May 22, 2013

$80 helmet makes lung transplant possible
Blending invention with necessity, UAB professionals use a little ingenuity to help a cystic fibrosis patient.

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Medical professionals at the University of Alabama at Birmingham took a new technology, added some ingenuity, inventiveness and a plastic helmet, and enabled a 29-year-old cystic fibrosis patient to get a life-saving lung transplant.

After waiting for a transplant for 11 months, Brandon Rylant’s lungs were failing. As 2012 wound to a close, Brandon could no longer expel carbon dioxide. An ECMO (extracorporeal membrane oxygenation) machine, a kind of heart-lung bypass device, could temporarily take the place of his lungs. The machine pumps a patient’s blood out of their body into a tube that passes it through the machine, removing carbon dioxide and adding oxygen. Another tube then returns the blood to the bloodstream.

A patient on ECMO has to be immobile in a hospital bed, tethered by tubes to the bulky machine. But Rylant’s UAB transplant team needed him to walk down the hall to prove he was healthy enough and build strength to undergo the transplant.

UAB had recently acquired two portable ECMO machines intended for uses including transporting a critically ill heart patient on the UAB Critical Care Transport air ambulance.

Only a few medical centers in the nation have reported using these miniaturized versions of the big ECMO machines as a means to keep a lung transplant candidate alive while awaiting transplant. UAB was the first in Alabama to try.

A portable ECMO machine is about the size of a microwave oven and sits on a small, wheeled cart. The tubes fed from an incision in Rylant’s neck to the machine; they had to be safely secured to ensure they would not come out. The first effort led the tubes up and over Rylant’s head secured by gauze, wrapped much like a turban. It was hot, bulky and nobody was very happy with it — time for some creativity.

UAB perfusionist Mat Tyndal thought he had a better option stashed among the gear stored in his basement, gear he uses for his mountain climbing hobby.

“I’m a climber and spend a good bit of time wearing helmets,” said Tyndal. “I thought maybe a climbing helmet that would securely encompass the head, tightened down and adjusted so it couldn’t slide around, would give us a firm foundation to put the tubing on.”

He brought in his old red helmet that had been to the top of 21,122-foot Mt. Illimani in Bolivia and the north face of the Grand Teton. After tightly fitting the helmet to Rylant’s head, a few pieces of Velcro secured the tubing to the helmet, and he was on his way. A small army of perfusionists, respiratory therapists and nurses escorted him on his first walk down the intensive care unit. Some pushed the ECMO cart, some kept a careful eye on the tubing, some simply provided a hand or shoulder on which Rylant could brace himself.

Only a few medical centers in the nation have reported using these miniaturized versions of the big ECMO machines as a means to keep a lung transplant candidate alive while awaiting transplant. UAB was the first in Alabama to try.  
“I likened it to choreographing a ballet, as there must have been fifteen of us assisting in the walk,” said UAB Chief of Perfusion Bobby Reed.

Spencer Melby, M.D., one of Rylant’s transplant surgeons, was one of many committed to the exercise.

“It took a bunch of people who were willing to put in the time, effort, coordination and organization to gather up all the machines and equipment and walk Brandon up and down the hall,” said Melby. “We agreed that we’d do what it took to keep him walking and mobile, so he wouldn’t be so far behind the eight ball that he couldn’t recover when donor lungs became available.”

Rylant was now taking daily walks with the helmet and portable ECMO. Ultimately, the team found an even better solution than the helmet to secure the tubing, using the frame of a surgeon’s headlamp. Teamwork and ingenuity led from necessity to invention.

“You have a lot of diverse people at UAB with different experiences, skill sets and even equipment at home,” said Tyndal. “We came up with an idea, and it worked. The helmet was the start of a solution that then led us to a better one.”

After two weeks of daily walks, Melby’s team got the word; lungs that were a match for Rylant were available from an organ donor in New Orleans. Melby flew to Louisiana to retrieve the organs.

On Dec. 12, 2012, Rylant got his new lungs.

“I’ve been great,” said Rylant at a follow-up visit at The Kirklin Clinic the following April. “I’ve been breathing better than I ever have in my whole life. My lungs are clear, and my breathing function keeps going up. My weight keeps going up, so everything is going good.”

The red helmet has been returned to mountain climbing duty, and perfusionists Reed and Tyndal are already using the portable ECMO machine on another lung patient – now with an even better head framework; UAB Orthotics designed and built a unique, custom-fitted flexible helmet for use with the ECMO machine. More invention, even better results.

As for Brandon Rylant, after eleven months in the hospital and two weeks on ECMO, he now walks just about everywhere he can.

“Now people have to wait on me because I enjoy walking so much,” he said. “I guess I get carried away.”
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