ECMO Adult | Victor Carlos knew he didn’t feel like himself. In early December, he thought he had nothing more than an annoying common cold. But then came the cough that wouldn’t go away, accompanied by chills and fever, shortness of breath, and a loss of concentration. He started bumping into things.
He was diagnosed with an influenza infection – he and wife Brenda Voglewede had gotten their kids vaccinated, but not themselves. When Carlos reported his worsening symptoms to his internists, he was twice told he’d need to ride it out.
That didn’t seem unreasonable. The 41-year-old Carlos was in otherwise good health and was unusually fit. He’d completed three marathons between 2010 and 2012.
But Voglewede knew something more was wrong. Carlos couldn’t perform simple addition. He felt panicky about the shortness of breath and was so weak he couldn’t attend his daughter’s gymnastics meet. He talked mysteriously to Voglewede about taking a spelling bee.
“I looked him straight in the eye and I could tell something was wrong,” she said. On the evening of Dec. 15, she contacted another physician, reporting that Carlos’s fingernails were purple, a sure sign of oxygen deficiency.
Hearing that, the physician told her to take Carlos to the emergency department – now – and called ahead to University of Colorado Hospital to alert the ED staff to be ready for them.
What followed was a long, strange and very bad trip, one from which Carlos has only recently emerged, thanks to a quick emergency response and a last-ditch rescue effort using technology that saved his life. Carlos spent four weeks on an ECMO (extracorporeal membrane oxygenation) machine that supplied oxygenated blood to his failing organs while his badly damaged lungs recovered from the trauma caused by infection.
Cardiothoracic surgeon Ashok Babu, MD, who performed the ECMO surgery, succinctly summarized Carlos’s condition when he arrived at UCH. “He was near death,” Babu said.
That quickly became evident to ED staff. Carlos slumped weakly over the security desk and needed a wheelchair to get to an exam room. Anything below a 90 percent blood oxygen saturation rate is considered low. A pulse oximeter showed Carlos’s was 57 percent.
Providers placed a tightly fitting facemask on him to bring the oxygen level up, but within an hour they had to intubate and ventilate him. Staff rushed him to the Medical Intensive Care Unit (MICU) to monitor him.
By 12:30 a.m., an exhausted Voglewede was home, unable to sleep. The phone rang soon thereafter, the voice on the line telling her that even with the help of a ventilator Carlos’s oxygen saturation was at a still dangerously low 70 percent.
When she heard the word “ECMO,” she thought she heard “echo,” wondering why the hospital wanted to treat her husband’s respiratory failure with a picture of his heart. She called her brother-in-law Chris, a fourth-year medical student at Case Western Reserve University School of Medicine in Cleveland, who explained ECMO. Chris immediately jumped on a plane to fly to Denver.
Babu also outlined the procedure, explaining that ECMO could give Carlos a 40 percent to 50 percent chance of survival, odds that seemed pretty good given his almost certain death without it. In the midst of all this, Voglewede, who also had contracted the flu and was running a 103-degree fever, wound up in the ED herself, hooked to an IV and receiving antibiotics. When providers found a cloudy, pie-shaped section on X-rays of her right lung – a sign of pneumonia – they admitted her to the hospital.
Not that Carlos was aware of any of this. Babu performed surgery, inserting a cannula and two tubes in his jugular vein and hooking him up to the ECMO machine. Pumps sucked deoxygenated blood to an oxygenator that exchanged carbon dioxide and oxygen. The now bright-red blood returned through the vein to be pumped to Carlos’s oxygen-starved organs.
He spent 27 grueling days on ECMO in the Surgical ICU. “It felt like I was dreaming,” he said. “I was in and out of sedation.” He gave hand squeezes and vague signs of recognition, said Voglewede, who had recovered, but became fully cognizant only in the last five days of the ordeal. At the end of the third week, he was able to stand, still attached to the device.
Even with ECMO support, Carlos had to go on dialysis for a time to treat the effects of renal failure caused by oxygen depletion and the severe infection. A ventilator kept his upper bronchial tubes open for several days.
Sitting in his bed on the 10th floor Cardiology Unit early last week, Carlos was weak but in good spirits. He was looking forward to transferring to the Rehabilitation Medicine Unit – which happened later in the day – to work with physical therapists. “They’re badasses,” he whispered with a small smile.
Babu said he anticipates Carlos will go home this week. It might take as long as a year for Carlos to regain normal lung function, Babu added, but he expects it will happen.
Whatever the outcome, Voglewede and Carlos were outspoken in their gratitude to Babu and the entire hospital team that provided care. Babu, they said, visited every day. “He put our minds at ease,” Voglewede said, “and made us feel confident that Victor would get better. And the ICU staff was incredible. They were constantly aware, kind and invested in his recovery.”