Every time you hear a bell....

...an angel gets their wings.

Recently I used that line in one of my posts about the NICU. It's a line from "It's a Wonderful Life", a movie that everyone should see at least once in their lives.

The blog I used it in was about an ECMO baby, and I've promised to tell you what that's all about from my perspective. It's more impression than fact, because I don't actively work with those babies; all I can give you is basic information and what I see and feel when I'm around those areas.

ECMO is an acronym for Extracorporeal Membrane Oxygenation. If you have to say that to folks all the time, it's easy to see why it's been shortened to ECMO.

ECMO, simply put, is a state of the art heart and lung machine. It's job is to provide relief for children who have been born so early that their heart and lungs are not fully developed. It can be used to let a heart heal after surgery. In short, it buys a little more time for a life that sometimes would otherwise be tragically short.

It seems as though we see ECMO babies in batches, or not at all. This last round we had three ECMO babies at the same time. Of those three, only one is still alive, and even yet, he alternates back and forth between Bay 1 and Bay 4. He's likely to remain fragile for a good many weeks yet. I've nicknamed him "Hoss"

We Lab Tech Vampires generally punch the clock in Critical Care Lab before heading upstairs. So, the word is given to us in CCL: "An ECMO baby came in tonight."

Generally, these words are accompanied by a huge sigh from the reporting party. Invariably, we all heave a big sigh of sadness and despair when we hear the news. It's not pretty at all - for anyone, even if your role is strictly on the periphery of things.

ECMO babies are put on massive amounts of steroids. Since steroids increase mass, the baby sometimes doubles in size. It's absolutely shocking to see a child who might, under "healthy baby" conditions be that nice armful, become a swollen and grotesque caricature of a baby. The baby I told you about recently who didn't make it had the size and appearance of a 30 pound newborn.

These babies are also on a ventilator to ensure that their lungs continue to expand and contract in some way as the pulmonary system rests and heals. So, first of all, the baby has a tube either through his nose or mouth which is hooked to the vent. The baby also has both an arterial line and a venous line attached somewhere on their bodies. Babies are given massive doses of heparin to make sure their blood is thinned to prevent potential damage from blood clots and to make sure that the machine itself can pump the blood smoothly through the babies' system.

On top of that, the babies are attached to heart monitors, and have a tiny blood pressure cuff wrapped around their leg. They also have IV lines in place, which may or may not be used for medications or blood products. The baby is generally clad only in a diaper, and sometimes the diaper isn't even fastened, but simply pulled up and around the necessary parts.

At BHTS, a nurse is assigned to that child only. And, an RT (respiratory therapist) is always in the room with the baby. They eat either in the room or just outside; the same goes for sleep. If something calls them away, another RT steps in to cover. You see the peds cardiologist and neurologist on the floor far more often. Both the RT and the nurse put so much effort into working with that child, they are usually exhausted far beyond what you'd think to expect. They develop bonds with that family of that child quickly and intensively; they are the support line for the family as well as the means to keep the life force going for the child.

The baby is put in the bed sideways, laying on their back. They are also elevated, usually at about a 30 degree angle. And, their bed is raised up to almost its highest level. A lot of the nurses are actually lifting their arms almost to shoulder height in order to draw blood for us. But, this is necessary because of the tubing system that works with the ECMO machine.

ECMO babies have their blood checked constantly. How often depends on the condition of the child, but it's usually every hour. We collect two syringes from the nurse; one is an arterial sample and the other is a venous sample. Other labs are taken periodically, too. A constant watch must be done on blood counts, liver functions, etc. ECMO babies can generally be expected to have blood transfusions.

The hope with most ECMO babies is that they will be on the machine for approximately five days. Of course, this depends on whatever factor caused the child to be placed on ECMO in the first place.

If things don't go well, there is a lot of weeping. It hurts to see these little ones fight for life and lose the battle. But, as awful as it may sound, within that weeping are tears of joy that this child is at peace once again. Those that don't make it...well...let me bluntly say that God/dess is merciful and loving to take these children back to a place where they can be happy and healthy once more. That would not be the case had they remained with those who loved them in this plane.

Hoss is, so far, one of the Warrior Babies who have made it off ECMO. He's still hooked up to a vent, and has IV lines hooked up, but he's been detached from almost everything. He's not out of the woods, yet, but each day brings more improvement.

Hoss is slowly returning to normal baby size; he's being weaned off the steroids. He's also learned the sympathy ploy. He is a good boy when we go in to do a heelstick on him; he jumps when the lancet bites, and fusses a wee bit, but tolerates it pretty well...

...unless his mommy is there. Then, as soon as we walk into the room, he winds up, letting Mommy know that these people ARE GOING TO HURT HIM. And he cries and bellows and kicks and shows true Academy Award potential for Best Actor in a Dramatic Series.

He's got the routine pegged, too. As soon as he feels the bandaid being placed on his heel, he turns it off - just like that. After Mom saw the act a time or two, she just rolls her eyes and mutters something that sounds vaguely along the lines of "just like his father..." and we all pretend that we didn't hear a thing.

Dean told me that he recently saw one of the first ECMO babies he'd ever dealt with. She's three or four years old now, perfectly healthy and normal and according to Dean, is an absolutely stunning child. He says he'd never have had a clue about her rocky start had he and the child's mother not recognized each other. It's good to hear about those things. Knowing about the successes makes it easier to have and to give hope when we need it.