NYPH/Columbia's ECMO and Lung Transplant teams have reported the best survival rates to date for ECMO-supported bridge to lung transplant.
Patients waiting for a lung transplant may develop severe respiratory failure while on the transplant waitlist and require mechanical ventilation. Traditionally, such patients rapidly become too sick and deconditioned to tolerate a transplant and they are soon removed from the waitlist.
The Columbia program is considered a leader in the field and has pioneered the use of extracorporeal membrane oxygenation (ECMO) as an artificial lung to temporarily support patients with severe respiratory failure. In many cases, ECMO provides adequate support without the need for mechanical ventilation, and sometimes even allows patients to get out of bed and exercise. This permits them to maintain or even improve their physical conditioning rather than allowing it to worsen, greatly increasing the likelihood that they will be successfully transplanted.
Results of experience at NYPH/Columbia were published in the Journal of Thoracic and Cardiovascular Surgery July 13, 2012.
Daniel Brodie, MD
Matthew Bacchetta, MD, MBA, MA
Center for Acute Respiratory Failure Opens at NewYork-Presbyterian/Columbia
NewYork-Presbyterian Hospital/Columbia University Medical Center has officially launched the Center for Acute Respiratory Failure, which offers expertise in using lung bypass technology to help adult patients whose lungs are rapidly shutting down. Already one of the largest centers in the world for respiratory as well as cardiac failure in adults, NewYork-Presbyterian/Columbia is expanding further due to its new ECMO program.
Extracorporeal membrane oxygenation (ECMO) can take over the function of the lungs in adults with acute respiratory distress syndrome (ARDS) to give severely damaged lungs time to rest and heal. The ECMO program has improved the techniques used for delivering ECMO in adults and has developed a novel mini-ECMO unit that can be used to transport critically ill patients to the Center.
While ECMO is used at other centers, very few hospitals in the world treat as many adult patients with ECMO. NewYork-Presbyterian/Columbia treats about 70 a year, and that number is growing. More unusual in the U.S. is the team's ability to travel to area hospitals, place patients on their adapted ECMO unit, and transport them to the Center. This allows the team to bring patients into NYP/Columbia who would otherwise be too sick to be transported by ambulance, so that they can receive ECMO and other advanced respiratory care.
Co-directed by Daniel Brodie, MD, and Matthew Bacchetta, MD, the program's innovative use of ECMO has been highly successful: every adult ECMO patient has recovered and is now thriving. Click here to read their stories, and learn about the Center for Acute Respiratory Failure here.
Daniel Brodie, MD
Matthew Bacchetta, MD, MBA, MA
Drs. Brodie and Bacchetta publish review article on ECMO in NEJM
November 17, 2011: Daniel Brodie, MD, and Matthew Bacchetta, MD, Co-directors of the Center for Respiratory Failure at NewYork-Presbyterian/Columbia, have published an important review article about ECMO in the New England Journal of Medicine. The article details how extracorporeal membrane oxygenation (ECMO) can take over the function of the lungs in adults with acute respiratory distress syndrome (ARDS) to give severely damaged lungs time to rest and heal.
In addition to improving ECMO techniques in order to reduce side effects, Drs. Brodie and Bacchetta have also devised a mini-ECMO unit that can be used to transport critically ill patients to the Center. These advances represent a dramatic improvement in the treatment of patients with ARDS, which can be associated with high mortality rates. To date, every patient treated by the new ECMO program has recovered and is now thriving. According to Dr. Brodie, "Evidence is accumulating that referring patients with severe respiratory failure to a center capable of performing ECMO is beneficial for these patients."
Learn more about the new Center for Acute Respiratory Failure here.
- May 25, 2011
NewYork-Presbyterian Hospital campuses collaborate to use ECMO, saving patient's life
Extracorporeal membrane oxygenation, or ECMO, can provide respiratory and cardiac support during severe respiratory illness. The ECMO machine directly oxygenates the blood, providing an opportunity for the lungs to heal. Importantly, it avoids damage to the lungs that can be caused by use of a ventilator, which forces air into the lungs with pressure. Watch this video of Jay Shiland, who underwent ECMO treatment at NYP/Columbia and recovered from a severe case of what was believed to be pneumonia.
Funded by the National Institute of Neurological Disorders and Stroke (NINDS), this international, multicenter clinical study is evaluating the effectiveness of thymus gland removal (thymectomy) as a treatment for myasthenia gravis. The trial commenced in 2006 and has an expected completion date of August 2010. Joshua Sonett, MD, Chief of Thoracic Surgery at Columbia, is the surgeon for the Columbia site. Alfred Jaretzki, MD, Professor Emeritus of Clinical Surgery at Columbia is a member of the trial's Executive Committee, and in this role is an author on two articles regarding the study.
ECMO Lung Support Improves Patient's Health, Making Way for Lung Transplant
The December 14, 2009, USA Today ran an article about Liesbeth Stoeffler, a cystic fibrosis patient who received lifesaving lung support with a device called ECMO (short for extracorporeal membrane osxygenation). According to the USA Today article, ECMO enabled Ms. Stoeffler's doctors Matthew Bacchetta, MD, MBA, MA, and David Lederer, MD, to remove her from the ventilator, thereby improving her health so that she could maintain eligibility for lung transplant, which she received at NYP/Columbia on July 20, 2009. The ECMO gave Ms. Stoeffler's lungs relief from the ventilator, improving her oxygen and carbon dioxide levels, ultimately bridging her to transplant. According to the article, Ms. Stoeffler's doctors pared down her ECMO equipment and she was able to take liquids and food, which helped her gain weight and strength. She could eventually sit up, talk and even use her laptop and iPhone. "About five days into it, she told me it was the best she'd felt in years," Dr. Bacchetta said.
Ventilators may cause damage to the lungs because they push air into the lungs. ECMO, short for extracorporeal membrane oxygenation, directly oxygenates the blood, and does not cause lung damage. Patients may move around, eat, and even undergo pulmonary rehabilitation while on ECMO. Doctors at Columbia have been using ECMO technology as both a bridge to transplant and a bridge to recovery, using it to treat patients with H1N1, pulmonary fibrosis, COPD, cystic fibrosis, and pneumonia.
Watch an interview with Ellisabeth Stoeffler and her physicians.
After visiting the emergency room with fainting spells and shortness of breath, a 17-year-old Morningside Heights boy was diagnosed with rare, life-threatening blood clots blocking his pulmonary arteries. Matthew Bacchetta, MD, MBA, MA, led a complex, eight-hour open procedure to remove the clots, in which surgeons stopped the patient's heart, hooked him up to a heart-lung bypass pump, and cooled him to 18 degrees Celsius, or 64 degrees Fahrenheit, in order to reduce his body's need for oxygen. They then opened his pulmonary artery, shut off the bypass pump in order to eliminate blood flow, and removed several large branching clots. The process was repeated for each artery. Dr. Bacchetta learned the technique of PTE surgery at the University of California at San Diego (UCSD), where it was developed.
Columbia Offers Innovative Surgery for Chronic Pulmonary Emboli
A new Columbia program led by Matthew Bacchetta, MD, MBA, MA, is offering patients an innovative procedure known as pulmonary thromboendarterectomy (PTE) to clear the pulmonary arteries of chronic blockages. Columbia is the only center in the eastern U.S. currently offering the procedure. Ongoing blockage of the pulmonary arteries occurs when thrombus, or blood clots, build up in these vessels, inhibiting or blocking the path of blood flow through the lungs. The blockage may result in high pressure in the lungs (pulmonary hypertension), a condition known as chronic thromboembolic pulmonary hypertension (CTEPH). Depending on the size and location of the clots, CTEPH can dangerously reduce oxygenation of blood and weaken the heart.
Read more about pulmonary emboli and their treatment.
With the establishing of the Cecily and Robert Harris Pulmonary Diagnostic Center in 2007 and additional support from the Harris family during 2008, pulmonary specialties at NYP/Columbia consolidated evaluation, diagnostic, rehabilitation, and clinical consultation services into one suite and added sophisticated equipment and research capabilities. The latest addition to this full-service pulmonary facility is an opto-electronic plethysmography (OEP) system.
Navigating confusion and controversy about CT screening for lung cancer
Detecting a disease in its early stages usually leads to a better chance of successfully treating it. So should we all go out and have ourselves screened for lung cancer just to be on the safe side? While there are strong advocates of computed tomography (CT) screening for lung cancer, the American Cancer Society does not recommend screening as a routine test. We weigh in on the question, which turns out to be more complex than one might expect. The Columbia High-Risk Lung Assessment Program uses an algorithm-driven approach to provide comprehensive, thorough care to patients with known risk factors for lung cancer.
Columbia's Center for Chest Disease tests new devices to treat advanced emphysema.
Lung Volume Reduction Surgery (LVRS) is the gold standard in treating advanced emphysema, and in addition to oxygen therapy, the only treatment shown to prolong survival. NewYork-Presbyterian Hospital/Columbia University Medical Center has been a leader in LVRS since 1994, with success rates of over 90%. In most cases, surgeons at the center perform LVRS using video-assisted thoracoscopic techniques through minimally invasive incisions. The procedure is very safe and effective, with no procedure-related deaths occurring at the center in over twelve years. To expand treatment options for more patients, the Center for Chest Disease is currently investigating two devices that could achieve LVRS-like results without surgery.
Columbia/NYP Lung Cancer Trial Targets Asbestos-Related Disease
NEW YORK (Jun 26, 2008) The Mesothelioma Center within the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital and Columbia University Medical Center is now recruiting patients for a clinical research study of a new targeted radiation and chemotherapy protocol for pleural mesothelioma, a cancer of the lung's lining that is almost always caused by previous exposure to asbestos. Co-investigators include Drs. Joshua Sonett, Mark Ginsberg, and Lyall Gorenstein.
Read the NYP press release. The release was picked up by Health Day News, in addition to the Atlanta Journal Constitution, the Austin-American Statesman, U.S. News & World Report, Forbes.Com, Health Central.Com, and Washington Post.com.
Dr. Ginsburg, LVRS, and Lung Disease Programs Featured in New York Times
The NewYork-Presbyterian/Columbia lung disease programs were prominently featured in a three-page spread in the November 28, 2007 New York Times about lung disease and chronic obstructive pulmonary disease (COPD).
The Section of General Thoracic Surgery's lung volume reduction surgery (LVRS) program took center stage in an article on surgical treatments for COPD. The article included photographs of a recent lung volume reduction surgery performed by Mark Ginsburg, MD and an NYPH/Columbia surgical team. Patricia A. Jellen, a nurse at the Center for Chest Disease at NewYork-Presbyterian/Columbia, was also interviewed andphotographed.
In a separate article, on women and lung disease, Dr. Byron Thomashow, director of the Chest Disease Center, was quoted about how COPD, while often-overlooked, can be properly managed through the appropriate use of medications and exercise. He was featured in an accompanying article offering advice on symptoms of COPD, and also answered reader questions on NYTimes.com.
Every year, hundreds of thousands of people are diagnosed with lung cancer, mesothelioma, emphysema, or another serious lung disease. A new program at Columbia University Medical Center aims to turn the tide on both genetic and acquired lung diseases by helping people who are at high risk to get the care they need in the earliest stages of disease progression. New this year, the High-Risk Lung Assessment Program is directed by Joshua Sonett, MD, Chief, General Thoracic Surgery.
Alandmark study in The New England Journal of Medicine has shown that early detection of lung cancer can favorably change outcomes (2006;355:1763-1771). The study, a multinational collaboration published under the auspices of the International Early Lung Cancer Action Program (I-ELCAP), was initiated by Weill Cornell investigators at NewYork-Presbyterian Hospital under the direction of Claudia I. Henschke, MD, PhD, principal investigator. Dr. Henschke also chaired the Writing Committee of I-ELCAP; the other members were David Yankelevitz, MD, Daniel Libby, MD, Mark Pasmantier, MD, James Smith, MD, and Olli Miettinen, MD, PhD. From the initiation of I-ELCAP, Columbia investigators led by John Austin, MD, have been key collaborators.
Dr. Sonett Receives Humanitarian Award
Chesed of New Square in Spring Valley, New York has presented Joshua R. Sonett, MD, with its 2007 Chesed Humanitarian Award for excellent medical/surgical care in the Rockland community. Chesed of New Square is a community service organization dedicated to facilitating access to medical care for members of the Rockland community.
Dr. Sonett featured in The New York Times
Dr. Joshua R. Sonett, Associate Professor of Surgery and Director, Lung Transplant Program, was featured in a February 16, 2005 New York Times article, "Linked Forever by the Ultimate Gift: One Woman's Death Provides Life for Another," by Marc Santora. The article delved into the path of a lung transplant, from the family's decision to donate to the transplant operation and the recipient's recovery.
Until recently, Ramona Gomez, a 39-year-old insurance consultant from Rockaway, New Jersey, had to offer her clients hugs instead of handshakes because of her pronounced fear of one thingher sweaty palms. "I could literally hold my hand parallel to the ground and you could see the sweat drip off of it," explains Mrs. Gomez.
In her early 20s, Mrs. Gomez found some initial answers. She learned that she had a medical condition known as hyperhidrosis, which literally means excessive sweating.
A 31-year-old attorney from West Orange, New Jersey, who asked that his name not be mentioned in this article, thought he had an anxiety problem when he would sweat excessively in the courtroom. "I thought it was just me, that it was a simple case of suffering from lack of self-confidence or nerves," he says. But there was one problem with that assumptionhe was not feeling nervous; he was feeling perfectly confident. So, why was sweat trickling down his forehead every time he had an audience? The attorney began a personal journey to get to the bottom of a case that had remained a mystery for years.
Most people haven't heard of hyperhidrosis and, once they do, they'd probably never guess what the word means: excessive sweating. About 1% of adults suffer from hyperhidrosis, even though many of them don't even realize it. However, there is one dead give-awaysweat, and lots of it.
A 27-year-old graphic designer knows the symptoms of hyperhidrosis all too well. For all of her life she has suffered from palmar hyperhidrosis, or sweaty palms. "As far back as I can remember, I've always had sweaty hands," she says. "They were always wet and cold, and just left me feeling uncomfortable. They would sweat from morning to tonight, for no reason at all; nothing would trigger it, not even temperature. Even in the freezing cold of winter, they were sweaty."
Results of the largest study of bilateral lung volume reduction surgery (LVRS) to treat severe emphysema indicate that, on average, patients who undergo LVRS with medical therapy are more likely to function better after two years compared to those who receive medical therapy only.
NewYork-Presbyterian/Columbia was the only New York facility to participate in this national study. The site directors were Mark E. Ginsburg, MD and Byron M. Thomashow, MD.