When was ecmo invented

These experiments paved the way for the artificial perfusion of single organs in vitro and the proof of the concept that organ function can remain with artificially perfused organs. By the end of the 19 th Century, von Frey and Gruber had developed a precursor to cardiopulmonary bypass — an artificial oxygenating machine which operated in a closed system. Until the 20 th century the progress of ECMO was plagued by various practical issues, such as the bubbling and clotting of blood, which inhibited its use in humans.

In fact, many earlier experiments defibrinated the blood thereby restricting it from use in living animals Boettcher This device was used to perform whole body extracorporeal perfusion on a living dog.

It consisted of 2 mechanical pumps with valves along with an oxygenator made of the ventilated lungs of a separate animal. One pump moved blood through the lungs and the second maintained systemic perfusion after the heart had stopped. Boettcher This proof of concept provided sure footing to develop the first human ECMO machines. The period of the 30s and 40s introduces us to John Gibbon Jr, the individual credited for the first successful use of cardiopulmonary bypass on a human.

The catalyst for his work began after caring for a young woman with a massive pulmonary embolism Hessel He conceived the idea of cardiopulmonary bypass to support her while performing an embolectomy. By the s a few cardiac operations exist — they include the closure of patent ductus, a coarctation of the aorta repair, the Blalock-Taussig shunt procedure, a mitral commissurotomy and the closure of some atrial septal defects.

Some of these are facilitated by deep hypothermia but in order to perform more complex open-heart operations it is evident that a system of Cardiopulmonary bypass is required Stoney This period marks the first actual use of cardiopulmonary bypass in human patients.

Walton Lillehei at the University of Minnesota. By the end of this decade open heart surgery using cardiopulmonary bypass is a viable reality. By the mid s, oxygenators are mostly either film oxygenators or bubble oxygenators. The film oxygenators use a rotating cylinder, disc or screen to create a thin film of blood which is then exposed to oxygen.

The bubbling oxygenator bubbles a stream of oxygen through a reservoir of blood in order to oxygenate it Yeager These primitive oxygenators are plagued with issues of blood foaming which lead to trauma and the loss of products along with a high risk of arterial gas emboli. Thus, there is a push for new types of oxygenators.

By the s cardiopulmonary bypass was gaining momentum and open-heart surgery was viable. This decade would also lead to the development of artificial heart valves, the introduction of coronary artery bypass grafting and the first heart transplant Hessel By the s cardiac bypass was reliable enough to perform relatively quick open-heart surgeries.

However, in order to support a patient for an extended duration as in ECMO, further modifications would have to be made. For instance, the development of silicone membranes for oxygenators through the s prolonged the lifespan of circuits and allowed their ongoing use for weeks Bartlett The success of the s and 60s gave way to the advances in the s. The s saw the first use of cardiopulmonary bypass in a non-surgical patient — this can be said to be the birth of ECMO as we know it.

Over this decade case reports build regarding the use of cardiopulmonary bypass in cardiac failure and respiratory failure of various causes Bartlett Furthermore, this decade is important for various advances in oxygenators.

Hollow fibre oxygenators are introduced Yeager They are constructed similar to renal dialysers where small tubes are used to separate the blood and gas thereby providing a large surface to volume ratio. However, despite the initial successes of ECMO, the s silicone membrane oxygenators are plagued with many coagulation issues. Microporous polypropylene hollow fibre oxygenators are developed which reduce many of these coagulation issues and further improve gas transport Yeager This is where plasma would be driven through the micropores in the membrane by the pressure of the blood causing soapy bubbles to form and limiting the lifespan of the membrane Yeager Despite the technological advancements, early studies fail to show a benefit of ECMO and thus it suffers a significant setback in its widespread adoption Cavarocchi This speed bump causes many to stop offering it Vuylsteke However, the experience in paediatrics and neonatology would be very different and it would prove to be an important, life-saving treatment Wolfson Compared to the current technology, the s technology was still relatively archaic though later this decade, centrifugal pumps begin to be used Passaroni, These pumps consist of a central rotating impeller that spins and generates centrifugal force to pump blood forward.

As an aside, this decade also saw the introduction of the ballooned tipped pulmonary artery catheter introduced by Swan and Ganz. The period of the ss saw further development in the hardware of ECMO along with its wider distribution. During this time, the hollow fibre oxygenators with extraluminal crossflow of blood became commonplace Yeager Cyclosporine was introduced as an antirejection medication which vastly improved the survival rates of heart transplantation.

This made it a more viable treatment option for end stage heart failure Hessel Furthermore, ventricular assist devices also take off as therapy for end stage heart failure. Further important advances in circuits take place over this time — Earlier ECMO circuits had silicone membranes and used roller pumps.

These circuits were complicated by wetting. The average ECMO run would require perhaps oxygenators. This decade saw the introduction of Polymethylpentene PMP oxygenators and the further spread of centrifugal pumps. PMP hollow fibre oxygenators now become the standard of care Yeager Centrifugal pumps are introduced over the previously used roller pumps.

This new ECMO now boasts reduced haemolysis, heparin use, transfusion requirements and less complications Cavarocchi ELSO begins creating guidelines for training, staffing and equipment Cavarocchi The use of ECMO in refractory respiratory failure in adults continues and in the H1N1 influenza epidemic strikes.

It is a large multicentre randomised controlled trial in the United Kingdom featuring an Intention to treat analysis of conventional ventilation vs transfer to an ECMO referral centre. However, there are many criticisms of this publication and interpetation of the study is frustrated by the fact that many patients who were transferred to the ECMO centre were not put on ECMO. But as she kept tabs on the patient, she was amazed to learn that he was able to recover and go home.

Haider Warraich of Duke University Medical Center came across three or four years ago during his cardiology training. Warraich was called to the waiting area of a lung transplant clinic, where a man in his 60s had collapsed on the floor due to a heart attack. The man, who had white hair and a scraggly beard, played Santa every Christmas, Warraich later learned.

Motivated to save not only the patient but the new set of lungs he had received, the team called in ECMO. Cardiologists did surgery on a blocked artery, but they never got his heart back to normal. The man lingered for a month, using ECMO for his heart, a ventilator for his lungs and dialysis for his kidneys, before he died. But he said doctors need more guidance to determine which patients would benefit the most and to prevent overuse.

The technology, developed in the s, was initially used primarily for newborns. Early clinical trials in adults were discouraging. Those findings, combined with improved technology and an epidemic of swine flu, prompted a swift growth of ECMO among adults. The average age for U. About 1 in 10 ECMO cases are for people over Warraich and other experts say they are now concerned that new organ-donation rules may inadvertently spur hospitals to place more patients on ECMO: Under guidelines approved by the Organ Procurement and Transplantation Network last October, patients on ECMO jump to the front of the heart transplant waiting list.

Once a patient is on ECMO, deciding when to stop can cause moral distress and division among medical staff, said Dr. The boy, who had already had one lung transplantation for cystic fibrosis, was now in end-stage respiratory failure. The only way to save his life was to give him another set of lungs. He started on ECMO as a bridge therapy while he awaited transplantation.

The boy was fully conscious, doing homework, texting friends and visiting with family. But after two months of living in the ICU, he was diagnosed with untreatable cancer that made him ineligible to receive new lungs. Clinicians were deeply divided over what to do next, Truog said.

Some wanted to stop ECMO immediately because its original goal — a bridge to transplantation — was no longer possible. They argued that the family should have the right to continue this form of life support, just as with dialysis, ventilation or an artificial heart.

Clinicians devised an alternative the family would agree to: They decided not to replace the ECMO oxygenator, a part that needs to be changed every week or two when it develops blood clots. After about a week, the oxygenator gradually failed and the patient lost consciousness and died, Truog said. The solution was not optimal, Truog said. Heart disease, which ran in his family, hit him early: He had his first coronary bypass surgery at age 30 and his second at 43, she said.

His heart was weaker than anticipated. Philip Ayoub, 58, an accountant and former comptroller for the National Football League, with his twin sons. Heart disease, which ran in his family, hit him early: He had his first coronary bypass surgery at age 30 and his second at Courtesy of Karen Ayoub. His time there was not easy, she said: Her husband, who had endured a series of mini-strokes during the bypass surgery, began to experience post-traumatic stress disorder, night terrors and side effects from medications.

The only option for further treatment, she said, was to get an implanted device that would help his heart pump. But as he weighed that decision, and the quality of life he would have, the window of time closed when he was eligible for the device, Karen Ayoub said. After they ran out of treatment options, the family gave permission for the hospital to discontinue life support. Philip was sedated before ECMO was turned off.

Shunichi Nakagawa, a palliative care doctor at Columbia who cared for Philip Ayoub. Paul, Minn. At Cedars-Sinai Medical Center in Los Angeles — where patients with poor chances of survival were being put on ECMO, and families were getting conflicting messages about the potential benefit — staff launched an improvement effort that has created more consensus and consistency around appropriate ECMO care, according to Dr.