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Seattle Girl Survives on Heart-Lung Machine Longer Than Any Child in the Northwest

March 11, 2008

 A 4-year-old girl suffering from respiratory failure becomes the first patient in the Northwest to survive on an artificial heart-lung machine known as ECMO (extracorporeal membrane oxygenation) for 46 days.

A 4-year-old girl suffering from respiratory failure becomes the first patient in the Northwest to survive on an artificial heart-lung machine known as ECMO (extracorporeal membrane oxygenation) for 46 days.

Amelia Chen, the third and middle child of Tammy and Ian Chen, was transferred to Children’s Hospital and Regional Medical Center in the early morning hours of Dec. 5, 2007, suffering from streptococcal pneumonia. Her condition rapidly worsened and she was eventually put on ECMO. “We were told there was a 50/50 chance of survival,” says Amelia’s mother, Tammy, “We just wanted to give her the best opportunity at life.”

Before Chen, the longest a patient was on ECMO and survived at Children’s was 33 days in 2003. “Many children don’t survive on ECMO longer than two weeks,” says Mike McMullan, MD, Children’s new surgical director of ECMO, who cared for Amelia during her most critical time. “Many children die due to complications from use of the ECMO machine, such as infections, blood clots or internal bleeding. The fact she got so far is a testament to her strength; she’s a tough little girl.”

ECMO is a type of heart-lung pump that provides support when a child’s heart or lungs fail to work properly or need to rest. By taking over the work of the heart and lungs, the machine gives a child’s heart or lungs a chance to recover. To initiate ECMO, catheters are placed in large blood vessels to provide access to the patient’s blood stream. Anticoagulant drugs are given to prevent blood clotting. The ECMO machine continuously removes blood from the patient and performs gas exchange, much like the lungs, before returning the blood to the patient.

During the end of her time on ECMO, Chen’s parents say Amelia started acting like their little girl again. Despite the tubes running in and out of her body and the constant flow of medication, she was able to move around in bed, paint and play Pokemon. “She wants to be able to beat her brother the next time they see each other,” says her mother, “she’s competitive that way.”

Children’s Hospital was the first to offer ECMO in Washington state to neonates and infants (those under 12 months old) in 1990, and in 1995, began to offer treatment on patients over 1-year. Over the last 28 years, about 405 children have been on ECMO at Children’s. Most of these children would have died without the availability of ECMO. Children like Chen who are placed on ECMO for acute respiratory distress syndrome (ARDS) typically have a 56% survival rate. According to the Extracorporeal Life Support Organization’s (ELSO) world-wide database, the longest period of time that a pediatric patient with ARDS has survived on ECMO is 52 days. Chen is the world’s third longest pediatric ECMO survivor who was supported for ARDS.

Traditionally, physicians have used ECMO to provide cardiopulmonary support to patients recovering from lung failure, heart failure or surgery. “At Children’s, we tend to use the machine earlier in children to give them a chance at a quicker recovery,” says McMullan. “We are also willing to keep a child on the machine longer than many institutions because we believe it can be an effective bridge to recovery.” A specially-trained team of people made up of intensive care physicians, perfusionists, respiratory therapists and registered nurses managed Chen’s care while she was on ECMO.

McMullan says Children’s ECMO team developed a variety of new techniques with the machine during Chen’s 46-day ordeal. “She had lots of bleeding during that time and our team was able to come up with strategies that included the uses of medicines to dissolve clots so that they would pose less of a threat to her life. We have also designed a novel ECMO circuit that enables us to use less anticoagulation medication, which can decrease bleeding complications.”

“On more than one occasion a line of the machine had to be cut out because of blood clots that had accumulated,” says Chen’s mother, Tammy. “The machine was a blessing and a curse. It truly was a roller coaster ride, but we appreciate doctors offering it as an option of care for our daughter.”

Chen was taken off the ECMO machine on Jan. 28 and after several weeks of follow-up care was discharged from the hospital on March 11. “I just hope our daughter’s story can offer some hope,” says Tammy, “it was a long and difficult journey, but now we are taking our daughter home.”

“As we have gained more experience, we have learned that there are additional patients who may benefit from ECMO technology. In the coming months we will become the first hospital in the region to offer ECMO to all children who experience cardiac arrest and in the future we plan to develop a mobile ECMO system that can transport patients from other institutions during ECMO support,” says McMullan.

About Seattle Children’s

Consistently ranked as one of the best children’s hospitals in the country by U.S. News & World Report, Seattle Children’s serves as the pediatric and adolescent academic medical referral center for the largest landmass of any children’s hospital in the country (Washington, Alaska, Montana and Idaho). For more than 100 years, Seattle Children’s has been delivering superior patient care while advancing new treatments through pediatric research. Seattle Children’s serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine. The hospital works in partnership with Seattle Children’s Research Institute and Seattle Children’s Hospital Foundation. For more information, visit www.seattlechildrens.org or follow us on Twitter or Facebook.

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