Medical Devices

With the advent of modern anesthesia and increased use of surgical methods, surgeons sought ways to repair damage on the heart and lungs. The proposed solution at the time was to develop a mechanical device to perform the bodys cardiopulmonary function. The development of the extracorporeal membrane oxygenation (ECMO) system dates back to 1936 with surgeon Dr. John Gibbon utilizing a roller pump to take over cardiac function. Pulmonary function was bypassed by allowing the pumped blood to drip vertically allowing for oxygenation through direct air exposure. After some modifications, in 1953 Dr. Gibbon was able to use the artificial cardiovascular machine to successfully perform the first open heart surgery (1). The components of the current ECMO system are essentially the same as the early invention used by Dr. Gibbon. Briefly, right atrial venous blood from the patient is pumped to a membrane oxygenator which is then passed through a heat exchanger and delivered sent back into the patient using either venoarterial or venovenous bypass routes. The modifications used in todays ECMO machines allow for longer usage compared to early devices, which had lethal effects after a few hours. Membrane oxygenators using specialized materials to control blood oxygen exposure and controlled administration of heparin helped reduce hemolysis and coagulopathies (2). Although not a cure, ECMO is crucial in that it provides the surgical team time to diagnose and treat life-threatening conditions of the heart and lung. Aside from applications in adult cardiorespiratory failures, a major use of ECMO today is in neonatal and pediatric patients. University of Michigan surgeon Dr. Robert Bartlett is considered the Father of ECMO as he had envisioned extracorporeal support capable of sustaining a patient for days and performed the first successful neonatal ECMO procedure to treat respiratory failure in 1976. ECMO can be used to sustain life while treating disorders causing respiratory distress including meconium aspiration, primary pulmonary hypertension of the newborn, streptococcal infection and asphyxia (3). Modern ECMO differs from cardiopulmonary bypass in that ECMO is used to support patients for longer periods of time (3-10 days) compared to traditional bypass (1-3 hours). The most common complication of ECMO is clot formation (1) and is treated with heparin, which has its own contraindications including hemorrhagic bleeding. ECMO has a survival rate of 95% when used in neonatal meconium aspiration making it a highly successful tool in helping treat an otherwise fatal condition (2). As far as cost, ECMO was determined to be cost-effective even when used in salvage therapy resulting in a cost of $4190 in 1994 per life-year saved which is within the range of accepted cost-utility (4).

Medical Devices I chose to research ECMO because of the significant involvement the University of Michigan researchers had in its inception and continues to have in its development. I encountered the device in action as my lab occasionally uses the animals sacrificed by the ECMO lab for bone marrow harvests. The researchers are evaluating future uses to develop implantable total artificial lungs using in-house ECMO oxygenator technology and to also develop an ECMO device with non-thrombogenic coating to eliminate the need for anticoagulation. In addition, other future directions of ECMO include reevaluating the circuitry to enhance safety as well as make the device portable which would allow it to be used during transport for patients with acute respiratory distress (5).

Reference: 1: Rodriguez-Cruz E. Extracorporeal Membrane Oxygenation. Medscape . March 29, 2011. http://emedicine.medscape.com/article/1818617. 2: Bartlett RH, Gattinoni L. Current status of extracorporeal life support (ECMO) for cardiopulmonary failure. Minerva Anestesiol. 2010 Jul;76(7):534-40. PubMed PMID: 20613694. 3: Sinard JM, Bartlett RH. Extracorporeal membrane oxygenation (ECMO): prolonged bedside cardiopulmonary bypass. Perfusion. 1990;5(4):239-49. Review. PubMed PMID: 10149492. 4: Mahle WT, Forbess JM, Kirshbom PM, Cuadrado AR, Simsic JM, Kanter KR. Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in children. J Thorac Cardiovasc Surg. 2005 May;129(5):1084-90. PubMed PMID: 15867784. 5: Morris AH. Exciting new ECMO technology awaits compelling scientific evidence for widespread use in adults with respiratory failure. Intensive Care Med. 2012 Feb;38(2):186-8. Epub 2011 Dec 7. PubMed PMID: 22147117.