which offers expertise in using lung bypass technology to help adult patients whose lungs are rapidly shutting down.
The Center’s launch coincides with publication of a review article in today’s New England Journal of Medicine that details how the technology, extracorporeal membrane oxygenation can take over the function of the lungs in adults with acute respiratory distress syndrome to give severely damaged lungs time to rest and heal.
ARDS, which can be caused by injury or disease, affects more than 140,000 individuals a year, and mortality may be very high, especially in those with the most severe forms of the disease, according to the NEJM article.
It was written by Dr. Daniel Brodie, a pulmonary critical care specialist, and Dr. Matthew Bacchetta, a thoracic surgeon, who are co-directors of the new Center.
“The evidence is accumulating that, at the very least, referring patients with severe respiratory failure to a center capable of performing ECMO is beneficial for these patients. The Center for Acute Respiratory Failure is exactly such a center,” says Dr. Brodie, who is an assistant professor of medicine at Columbia University College of Physicians and Surgeons.
While ECMO is used at other centers, very few hospitals in the world treat as many adult patients with ECMO. NewYork-Presbyterian/Columbia treats about 70 a year, and that number is growing. More unusual in the U.S. is the team’s ability to travel to area hospitals, place patients on their adapted ECMO unit, and transport them to the Center, he says.
“This allows us to bring patients into our center who would otherwise be too sick to be transported by ambulance so that they can receive ECMO and other advanced respiratory care,” adds Brodie, who credits Dr. Bacchetta, assistant professor of surgery at Columbia University College of Physicians and Surgeons, for the success of the ECMO transport program.
The first such patient they transported on ECMO, in 2008, was a 27-year-old woman who was being treated at another New York hospital. Severe lung inflammation caused her lungs to fill with blood and her oxygen levels plummeted. By the time the ECMO team was called, she had had two cardiac arrests, according to Brodie.
Albany is the farthest the physicians have traveled to put patients on ECMO and bring them back to the Center. However, preparations are being put in place for air transport on ECMO from around the region and internationally.
The majority of patients treated with ECMO at the Center are referred to NewYork-Presbyterian/Columbia by other hospitals. One such patient is a woman who developed malaria after she returned from a missionary trip to Uganda. She had a rare and severe response to malaria that resulted in ARDS. She was on ECMO for nine days, and she recovered.
Most patients in respiratory distress are placed on ventilators, which move air in and out of the lungs. The forces involved in mechanical ventilation itself can harm the lungs. ECMO uses instead a mechanical pump that draws the blood from the body, gives it oxygen, and passes it back into the body, allowing the lungs time to heal.
Although ECMO has been available for decades, it has been considered an option of last resort in adults, used sparingly because it had high risks of bleeding, infection and stroke. However, advances in the technology of ECMO have greatly reduced the risks and made ECMO an important option for selected patients with respiratory failure.
The Center offers other procedures that can be life-saving in patients with lung failure. One is embolectomy, a surgery that directly removes clots from the lungs of patients with severe acute pulmonary embolism. “We are one of the few centers in the U.S. that does this procedure,” Dr. Bacchetta says.