acuterespiratorysyndrome

What is Acute Respiratory Distress Syndrome?

by Columbia Surgery on February 6, 2012

Drs. Daniel Brodie, left, and Matthew Bacchetta, right

Drs. Daniel Brodie, left, and Matthew Bacchetta, right

We all know what it’s like to bump an elbow or jam a finger and watch it swell up like rising dough. This swelling, due to increased fluid in the injured tissue, is part of the body’s attempt to promote healing. However, when it occurs in the lungs, it can have dangerous consequences.

Acute respiratory distress syndrome (ARDS) occurs when the millions of tiny air sacs in the lungs, called alveoli, fill with excess fluid. This can be the result of any kind of injury to or illness in the lung. Pneumonia, trauma, sepsis, and inhalation of stomach contents or smoke can all cause the body to initiate an inflammatory response, sending excess fluid to the lungs.

In healthy lungs, the alveoli fill with inhaled air, transferring oxygen into the blood carried by small neighboring vessels. The oxygen-rich blood can then travel throughout the body to deliver its cargo to the kidneys, brain, liver, and other organs. But when fluid accumulates in the alveoli, they can no longer fill with air, and oxygen cannot pass as easily into the blood. Soon after the initial injury or illness, blood oxygen levels decline, and breathing becomes fast and difficult as the body tries to compensate. There may also be signs, such as confusion or low blood pressure, that the vital organs aren’t getting enough oxygen. In some patients, the lung may try to heal itself, creating scar tissue that decreases the lung’s elasticity and makes it still harder to breathe. The majority of patients recover, but around 40% die in the setting of ARDS, says Daniel Brodie, MD, Director of the Medical ECMO Program at NewYork-Presbyterian Hospital/Columbia University Medical Center.

Treatment for ARDS aims to restore oxygen levels. This may be done with a mechanical ventilator, or through a process called extracorporeal membrane oxygenation (ECMO), in which the blood is removed from the body and oxygenated externally before it is returned. In November 2011, NewYork-Presbyterian Hospital/Columbia University Medical Center opened the Center for Acute Respiratory Failure, which specializes in ECMO. Accompanying the Center’s launch was an article on ECMO for ARDS in adults by the Center’s co-directors, Daniel Brodie, MD, and Matthew Bacchetta, MD, published in the New England Journal of Medicine.

The ECMO program’s innovative approach has been highly successful: every adult ECMO patient has recovered and is now thriving. Click here to read their stories.

Tagged as: acuterespiratorysyndrome, Bacchetta, ECMO

{ 0 comments }

The Road to Recovery: Just Over a Year Later, ECMO Patient Completes Bike-A-Thon

by Columbia Surgery on November 28, 2011

Pamela Abma has come a long way since she spent several weeks hospitalized at NewYork-Presbyterian Hospital/Columbia University Medical Center last year, barely clinging to life. Just as June of 2010 began, she suddenly developed acute respiratory distress syndrome (ARDS) as a result of an unusually violent reaction to a form of malaria that she had caught while performing missionary work in Uganda. Her reaction was so severe that she might not have survived were it not for the extracorporeal membrane oxygenation technology (ECMO) provided by Daniel Brodie, MD, Director of the Medical ECMO Program, and Matthew Bacchetta, MD, MBA, MA, Director of the Adult ECMO Program. Thanks to ECMO, she made a miraculous recovery, and was out of the hospital in mid-July.

Pamela Abma at MS Bike-a-Thon

Pamela Abma at MS Bike-a-Thon

Her recovery was by no means complete when she left the hospital, however. She had lost twenty pounds while on ECMO, and was extremely weak; she could barely walk around. She desperately needed to put on the muscle mass she had lost. Choosing to forgo rehabilitation, she hired a personal trainer, and began her recovery by using weights in her swimming pool. Before long, she was spending the hot summer days swimming laps. Her strength gradually returned, and she was thrilled to be able to attend her son’s wedding in August.

As winter set in, Pamela’s daughter, Joy Abma, suggested that she make it a goal to participate in the following year’s Bike MS, a bike-a-thon put on by the National Multiple Sclerosis Society. Pamela’s niece had recently been diagnosed with MS, so the biking event seemed like an excellent way to support the fight against MS while also forcing Pamela to get in shape. She began to take spinning classes in preparation for the 50-mile ride, which she knew would be more strenuous, physically, than anything she had done in her life.

When winter was past and it warmed up again, Pamela took to the streets, biking regularly. That summer, Pamela and her family decided to commemorate the anniversary of her illness by reading aloud from a journal that Joy had kept throughout the time Pamela was on ECMO. Every day for those six weeks, Pamela would re-experience her illness through the eyes of her daughter, reading the passage written on that day the year before: “today, the doctors said you might not survive”; “today, you opened your eyes for the first time”; and so on. Until then, Pamela hadn’t been able to bring herself to read through Joy’s incredible journal in its entirety; finally doing so helped her understand exactly why her family calls her “the miracle girl.”

The next fall, the big day finally arrived: on October 3rd, 2011, Pamela joined her daughter and her sister-in-law in a ride that began at the Lincoln Tunnel and ended by the piers near the George Washington Bridge. She recalls pausing on the bridge itself, to reminisce: while she had been on ECMO, her hospital room had had a view of the George Washington bridge; she couldn’t see it herself from her position lying in the bed, but her guests remember it vividly. The cyclists decided to bike down to NewYork-Presbyterian Hospital/Columbia Medical Center itself, where Joy took the picture seen here of Pamela in front of the giant banner. Needless to say, Pamela’s recovery has been an incredible success — and the family is already talking about participating in a three-day bike-a-thon next year, in order to raise money for the fight against malaria.

Related Link:
ECMO Saves Life of NJ Missionary with Acute Respiratory Distress Syndrome

Tagged as: acuterespiratorysyndrome, Bacchetta, ECMO

{ 0 comments }

ECMO Patient Survives Acute Respiratory Failure; Proposes to his Girlfriend in ICU

by Columbia Surgery on October 24, 2011

On March 20, 2010, Chris Costa, a 26-year-old paramedic in Connecticut, was taking a quick ride on his motorcycle when he was sideswiped by a truck. He sustained serious trauma, including seven broken ribs and a broken right femur, and was rushed to St. Vincent’s Medical Center in Bridgeport. While there, he developed acute respiratory distress syndrome, or ARDS, a condition in which the lungs fill with fluid. He was put on a mechanical ventilator, to no avail; his lungs stopped working, and his kidneys soon followed. Recognizing that Chris’s life was in danger, his cardiothoracic surgeon, Dr. Albert Dimeo, called Daniel Brodie, MD, Director of the Medical ECMO Program at NewYork-Presbyterian Hospital/Columbia University Medical Center, and asked that Chris be put on ECMO.

ECMO stands for extracorporeal membrane oxygenation. When human lungs are functioning normally, they add oxygen to the blood and remove carbon dioxide from it. But when they are failing, as in Chris’s case, ECMO can perform this vital function for them. The patient’s blood is run out of the body, through the ECMO machine, and back in, through a system of tubes; the ECMO machine essentially serves as a set of out-of-body lungs, continually oxygenating the blood. Because this advanced technique allows the patient’s lungs to rest, it avoids causing the damage and complications associated with other techniques, such as mechanical ventilation. According to Dr. Brodie, “It is a technique with the potential to save many lives.”

On March 24, four days after the accident, NYP/Columbia rushed their mobile ECMO Transport Team to St. Vincent’s, where Matthew Bacchetta, MD, MBA, MA, Director of the Adult ECMO program, and his team put Chris on ECMO. He was then transferred to NewYork-Presbyterian/Columbia University Medical Center (via police escort — he also worked for the Fairfield police at the time), where Dr. Brodie, Dr. Bacchetta, and the rest of the ECMO team continued to provide and monitor Chris’s ECMO support.

Sarah and Chris Costa at their wedding, May 14, 2011

Sarah and Chris Costa at their wedding, May 14, 2011

Chris’s condition gradually improved; when he regained consciousness about two weeks later, although still breathing through a hole in his neck know as a tracheostomy, he was already cracking jokes. His family and girlfriend of five months (Sarah, a Connecticut policewoman with the Bridgeport police) were there with him. He could hardly speak, however, due to the tracheostomy. It was so difficult to talk, in fact, that his mother had brought him a whiteboard so that he could avoid the effort of speaking.

One day, still in the ICU with his tracheostomy, Chris sent Sarah a text message as she was out getting dinner with a friend — asking her for her hand in marriage. She dropped her food, ran back to the ICU, and accepted his proposal. It was the first engagement the Columbia ICU had ever seen.

Several weeks later, as his recovery continued, Chris devoted an afternoon with his occupational therapist to mastering the difficult task of climbing out of bed, getting down on one knee, and climbing back into bed. That evening, Sarah came to visit him in his hospital room. Chris asked her to close the door. She walked to the door saying “shouldn’t you do this by yourself,” and when she turned around, she found him kneeling before her, presenting a wedding ring — their formal proposal.

After about two and a half months, Chris and Sarah left the hospital and went home. Chris has made a full recovery, and the two are even riding again. But as Dr. Brodie warns, the happy outcome might have been different if St. Vincent’s Medical Center hadn’t provided such outstanding initial care and if Dr. Dimeo hadn’t thought to call upon the NYP/Columbia team to put Chris on ECMO as soon as he did. “ECMO is proving to be valuable therapy in the most severe cases of ARDS,” he says. Drs. Brodie and Bacchetta hope that stories like Chris’s will help spread the word about ECMO, and the lives it has the potential to save.

Tagged as: acuterespiratorysyndrome, Bacchetta, Brodie, ECMO

{ 6 comments }

ECMO Helps Save the Life of a Young Man After a Football Injury

by Columbia Surgery on September 23, 2011

On August 5, 2011,19-year-old Robert Loftus tripped while catching the game-winning touchdown pass in a football game with friends. He broke his leg — both his tibia and fibula — and was rushed to the ER at Hudson Valley Hospital Center. On the morning of the 6th, he was visited by his orthopedist, Dr. Steven Small, and surgery to place a rod in his broken leg was scheduled for 3 pm that day. Just as the operation was beginning, however, the anesthesiologist was alarmed to find that Robert’s lungs were dangerously filling with fluid. The surgery was called off, and while still in the OR, Robert was put on a mechanical ventilator.

Robert Loftus

Robert Loftus

Robert had developed a severe case of ARDS, or acute respiratory distress syndrome; his lungs were failing. After four days on the ventilator, Robert’s breathing was not improving; on the contrary, it was rapidly getting worse. Recognizing the severity of his patient’s condition, Dr. Alex Fijman, pulmonologist at Hudson Valley, called the Medical ICU team at NewYork-Presbyterian Hospital/Columbia University Medical Center, to see if Robert could be transferred. Discussing the case, they soon realized that Robert was too sick even to be transferred; he needed ECMO, right away. Daniel Brodie, MD, Director of the Medical ECMO Program, was contacted immediately.

ECMO stands for extracorporeal membrane oxygenation; it is a machine that takes over the function of the lungs. A patient’s blood is run out of his or her body, through the ECMO machine, which provides oxygen to the blood and removes carbon dioxide, and is then sent back into the body. The machine serves essentially as a set of mechanical lungs, allowing the patient to rest his or her biological lungs. It is far less damaging than using just the mechanical ventilator Robert had been relying on. The team was hoping that ECMO would help provide Robert’s lungs with the reprieve they desperately needed.

Dr. Matthew Bacchetta, MD, MBA, MA, Director of the Adult ECMO program, and his Mobile ECMO Transport team rushed to Hudson Valley Hospital Center and put Robert on ECMO in swift, organized fashion. They warned Robert’s parents that because his condition was so critical, he might not survive. To his family’s relief, he recovered much more quickly than expected; about a week later, his condition had already improved dramatically, and Robert was taken off ECMO August 15. Robert stayed in the hospital for another week as his broken leg was X-rayed and recast; then, on August 24, he went home.

Dr. Brodie says that Robert is lucky. “If Dr. Fijman hadn’t taken such good care of Robert early on and hadn’t had the presence of mind to call Columbia so quickly, Robert may not have survived at all,” he says. Dr. Brodie, Dr. Bacchetta, and the rest of the ECMO team are working to spread the awareness to hospitals that if a patient develops severe ARDS, ECMO is an important option to consider. In patients like Robert, ECMO can save lives.

Related Link:
NewYork-Presbyterian Hospital campuses collaborate to use ECMO, saving patient’s life

Tagged as: acuterespiratorysyndrome, Bacchetta, Brodie, ECMO

{ 0 comments }

ECMO Saves Life of NJ Missionary with Acute Respiratory Distress Syndrome

by Columbia Surgery on November 2, 2010

When Pamela Abma traveled to Uganda in April 2010 on a missionary trip, she took all the proper medical steps to avoid illness. A healthy, fit, 47-year-old from NJ, she received the requisite immunizations and took her antimalarial medications. While in Uganda, Pam took care to retreat under mosquito netting before the onset of dark and to use bug spray to prevent malaria-bearing mosquito bites. She drank only bottled water to avoid the intestinal parasites present in the local water supply. She had a fantastic, rewarding experience, working with other missionaries and local residents to help develop a source of clean water and lay the groundwork for a health clinic.

Pamela Abma on ECMO Machine

Pamela Abma on ECMO Machine

Pam returned to her northern New Jersey home April 15, and for six weeks, had no signs of the illness that would soon change her life. She rode with her local ambulance corps, of which she is a member, in the Memorial Day parade in her town. That night, she recalls, a fever took hold. Three more nights of fever followed, leading her to the emergency department at Valley Hospital in Ridgewood, New Jersey. “I kept telling the emergency room (ER) doctor that I had been in Africa, and finally he agreed to test me for malaria,” says Pam. The test was positive, and Pam was sent home with medications and the expectation that she would feel worse before she felt better.

But the ER doctor’s prediction could not anticipate what would follow: a rare, severe response sent Pam into a rapid downward spiral. Violent vomiting gave way to difficulty breathing, and within two days, Pam developed Acute Respiratory Distress Syndrome, or ARDS. Back in the hospital, she was sedated, intubated, and placed on a mechanical ventilator. She does not remember anything after that day.

With her lungs unable to send enough oxygenated blood through her body, her physician, Steven Jacoby, MD, contacted Daniel Brodie, MD at NewYork-Presbyterian Hospital/Columbia University Medical Center. Paramedics came from the hospital to transport Pam to the Medical Intensive Care Unit, and immediately placed her on extracorporeal membrane oxygenation, or ECMO. “Pam was very fortunate that Dr. Jacoby made that call when he did,” says Dr. Brodie. “He used great clinical judgment, and if he had not gotten in touch with us so quickly, it may have been too late.”

ECMO machines are used to help patients with ARDS by taking over the work of the lungs, which then allows the lungs to rest and recover. Unlike a ventilator, which forces air into the lungs and can cause lung injury, ECMO works similarly to a dialysis machine in that it removes the blood from the body, treats it externally in this case removes carbon dioxide and infuses oxygen, and then returns it to the body. During this version of ECMO, the blood is removed and returned through a catheter in the jugular vein. While Pam was on ECMO, she was in a drug-induced coma so that the tubing would not move and compromise her oxygen levels. Signs of progress were monitored by X-rays of her chest that were performed each day and by how her lungs interacted with the mechanical ventilator.

Pam’s doctors warned her husband and three children that there was no guarantee that the use of ECMO would be successful. They did not know if she might sustain brain or organ damage. “The doctors only began seeing small signs of improvement during my seventh day on ECMO,” Pam says. By day nine, enough fluid had drained and her lungs had regained enough function that she could be taken off ECMO. But after being in a coma for as long as she had been, she could not be awakened quickly – it took yet another eight or nine days to wean her off sedation and to start reintroducing sensory stimulation. When she woke up, Pam could not speak as she still had a tracheotomy, she was very confused, and had no strength to write. “My arms and legs felt like rubber. I couldn’t eat, but could only drink thick fluids.” She had lost 20 pounds.

“Pam’s reaction was highly unusual,” Dr. Brodie explains. “Her form of malaria, vivax malaria, is typically not the most serious. But a small number of patients with vivax malaria may develop ARDS, and her case was extreme. She was very close to death.” The team’s use of ECMO to sustain Pam was the first known time it had been used for a patient with malaria. This application of ECMO was available at NYP/Columbia because he and Matthew Bacchetta, MD, Director of the Adult ECMO Program, had already developed a specialized program to treat adult patients with ARDS.

Today Pam considers herself fully recovered, with the exception of continuing joint pain. She credits the expertise and caring of her doctors, prayers from her family and community, and God in helping her to recover. Having missed her daughter Joy’s high school prom and graduation in May, she was thrilled to be able to walk down the aisle and dance with her son, Jimmy, at his wedding in August.

Pam Abma serves on the Board of Directors of Touch the World Ministries, which works with orphans and young adults traumatized by the civil war in Uganda. Her trip helped to establish a source of clean water and a health clinic for the community of Adak, Uganda.

For Clinicians: If you are a clinician interested in ECMO information, please read ECMO Course: Current Uses and Future Directions. Additionally the Columbia University Department of Surgery has an upcoming continuing medical education seminar on November 30th, StO2: Rapid non-invasive perfusion assessment.

Tagged as: acuterespiratorysyndrome, Brodie, ECMO

{ 0 comments }