In rare event, ECMO machine saves life of new mother with amniotic fluid embolism

ECMO, works by removing blood from the persons body and artificially removing the carbon dioxide and oxygenating red blood cells.

By JUDY SIEGEL-ITZKOVICH
Updated: AUGUST 19, 2015 09:25
Pregnant woman (illustrative) (photo credit: INGIMAGE)
Pregnant woman (illustrative)
(photo credit: INGIMAGE)
The Health Ministry will look into the possible encouragement of general hospitals to purchase ECMO -- extracorporeal membrane oxygenation -- machines like the one that has saved the life at of a new mother who developed a pulmonary embolism from amniotic fluid a few weeks ago, ministry officials promised The Jerusalem Post on Tuesday.
 
Until now, new mothers dying from such a cause has killed an average of two young women per year, and their deaths have been regarded by experts as nearly inevitable, as multiple system failure develops very quickly. An amniotic fluid embolism is most likely to occur during childbirth or immediately afterward, when the fluid that surrounds a baby in the uterus during pregnancy or fetal material such as hair enters the maternal bloodstream.
 
Doctors at Petah Tikva’s Rabin Medical Center-Beilinson Campus for the first time in Israel saved the life of a woman who developed such an embolism while undergoing delivery of her baby during cesarean section. After she was attached to the ECMO machine, which temporarily takes over for the heart and lungs that cannot provide enough gas exchange to sustain life; the machine may make it possible for these organs to recover. They also performed emergency heart surgery on the woman, according to Beilinson doctors. She has been disconnected from the ECMO machine and will soon begin rehabilitation.
 
This machine, which costs $60,000 to $70,000, has been used here and abroad mostly on children. One of the most famous cases in which it saved lives was at Jerusalem’s Shaare Zedek Medical Center, where two Jerusalem boys overcome by toxic fumes from the use of illegal pesticides were saved after their two sisters died. Shaare Zedek borrowed the ECMO from another hospital.
 
Shaare Zedek director-general Prof. Jonathan Halevy told the Post on Tuesday that it has ordered two ECMO machines of its own and will soon receive them. “We are in the middle of training our staff in their use,” he added. Halevy said that it has ordered two ECMO machines of its own and will soon receive them. “We are in the middle of training our staff in their use,” he added.
 
The ECMO, which is being used more abroad now in adults with cardiac and respiratory failure, works by removing blood from the persons body and artificially removing the carbon dioxide and oxygenating red blood cells. It is a life-sustaining intervention, and has been used for treating mothers with amniotic fluid embolisms in a few attempts carried out abroad.
 
Prof. Amnon Wiznitzer, chairman of the Women’s Hospital at the Rabin Medical Center’s two campuses, Beilinson and Hasharon, said that the rare complication endangered the woman’s life. We are proud to have saved her life,” he added.
 
Prof. Dan Aravot, head of the cardiothoracic branch at Beilinson, said: “This is one of the first cases in the world in which a new mother’s life was saved thanks to ECMO technology and the heart operation. I hope that as a result of this breakthrough, the lives of additional mothers will be saved.”
 
Rabin Medical Center director-general Dr. Eran Halperin added: “I am proud of the outstanding and unique abilities of the Beilinson teams proven by their technological achievement and the boldness of the doctors who did not hesitate to carry out an open-heart operation in a patient in critical condition. Thanks to that, her life was saved,” said Halperin.
 
After the embolism was discovered, she underwent resuscitation by senior anesthesiologists, gynecologists and cardiologists. Dr. Philip Biederman, head of Beilinson’s cardiothoracic surgery intensive care unit, connected the woman to the ECMO, and Aravot performed the complicated heart surgery to remove the huge embolism that clogged her lungs. Her condition improved significantly in the last week, the doctors said, and she was able for the first time since the embolism to breathe without help, sit in a chair and react to those surrounding her.
Over the weekend, she as shown a video film with photos of her healthy baby girl whom she had never seen. The family and medical staff were so moved that they burst into tears.
 
A pathology exam of the embolism confirmed the doctor’s diagnosis that it was amniotic fluid that had entered the mother’s lungs through the placenta.
 
In September, friends of the hospital will hold a fundraising event in Kfar Shmaryahu to raise funds to buy new lifesaving medical technologies.
 
Asked to comment, the Health Ministry said that there are just four ECMO machines in the public hospitals -- Beilinson, Sheba Medical Center at Tel Hashomer, Wolfson Medical Center in Holon and Emek Medical Center in Afula. The ministry said it “does not purchase special medical equipment [like the ECMO] for any public hospital,” and that responsibility for such purchases is that of the hospitals -- and government-owned medical centers sometimes get financial assistance from the ministry. Operating the ECMO is “complicated and requires a relatively large number of highly trained staffers working round the clock,” the ministry added.
 
While relatively few patients have needed the machine, the ministry conceded that with the new application for deadly amniotic-fluid embolisms, it will study the possibility of encouraging more hospitals to buy one.