Tuesday, October 25, 2011

ECMO - A Closer Look

Let us say that the last thing you want as a parent is a room full of specialists who are puzzled and busily chirping about a phenomenon they haven't seen before.  Again, Brandi walked in on a conversation that was already midway which took her breath away.  Jordan's heart rate dropped last night to very low levels.  This, of course, raises great concern under normal circumstances.  On ECMO though, it is a little different because the circuit is handling the work.  They control the flow, the oxygenation, the pressures - it even controls the temperature of the body by warming or cooling the blood.  Last night, they modified the flow and it seemed to bring his heart rate back up.

Jordan's heart rate dropped again today.  They haven't seen a child's heart rate drop so much on ECMO before.  Baffled by a new experience, 8 or 9 individuals were discussing what the cause could be.  Some were concerned and some were not worried.  But, we got to see their expertise at work.  The team discussed options and came up with theories.  Jordan's vitals all look great with the exception of the heart rate.  The main theory at this time is that the cannulas - the plastic tubes inserted into Jordan's neck - are stimulating nerves in the neck that can affect the heart rate.  They are running some tests to see if this theory is correct.  Jordan's heart rate was good before they put him on ECMO - so, they are hoping this theory is correct.

Leave it to our son to make things more exciting for us.  We had no issues with our heart rates during this conversation.  We have had so many questions about ECMO.  The pictures below show Jordan on ECMO.  Two large cannulas are inserted in Jordan's neck.  One takes the blood out of Jordan's body before it enters the heart.  The blood is oxygenated and put back into his blood stream to be pushed out to the rest of his body.

Jordan on ECMO - 6 days old
They were worried at first that Jordan may be having seizures.  Further testing has shown that not to be the case.  Basically, they have discovered an incidental finding by Jordan being on ECMO.  By the way, the technician that is monitoring our son started with ECMO in 1989 at CHOP - testing it on sheep!

Jordan Receiving EEG Testing - 6 days old
Update: They think they have proved their theory - they added a medicine that stimulates the heart rate and Jordan's heart responded.  The cannulas in the neck are stimulating nerves in the neck that affect the heart rate.

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