When 18-month-old Addison Gonzalez fell into a small hole in an open septic tank, she needed the most drastic medical intervention. Many septic tank injuries end in death, because toxic hydrogen sulfide fumes can be ruinous to lungs from the inside out. Gonzalez was put on a ventilator and soon airlifted to University Hospital where she would need even more intensive life support.
Extracorporeal membrane oxygenation (ECMO) has been around for decades, but used more in recent years to help the most desperate cases. It mechanically replaces lung and heart function to give the patient’s organs time to rest and heal. The ECMO machine acts as an artificial lung, pumping blood outside of the body, filtering out carbon dioxide and putting oxygen into blood, then pumping it back into the patient’s body at the same rate as their heartbeat. It’s a drastic effort that’s usually only deployed as the only fighting chance at survival.
ECMO involves a lot of tubes, 24/7 monitoring, and in Gonzalez’ case, uncharted territory. The team’s research didn’t find any cases where ECMO saved someone who had been exposed to hydrogen sulfide fumes. However, doctors determined that she would likely not survive without trying the most extreme treatment. She endured 27 days on ECMO and several more on a ventilator, and against the odds, this strong little girl is on her way to complete recovery.
University Hospital has had a fully equipped ECMO program since 2014. Dr. Veronica Armijo-Garcia is a pediatric intensivist at UT Health San Antonio and medical director of University Health’s ECMO program. Her team is discovering that not only can ECMO be used sooner to start heart and lung recovery faster, it can also be used to treat different kinds of pediatric patients for extended periods of time. For example, children with severe respiratory infections, as well as trauma, burns and high-risk births can all benefit from ECMO.
To more fully appreciate the implications and possibilities of ECMO treatment, the team has conducted exercises and simulation training with state-of-the-art equipment. They help ensure that each team member knows their roles down to the second when a critically ill child arrives. Putting innovation into practice can help improve outcomes in even the most dire cases.