Quality of Life Innovations from the Columbia University Department of Surgery
ECMO Saves Life of NJ Missionary with Acute Respiratory Distress
Syndrome
The Lung Transplant Program
Columbia University Medical Center
800-227-2762
ECMO Saves Life of NJ Missionary with Acute Respiratory Distress
Syndrome
The Lung Transplant Program
Columbia University Medical Center
800-227-2762
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When Pamela Abma traveled to Uganda in April 2010 on a missionary trip, she took all the proper medical steps to avoid illness. A
healthy, fit, 47-year-old from NJ, she received the requisite immunizations and took her antimalarial medications. While in Uganda,
Pam took care to retreat under mosquito netting before the onset of dark and to use bug spray to prevent malaria-bearing mosquito
bites. She drank only bottled water to avoid the intestinal parasites present in the local water supply. She had a fantastic, rewarding
experience, working with other missionaries and local residents to help develop a source of clean water and lay the groundwork for a
health clinic.
healthy, fit, 47-year-old from NJ, she received the requisite immunizations and took her antimalarial medications. While in Uganda,
Pam took care to retreat under mosquito netting before the onset of dark and to use bug spray to prevent malaria-bearing mosquito
bites. She drank only bottled water to avoid the intestinal parasites present in the local water supply. She had a fantastic, rewarding
experience, working with other missionaries and local residents to help develop a source of clean water and lay the groundwork for a
health clinic.
Pam returned to her northern New Jersey home April 15, and for six weeks,
had no signs of the illness that would soon change her life. She rode with her
local ambulance corps, of which she is a member, in the Memorial Day parade
in her town. That night, she recalls, a fever took hold. Three more nights of
fever followed, leading her to the emergency department at Valley Hospital in
Ridgewood, New Jersey. “I kept telling the emergency room (ER) doctor that I
had been in Africa, and finally he agreed to test me for malaria,” says Pam.
The test was positive, and Pam was sent home with medications and the
expectation that she would feel worse before she felt better.
had no signs of the illness that would soon change her life. She rode with her
local ambulance corps, of which she is a member, in the Memorial Day parade
in her town. That night, she recalls, a fever took hold. Three more nights of
fever followed, leading her to the emergency department at Valley Hospital in
Ridgewood, New Jersey. “I kept telling the emergency room (ER) doctor that I
had been in Africa, and finally he agreed to test me for malaria,” says Pam.
The test was positive, and Pam was sent home with medications and the
expectation that she would feel worse before she felt better.
Pamela Abma on ECMO
Machine
Machine
But the ER doctor’s prediction could not anticipate what would follow: a rare,
severe response sent Pam into a rapid downward spiral. Violent vomiting gave
severe response sent Pam into a rapid downward spiral. Violent vomiting gave
way to difficulty breathing, and within two days, Pam developed Acute Respiratory Distress Syndrome,
or ARDS. Back in the hospital, she was sedated, intubated, and placed on a mechanical ventilator. She
does not remember anything after that day.
or ARDS. Back in the hospital, she was sedated, intubated, and placed on a mechanical ventilator. She
does not remember anything after that day.
With her lungs unable to send enough oxygenated blood through her body, her physician, Steven Jacoby,
MD, contacted Daniel Brodie, MD at NewYork-Presbyterian Hospital/Columbia University Medical
Center. Paramedics came from the hospital to transport Pam to the Medical Intensive Care Unit, and
immediately placed her on extracorporeal membrane oxygenation, or ECMO. “Pam was very fortunate
that Dr. Jacoby made that call when he did,” says Dr. Brodie. “He used great clinical judgment, and if he
had not gotten in touch with us so quickly, it may have been too late.”
MD, contacted Daniel Brodie, MD at NewYork-Presbyterian Hospital/Columbia University Medical
Center. Paramedics came from the hospital to transport Pam to the Medical Intensive Care Unit, and
immediately placed her on extracorporeal membrane oxygenation, or ECMO. “Pam was very fortunate
that Dr. Jacoby made that call when he did,” says Dr. Brodie. “He used great clinical judgment, and if he
had not gotten in touch with us so quickly, it may have been too late.”
ECMO machines are used to help patients with ARDS by taking over the work of the lungs, which then
allows the lungs to rest and recover. Unlike a ventilator, which forces air into the lungs and can cause
lung injury, ECMO works similarly to a dialysis machine in that it removes the blood from the body,
treats it externally in this case removes carbon dioxide and infuses oxygen, and then returns it to the
body. During this version of ECMO, the blood is removed and returned through a catheter in the jugular
vein. While Pam was on ECMO, she was in a drug-induced coma so that the tubing would not move
and compromise her oxygen levels. Signs of progress were monitored by X-rays of her chest that were
performed each day and by how her lungs interacted with the mechanical ventilator.
allows the lungs to rest and recover. Unlike a ventilator, which forces air into the lungs and can cause
lung injury, ECMO works similarly to a dialysis machine in that it removes the blood from the body,
treats it externally in this case removes carbon dioxide and infuses oxygen, and then returns it to the
body. During this version of ECMO, the blood is removed and returned through a catheter in the jugular
vein. While Pam was on ECMO, she was in a drug-induced coma so that the tubing would not move
and compromise her oxygen levels. Signs of progress were monitored by X-rays of her chest that were
performed each day and by how her lungs interacted with the mechanical ventilator.
Pam’s doctors warned her husband and three children that there was no guarantee that the use of
ECMO would be successful. They did not know if she might sustain brain or organ damage. “The
doctors only began seeing small signs of improvement during my seventh day on ECMO,” Pam says.
By day nine, enough fluid had drained and her lungs had regained enough function that she could be
taken off ECMO. But after being in a coma for as long as she had been, she could not be awakened
quickly – it took yet another eight or nine days to wean her off sedation and to start reintroducing
sensory stimulation. When she woke up, Pam could not speak as she still had a tracheotomy, she was
very confused, and had no strength to write. “My arms and legs felt like rubber. I couldn’t eat, but
could only drink thick fluids.” She had lost 20 pounds.
ECMO would be successful. They did not know if she might sustain brain or organ damage. “The
doctors only began seeing small signs of improvement during my seventh day on ECMO,” Pam says.
By day nine, enough fluid had drained and her lungs had regained enough function that she could be
taken off ECMO. But after being in a coma for as long as she had been, she could not be awakened
quickly – it took yet another eight or nine days to wean her off sedation and to start reintroducing
sensory stimulation. When she woke up, Pam could not speak as she still had a tracheotomy, she was
very confused, and had no strength to write. “My arms and legs felt like rubber. I couldn’t eat, but
could only drink thick fluids.” She had lost 20 pounds.
Rehabilitation then followed – walking with a walker, pool exercises, and more. After her ordeal she had
further medical issues including a bladder infection and pancreatitis, and she had to have her gall bladder
removed a week after returning home.
further medical issues including a bladder infection and pancreatitis, and she had to have her gall bladder
removed a week after returning home.
“Pam’s reaction was highly unusual,” Dr. Brodie explains. “Her form of malaria, vivax malaria, is
typically not the most serious. But a small number of patients with vivax malaria may develop ARDS,
and her case was extreme. She was very close to death.” The team’s use of ECMO to sustain Pam was
the first known time it had been used for a patient with malaria. This application of ECMO was
available at NYP/Columbia because he and Matthew Bacchetta, MD, Director of the Adult ECMO
Program, had already developed a specialized program to treat adult patients with ARDS.
typically not the most serious. But a small number of patients with vivax malaria may develop ARDS,
and her case was extreme. She was very close to death.” The team’s use of ECMO to sustain Pam was
the first known time it had been used for a patient with malaria. This application of ECMO was
available at NYP/Columbia because he and Matthew Bacchetta, MD, Director of the Adult ECMO
Program, had already developed a specialized program to treat adult patients with ARDS.
Today Pam considers herself fully recovered, with the exception of continuing joint pain. She credits
the expertise and caring of her doctors, prayers from her family and community, and God in helping
her to recover. Having missed her daughter Joy’s high school prom and graduation in May, she was
thrilled to be able to walk down the aisle and dance with her son, Jimmy, at his wedding in August.
the expertise and caring of her doctors, prayers from her family and community, and God in helping
her to recover. Having missed her daughter Joy’s high school prom and graduation in May, she was
thrilled to be able to walk down the aisle and dance with her son, Jimmy, at his wedding in August.
Pam Abma serves on the Board of Directors of Touch the World Ministries, which works with
orphans and young adults traumatized by the civil war in Uganda. Her trip helped to establish a
source of clean water and a health clinic for the community of Adak, Uganda.
orphans and young adults traumatized by the civil war in Uganda. Her trip helped to establish a
source of clean water and a health clinic for the community of Adak, Uganda.
For Clinicians: If you are a clinician interested in ECMO information, please read ECMO
Course: Current Uses and Future Directions. Additionally the Columbia University Department of
Surgery has an upcoming continuing medical education seminar on November 30th, StO2: Rapid
non-invasive perfusion assessment.
Course: Current Uses and Future Directions. Additionally the Columbia University Department of
Surgery has an upcoming continuing medical education seminar on November 30th, StO2: Rapid
non-invasive perfusion assessment.