When I first saw Lashondia Palmer, 41, in Baptist Memorial Hospital’s intensive care unit, she looked as if she were in a torture chamber. On a special bed rotated at 180 degrees, she was facing the floor, with a dozen black belts and blue pads strapped to hold up her body. Only her dark hair in cornrows was visible. A large tube exiting her mouth was attached to a ventilator machine that was pumping 100 percent pure oxygen at near maximum pressure.
“It was the most horrible sight,” her husband, Mianju Delk, recalled. “It broke me down … It was hard to hold myself together.”
Two weeks earlier, Palmer was busy holding down two jobs. When she developed fever, chills and a cough, she thought she could shake it off. On her second visit to the emergency room, she was airlifted from Starkville, Mississippi, to Memphis.
Palmer’s lungs had failed. Lung washings showed she had the H1N1 flu (aka swine flu), and Acute Respiratory Distress Syndrome, a severe form of inflammation of the lungs. With ARDS, half the patients do not survive.
The special bed, called “RotoProne,” had been the best hope of keeping her alive by rotating the body, taking pressure off the inflamed parts of her lungs, and getting oxygen to her brain and unborn baby. The 21-week-old fetus, too, was starving for oxygen.
During my initial examination of Palmer, I listened to her failed lungs. I was certain we were going to lose two lives.
I realized there was one hope for survival: a technique called ECMO, or extracorporeal membrane oxygenation, which can be used to bypass the heart and lungs. Recently, Baptist had become one of 148 centers in the country to provide this treatment.
Once before at Baptist, the team had placed a pregnant woman on ECMO. The baby survived, but the mother died from a brain hemorrhage, likely caused by the blood thinners required for the procedure.
Now Palmer was off the RotoProne bed and on ECMO with a large catheter piercing her neck. The line stretched nearly a foot into a great vessel alongside her heart with one bore hole in the catheter drawing nonoxygenated blood and another bore hole supplying fresh blood. “These tubes are like the mother’s umbilical cord supplying her with oxygen,” said Dr. John Craig, a cardiothoracic surgeon.
In essence, we had created a womb for the mother to allow the lung inflammation and stiffness to subside and normal lung function to recover.
Each day for two weeks, we monitored Palmer’s oxygenation, while the obstetricians monitored the fetal heart rate. The baby was not in any fetal distress. In fact, for much of the severe course of her illness Palmer too was sedated. “She woke up wondering where she was,” Delk said.
A “perfusionist” — a specially trained nurse-technician — minds the machine 24/7, in addition to the ICU nurse caring for Palmer. A dozen other doctors and nurses mind her kidneys, brain, heart, nutrition and the growing baby inside her.
The same week Palmer was hospitalized, a review paper was published on the successful use of ECMO in pregnant patients. Researchers reported on 45 pregnant patients across the nation, who on average were 26 weeks pregnant and required ECMO for nearly two weeks. In the study, nearly 80 percent of the mothers and 65 percent of the fetuses survived.
“This is beyond critical care,” Craig said. “What we were providing to the mother and baby is life supporting and life saving.”
I think it is more. It is life changing and life giving.
I often wonder what would have happened if there were no ECMO center, if there were no surgeon or if I had not made a call in sufficient time. Life is fragile, and something as simple and prevalent as the flu can go really badly. We only need to ask Lashondia Palmer, who will give birth to a healthy Christopher Palmer Delk in August.
Source: Commercial Appeal