November 13, 2009

ECMO program celebrates 20th anniversary

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Vanderbilt’s first ECMO patient, Chelsea Brown, with John Pietsch, M.D., who treated her 20 years ago. (photo by Mary Donaldson)

ECMO program celebrates 20th anniversary

She's the poster-child for the use of extracorporeal mechanical oxygenation, or ECMO, but 19-year-old Chelsea Brown doesn't remember much about her experience as a patient. She has only seen a couple of photos and news articles and heard the story from her mother.

“Every now and then people notice the scar on the right side of my neck, even though it is not big at all. When they ask me to explain, I say 'do you want the long or short story,'” Brown said.

The long story is Brown made history at Vanderbilt, becoming the first person placed on ECMO at a hospital in Tennessee. It happened when she was just hours old, on Nov. 24, 1989.

“She was 9 pounds 15 ounces. She was a big baby,” said Brown's mother, Norma Dam, with an emphasis on the word “big.”

Brown was delivered at a Hendersonville Hospital, in what should have been a routine delivery. Right after her daughter was born, Dam recalls the medical team was acting like something wasn't right.

“They just left me, so I knew something was wrong with the baby. When the pediatrician came to speak to me, she said Chelsea wasn't getting enough oxygen. She said there was a chance she would be flown to St. Louis or Cincinnati because there was something there that might help her,” recalled Dam.

That something was ECMO. During delivery, Chelsea had inhaled meconium (a term for the excrement of newborn babies) and was suffocating. Oxygen therapy was doing little for her. She was a deep blue color when Dam finally saw her — for just a moment — in a travel incubator as they whisked Chelsea away.

Hospital officials in Hendersonville had learned that Vanderbilt had been waiting for a baby just like Chelsea, so the baby's trip was much shorter than anticipated.

“We had been sending our patients up to Louisville, where I had worked before coming to Vanderbilt,” said John Pietsch, M.D., surgical director and founder of the ECMO program at Vanderbilt. “But I had convinced Vanderbilt to start an ECMO program, so we were prepared when Chelsea showed up.”

Brown was the perfect ECMO patient, if there is such a thing. She was absolutely healthy, except for the meconium in her lungs. Pietsch says he vividly recalls when he performed the surgical procedure to hook the infant to the ECMO machine through one incision in the right side of her neck. The effects of the mechanical pump, designed to artificially oxygenate blood, were immediate.

“She turned from blue to pink,” Pietsch said.

Since that day, 20 years later, about 650 patients — from infants and children to adult patients — have used the ECMO pump to support weakened lungs and hearts, giving them a chance to survive potentially threatening illnesses.

The pump is much like a heart-lung bypass machine used during open heart surgery, only with the expectation that the patient will remain on the pump until the heart and lungs recover from the injury or illness that has incapacitated them.

All patients have a very high-risk illness when they are placed on ECMO. Invariably, ECMO specialists get very close to the families because they spend so much time with them.

“That is one of the constants. The same ECMO specialists work with a patient while they are on the pump,” said Daphne Hardison, R.N., manager of ECMO Services at the Monroe Carell Jr. Children's Hospital at Vanderbilt. “It's an excellent team to work with and be a part of. Patients like Chelsea are a result of a team effort.”

But because it is the treatment of last resort for many patients, ECMO team members must also learn to accept bad outcomes. That makes patients like Chelsea Brown special to the team. Reunions are held periodically to celebrate the successes, and see the positive results.

On Saturday, Nov. 7, the ECMO program celebrated its 20th year. The reunion party to mark this milestone would not have been the same without the program's very first patient.

Both Brown and her mother have attended other reunions over the years.
Now Brown is attending college in Boston with the hopes of going to architecture school.

“Neither Chelsea nor I really put it all together, until we were talking about her coming to this 20th reunion. Then we realized how big this year is for us all, with Chelsea turning 20,” said Dam.

“I was excited to see her (Brown), especially since she's gone off to college. All the staff who had a chance to take care of her enjoyed seeing her,” Pietsch said.

The reunion at Children's Hospital was attended by nearly 200 people, including three ECMO team members who worked with Brown in 1989.

Christy Worden, R.N., Cindy Thomason, R.N., both of whom are still on the ECMO team, and former ECMO team member Cathy Krouse, R.N., returned for the celebration.