Tuesday, August 02, 2011

University of Kentucky pioneers use of life-saving device for lung transplantation

By Cheryl Truman kentucky.com
"With all my heart, I think the ECMO machine saved my life to where I could get through to a transplant,"

Ernie Gillispie might not understand the elaborate mechanics that got his body strong enough to withstand a double-lung transplant. They delight him nonetheless.

Gillispie could walk only a few feet in February. Now, the former coal miner and black lung sufferer from Pike County, who was thought too sick to be placed on the transplant list, can walk two miles at a time.

Gillispie, 68, is the first patient to undergo a process being pioneered at the University of Kentucky Chandler Hospital that can save the lives of patients who previously would not have been healthy enough for lung transplants.

The technology raises life-saving possibilities for Kentuckians, where the Centers for Disease Control lists respiratory disease as the fourth leading cause of death, with 61.3 deaths per 100,000 citizens each year, well ahead of the national average. Heart disease is the leading cause of death in the state, followed by cancer and stroke.

The underlying technology that helped bridge the time between black lung nearly killing Gillispie and a double-lung transplant is a long-used strategy called ECMO — extracorporeal membrane oxygenation. In this case, the treatment came with an extra twist that moves the medical field toward the day when such devices will be true mobile artificial lungs.

The enhanced ECMO device, implanted at UK, allowed Gillispie to walk and exercise, strengthening his body enough that a lung transplant became possible.

Gillispie was diagnosed with black lung in 2004. By the time he met UK transplant surgeon Charles Hoopes in February, Gillispie was using a wheelchair while Vanessia, his wife of nearly 34 years, shopped for a specially equipped vehicle to transport her husband.

"You lose every bit of your air," Gillispie said of the damage wrought by black lung. "It's like putting your hand over your mouth and trying to breathe through it."

For most patients with lungs that damaged, little could be done. But Hoopes had other ideas, and the Gillispies pleaded with him to try them on Ernie.

"I just barely could exist," Ernie Gillispie said.

Regional transplant center

By the time many lung disease patients appear at UK's transplant clinic, they might be in such bad shape that traditional transplant techniques are impossible.

Enter the enhanced ECMO, an artificial lung of sorts. It works by freeing patients from their decaying lungs and allowing them to become more active.

Joseph "Jay" Zwischenberger, chairman of UK's Department of Surgery, and a partner recently received a patent to improve the ECMO's performance with a two-channel catheter.

Previously, adult patients on ECMO were confined to bed, where they grew even weaker. But ECMO used with Zwischenberger's device — the Avalon Elite Double Lumen Canula — allows the patient to use a smaller, simpler heart-lung machine, which makes movement and even exercise possible.

Zwischenberger describes his design as simpler but more efficient.
Since Gillispie's mobile ECMO-assisted transplant on April 11, three other patients have undergone the procedure.

The combination of Zwisch enberger's innovation combined with the surgical skills of Hoopes — a recent hire from the University of California at San Francisco — is making UK a regional destination for such transplants, said Michael Karpf, UK's executive vice president for health administration.

Zwischenberger called Hoopes "a game changer" for UK's hopes to grow its business in solid organ transplants.
"There are Kentuckians who because these folks are here will get transplants that would not have received transplants," Karpf said.

Hope for lung patients

Gillispie described living with black lung as trying to breathe through an opening the size of a coffee stirrer.

The outlook for sufferers is often as dark as the holes in the earth where they dug for coal.

But Gillispie's story ends differently. At a checkup Wednesday, Vanessia Gillispie described her husband's lungs as "pristine." He scored well above normal on lung capacity.

That is a dramatic turnaround from Gillispie's previous medical situation.

Less than six months ago, Hoopes had told Gillispie a cold truth: Gillispie probably would never make it to a lung transplant. Gillispie was not surprised.

Then Hoopes mentioned something that Gillispie had never heard of, a machine that would help him breathe and perhaps strengthen him enough for the transplant.

Gillispie knew he had run out of other options. Sure, he said, he'd try it. The mobile ECMO was inserted. Two hours later, Gillispie was riding a stationary bicycle. A few days later, he had his transplant.

For Gillispie, the UK transplant technique means the difference between living a severely limited life and being able to take a stroll whenever he likes. It means he will be around for his three children and three grandchildren.

He won't be mowing the lawn this year or tending his roses, but those things can wait until he is healed more completely.

"With all my heart, I think the ECMO machine saved my life to where I could get through to a transplant," he said.

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