Without a fully functional heart and lungs, a patient’s life expectancy is greatly reduced. Consultants at RB&HH Specialist Care are working hard to improve patient survival through an innovative life-support technology called ECMO.
ECMO (extracorporeal membrane oxygenation) is a life-support machine which can replace the function of the heart and/or lungs. It is used for patients suffering from life-threatening conditions which cause these organs to fail, giving healthcare teams precious time to treat the underlying cause.
“Quite often, there are conditions that are entirely treatable which a patient can recover from – such as severe lung infections. But the infection may be so extreme that a patient can’t survive the recovery period, even with a ventilator. They need something that can take on the burden of oxygenating their blood until their lungs can do it again,” says Mr Richard Trimlett, consultant cardiac surgeon at RB&HH Specialist Care.
Royal Brompton Hospital is one of only five centres in the UK that offers ECMO services and Mr Trimlett explains that there are two main types:
Continuously improving survivial rates
Respiratory ECMO currently has excellent outcomes, with four out of five patients surviving. Mr Trimlett explains why: “The path to referral for respiratory ECMO is simpler. All sick patients needing ECMO are on a ventilator in intensive care, they are already being supported. We come in to help when the ventilator is not providing enough oxygen to sustain the patient.”
Royal Brompton Hospital is the largest of the five centres in the UK for respiratory ECMO and has the best results in terms of survival – just over 80 per cent, treating over a hundred patients a year.
Referring for cardiac ECMO tends to be a little more challenging. As heart failure happens more quickly and often without warning, it can be difficult to identify a patient in time to enable them to benefit.
However, Mr Trimlett explains that ECMO can make a big difference for these patients: “If we can get to them in time, it essentially stops the clock, enabling us to determine why the heart has stopped working and what we can do about it.”
“The survival rate for cardiac ECMO is lower at 56 per cent. Although we are pleased with this result – as it is improving a patient’s chance of surviving from close to zero without ECMO, we are continually researching ways on how we can improve it. In fact, we have the best published results of any centre.”
Mr Trimlett and his team are now trying to work with other hospitals to identify patients with heart failure sooner, so that they can have the best chance of surviving. As 150,000 people are lost from heart failure in the UK each year, Mr Trimlett feels ECMO will be a gamechanger in the field of cardiology.
Further, he describes the scale at which the use of this technology is growing: “Seven years ago, we had very few referrals for ECMO due to limited awareness. Now, we serve 45 hospitals. It’s great to see that healthcare teams are recognising this important way of sustaining the lives of their patients whilst they are being treated and how much trust there is on our services.”
Patient case study
We have many survivors - one was a young 20-year-old girl from Brighton. We happened to be in the A&E department at Royal Sussex County Hospital providing ECMO cover for the Brighton Marathon, when she came in.
She was in a very poorly state and suffered from a cardiac arrest. She was treated with adrenaline to try and re-start her heart, but it didn’t work. So, we stepped in and put her on cardiac ECMO.
Whilst we were supporting her, diagnostics revealed that she had a benign adrenal tumour which was causing the release of excessive amounts of adrenaline into her bloodstream and caused her heart to fail.
We treated her with phentolamine to counteract her high adrenaline levels and her heart managed to recover – at which point we took her off cardiac ECMO. Once her condition was under control, she had an elective operation to remove the tumour and was completely cured.
We are pleased to say that she managed to return and complete her studies at the University of Brighton with our help. We hope that one day, this will be the norm for all patients with heart failure.”
– Mr Richard Trimlett
Mr Richard Trimlett
Consultant cardiac surgeon
Mr Trimless specialises in cariothracic surgery. His main areas of interest are mechanical circulatory support and the use of robots in surgery.