ECMO keeps 10-year-old girl with severe COVID alive. What is it?

September 28, 2021
A 10-year-old girl from Conway named Tiera holds a teddy bear. Her mother asked that her last name not be used.
A teddy bear keeps Tiera company while the fifth grader from Conway, South Carolina, is kept alive by an ECMO machine. Photos by Sarah Pack

It was two hours of terror. While an ambulance rushed Delisha Bellamy’s 10-year-old daughter from a Myrtle Beach hospital to the MUSC Shawn Jenkins Children’s Hospital in Charleston, Bellamy drove the 100-plus miles on her own. “I was so scared.”

Her mind raced. How had COVID-19, which another of her children caught and quickly recovered from, taken such a toll on Tiera? The fifth grader was now so sick, unable to breathe on her own, that she needed a life-support machine called ECMO. 

But at least she had that option. There are only a few hospitals in South Carolina that offer ECMO, which stands for extra corporeal membrane oxygenation. MUSC is the only one in the Charleston area.

Dr. Laura Hollinger 
Dr. Laura Hollinger

“ECMO is for patients that otherwise wouldn't survive because it is risky,” said Laura Hollinger, M.D. She serves as medical director of the pediatric ECMO program in the MUSC Shawn Jenkins Children’s Hospital.

“It can be used to bypass the lungs. It helps the patients oxygenate and ventilate while the rest of their body is healing.”

She said it’s become a hot topic during the pandemic because it can be used to treat patients suffering from primary respiratory failure from COVID-19. Their lungs are so damaged they can’t breathe. 

“I would say nearly every day, physicians across the institution are getting requests for transfers for patients who are either already on ECMO or look like they need ECMO,” Hollinger said.

“It's a challenging time, because we are the pediatric ECMO center for South Carolinians for many medical conditions, in addition to COVID-19. But it’s an extremely risky resource, so we have to be judicious and selective about providing a therapy to the patients who are most likely to benefit.”

Tiera is one of those patients. Her doctors believed that if ECMO could give her lungs time to heal by doing their work for them, she would have a chance at recovery. 

ECMO cart, which has a lot of tubes and wires, in a child's hospital room. 
The extracorporeal membrane oxygenation machine that did what Tiera's lungs couldn't. It pulled blood from her heart, added oxygen and removed carbon dioxide, then pumped it back in.

So Tiera’s mother stayed in her hospital room, letting the girl who loves to read, listen to music and spend time with family know she wasn’t alone. “I talk to her; she’ll cry, whatnot, start to get fidgety and start moving,” Bellamy said.

Seeing her daughter in that condition also helped her make a decision. “I went and got vaccinated. I was just scared before. I was so skeptical about it. But when she got sick, I said, ‘I'm just going to get it.’”

At times during the pandemic, many of the ECMO machines in the children’s hospital and in the adult hospital have been busy keeping patients alive. All of those patients were unvaccinated. Some, like Tiera, are too young to get a COVID vaccine. 

“In the past, it was thought that children didn't get so sick with COVID. We're finding that not to be the case. In this third wave, we started seeing very severe respiratory failure,” Hollinger said. “Many patients who end up needing ECMO therapy need it for weeks in order for their lungs to recover."

So how does ECMO work? “It requires an operation to place them on ECMO, meaning attach them to the ECMO machine surgically. We have to put in these really large IVs called cannulas,” Hollinger said.

ECMO coordinator and registered nurse Lucy Linkowski described what those IVs do. “They drain blood out of the right side of her heart, and it comes through all this tubing,” she said, pointing to tubes behind Tiera’s head. 

“You can see the colors are different. So this blood without oxygen in it is from the right side of the heart.” The blood had a bluish tinge.

“Then, a pump head spins the blood really fast and pushes it forward. It pushes it through an oxygenator, which gives it oxygen and clears carbon dioxide, just like her lungs would. And there’s positive pressure, and it pushes that blood, which is now bright red, right back to the patient. So now that blood goes into the right side of the heart and can go through its normal blood flow path through the lungs, and it doesn’t have to do oxygenation or anything.”

Donated blood is used as well because when red blood cells go through the machine, they get damaged over time. “We’re constantly having to replenish the pool,” Hollinger said.

But ECMO isn’t just for COVID patients. The American Thoracic Society notes that it can sub in for the heart as well as lungs in people with severe life-threatening illness that stops those organs from doing their jobs. 

Two red folders with the word ECMO on them. 
During the pandemic, there have been times when multiple patients needed ECMO. MUSC Health is one of the few hospital systems in South Carolina to offer this form of life support.

 MUSC Children’s Health has been using ECMO in babies and children since the early ‘90s. Hollinger said it’s a huge commitment. 

“ECMO is truly intensive care; it requires the highest level of time at the bedside, equipment and staffing. It's an hour-to-hour, minute-to-minute therapy that these patients require. It's equipment. It's critical care. It's blood transfusions. It’s a highly trained multidisciplinary team. All of these things add up to ECMO really being one of the more complex treatments available,” Hollinger said. “It is truly a situation where it takes a village.”

She said MUSC Health’s ECMO teams have received national recognition. “Our adult and pediatric ECMO centers have been individually honored by the Extracorporeal Life Support Organization as Centers of Excellence in Life Support. And we have been awarded the highest level of recognition in that regard; we've both achieved the Platinum Level Center of Excellence Awards."

But what Hollinger said is most important is ECMO’s impact on people’s lives. During the pandemic, global research by ELSO has helped doctors figure out which COVID patients have the best chance of survival.

Tiera’s mother was grateful her daughter was one of them. Tiera is no longer on ECMO, a welcome development for her family. But the 10-year-old girl still has a long recovery ahead.

Her mother had a message for other families. “COVID is serious. Some people think that, I guess, just older people are getting it. But actually, it’s attacking the kids more now than it is the older people.”

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