Fueled by over-the-counter cold and flu medicines, Scott Ranahan soldiered to work at the local ship yard, shrugging off his nagging cough and difficulty breathing.
An avid runner and weightlifter, the 52-year-old Everson man wasn’t about to let a little flu bug get the better of him.
“I’ve never been sick, never been bedridden and no thermometer has ever been in my mouth,” he said in a telephone interview.
In addition to his pride, the December 2016 holidays were on his doorstep. He wanted to partake in all of the festivities.
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On New Year’s Day 2017, fighting his wife at every turn, she convinced him he needed medical attention and drove him to St. Joseph hospital in Bellingham. He barely arrived before doubling over, as one of his lungs had nearly collapsed. He was intubated and put into a medically induced coma, he said.
Unable to breathe on his own, he was kept alive by extracorporeal membrane oxygenation, known as ECMO, from Jan. 2 until Jan. 16, according to the hospital’s ECMO coordinator. His wife remained vigil by his side.
“I had no idea I was that sick,” Ranahan said.
ECMO is a type of cardiopulmonary bypass, in which a machine, similar to that used during open-heart surgery, will take over the function of a patient’s heart and/or lungs when their own organs are too sick to do the work, according to Dr. M. Cristy Smith, associate medical director for mechanical circulatory support. She oversees the ECMO program.
This temporary treatment gives time for the body time to heal. ECMO is also referred to as extracorporeal life support or just “bypass.”
ECMO is only available at healthcare centers with clinicians specially trained in this procedure, Smith said. They can provide the best care possible for the patient and family before, during and after the procedure.
ECMO, according to Smith, is performed on patients who:
▪ Have good brain function.
▪ Have reversible heart or lung illness.
▪ Cannot deliver enough oxygen or remove enough carbon dioxide from their blood on their own.
▪ Have not responded to other treatments, including conventional mechanical ventilation.
The life-saving device ensures the patient’s body receives enough oxygen while removing carbon dioxide. It also gives the affected organs a break from work so they can rest and heal, according to Smith. ECMO does not directly heal the sick organs.
ECMO also may be used to support people with heart or lung disease that cannot be cured while they wait for an organ transplant.
While the procedure saved Ranahan’s life, it is not without side effects.
Whenever large catheters are placed in patient’s veins and arteries, there is risk of bleeding and infection, according to Smith. Large catheters also have a risk of causing clots. For this reason, all patients on ECMO are placed on blood thinning medication, called heparin. This further increases the risk of bleeding.
Blood clots or air bubbles can enter the blood, which can cause injury to other parts of the body such as the legs, arms or brain.
Infection is a risk, Smith said. Patients are monitored closely for signs of infection and treated with antibiotics if necessary.
“My journey was waking up,” Ranahan said. “When I woke up, I was paralyzed. I had to learn all of my motor skills, again.”
He said he was forced to resort to infantile exercises of playing with rattles and Lego pieces.
“You go in one way, and you come out a different man,” Ranahan said.
More than a year later, he is back at work, but life is not the same. He lives with memory loss, imbalance, a sleep disorder and has been in counseling.
Ranahan said he suffers from post-intensive care syndrome, which is made up of health problems that remain after critical illness. They are present when the patient is in the ICU and may persist after the patient returns home.
“There needs to be some sort of help for us,” he said. “They say it has aged me. I can’t have that. I have the lung capacity of a 65-year-old and am in the early stages of dementia. You have got to be kidding me. It’s my drive that gets me up every day.”
Questions about ECMO
How long can someone stay on ECMO?
That is a complicated question. Due to the risks of ECMO, doctors try to keep patients on ECMO for as short a time as possible. Often patients will be on ECMO for several days or up to two weeks. Every day, several blood and imaging tests are done to determine if a patient is ready to come off ECMO. As the technology of ECMO improves, side effects should decrease and patients can remain on ECMO for longer periods of time.
What is the difference between ECMO and a ventilator?
Both ECMO and a ventilator aim to provide oxygen to the body when the patient’s own lungs and breathing are failing. The ventilator assists the patient’s own lungs by pushing oxygen with pressure into the lungs. ECMO instead provides oxygen directly via a catheter placed in a patient’s vein or artery.
Doctors almost always try oxygenating a patient with a ventilator first. However, when a patient’s lungs are too sick for this, they turn to ECMO to assist in providing oxygen to the body.
V-V ECMO provides oxygen through a vein. This blood then has to travel to the heart and be pumped around the rest of the body through arteries. Therefore, with V-V ECMO or with a ventilator, a patient must have a well-functioning heart to get the oxygen pumped throughout the body.
V-A ECMO has the additional advantage of pumping blood directly to arteries. This “by-passes” the heart and is therefore the method of ECMO we use when a patient’s heart is failing. It is not used routinely because there are greater side effects with V-A ECMO.
What daily tests need to be done for someone on ECMO?
Patients on ECMO are constantly monitored. They require continuous monitoring of their vital signs, including their blood pressure and oxygen levels. In addition, they require blood tests each day. They must be tested for anemia, since normal blood counts are essential for ECMO to work best.
The team also will look for signs that certain organs are receiving enough oxygen. Kidney function should be checked every day. Each day a patient should have a neurological exam to ensure he/she is receiving enough oxygen delivery to the brain.
Arms and legs must be examined also to make sure oxygen is traveling to all four limbs and that there have been no complications from a catheter insertion.