Pasta for all: Abiomed Breethe extracorporeal membrane oxygenation system

Abstract

Central MessageAn ECMO device free of compressed gases has been developed to provide patients an opportunity for its use at home and during ambulation.See Commentary on page 114.More than 700,000 Americans died from heart-related causes in 1963. The high rate of 560 per 100,000 fortunately has dropped now by 68%. The concern for killer heart disease helped Michael DeBakey convince President Lyndon Baines Johnson to call for a National Artificial Heart Program. DeBakey treated LBJ, a chain smoker, who experienced his own first heart attack in 1955, and Johnson died in 1973 from heart failure at age 64 years. In the 66 years since, only recently have ventricular assist devices been used with expectations of reasonable survival and quality of life. The development of implantable hearts and single pumps has proven more difficult and costly than expected. Patients remain tethered to percutaneous drivelines, there is currently only a single commercially approved pump in the United States, and a total heart remains elusive. Similar development of an artificial lung has proven more difficult and followed progress of cardiopulmonary bypass developed to enable open heart surgery.Oxygenators and Artificial Pump–lungsEfforts to mechanically oxygenate and ventilate the blood evolved from need for short-term cardiopulmonary support of emerging cardiac repairs. John Gibbon's success on May 19, 1954, is well known to cardiac surgeons today (Figure 1, A). As a graduate of Jefferson, the Gibbon story is particularly motivating to this author (B.P.G).1Shumacker Jr., H.B. The Life of John H. Gibbon, Jr. Fithian Press, 1999Google Scholar It is sobering that in the same year, 17 out of 18 patients supported by early screen and disc film oxygenators died. In 1931, during his residency, Gibbon had observed a patient die from a pulmonary embolism.2Gibbon Jr., J.H. The development of the heart–lung apparatus.Rev Surg. 1970; 27: 231-244PubMed Google Scholar He later commented:“During that long night, helplessly watching the patient struggle for life as her blood became darker and her veins more distended, the idea naturally occurred to me that if it were possible to remove continuously some of the blue blood from the patient's swollen veins, put oxygen into that blood and allow carbon dioxide to escape from it and then to inject continuously the now-red blood back into the patient's arteries, we might have saved her life. We would have bypassed the obstructing embolus and performed part of the work of the patient's heart and lungs outside the body.”2Gibbon Jr., J.H. The development of the heart–lung apparatus.Rev Surg. 1970; 27: 231-244PubMed Google ScholarFigure 1Images of pioneers in the field of extracorporeal membrane oxygenation. A, Dr John Gibbon and his wife Mary “Maly” Gibbon with an early heart–lung machine in 1950s. B, Dr Willem Kolff attended a meeting wearing his wearable oxygenator. C, Dr Robert Bartlett holding an oxygenator developed in his laboratory for pumpless application.View Large Image Figure ViewerDownload Hi-res image Download (PPT)In 1965, during his training under Robert Gross, MD, at the Peter Brent Brigham, Bob Bartlett challenged himself to use prolonged postoperative cardiopulmonary bypass. He saw a need to rest the heart after surgery. He went to the lab to work on the problem of what his chief described as cardiopulmonary bypass being “lethal after an hour or 2 of use.”3Bartlett R.H. Extracorporeal life support: Gibbon fulfilled.J Am Coll Surg. 2014; 218: 3127Abstract Full Text Full Text PDF Scopus (20) Google Scholar His effort on early membrane oxygenators paved the way for his lifelong development of extracorporeal membrane oxygenation (ECMO). Advances leading blood pumps and membrane oxygenators have ECMO and ECMO to or now of ECMO in support of lung is the of lung failure is ECMO might a for to and support of lung has had years of support from the National and that more recently a to into a and a wearable of a wearab