Ecmo can replace the failing heart and lungs by the time it gets to the hospital. This is the secret of a few extreme emergency workers. This machine, capable of oxygenating the blood and returning it to the body, was used in cardiac surgery. It can now be used everywhere. In the event of heart failure, it is the operation of the last chance, practiced by some pioneers. Paris Match was able to follow these emergency responders in intervention.
On October 15, in the Paris metro, La Chapelle station, a 26-year-old man was on the verge of death, in cardiac arrest. His clothes were cut off by firefighters who performed a long cardiac massage. Then the Smur Lariboisière team took over, resuscitation, electric shocks. Nothing to do… Without oxygen, the brain turns off in a few minutes. Hope remains: Ecmo.
A 20-kilo machine that has become portable
Developed in the service of Prof. Pierre Carli, the head of the Samu in Paris, this cardiac surgery technique eventually came out of the operating room. A shock team was formed: nurse anesthetists and six doctors from Samu Necker, including Dr. Lionel Lamhaut, one of the two inventors of the mobile device.
“For the first interventions,” he says, “we used our personal cars and the machine weighed 20 kilos! Since then, we have miniaturized it”. At each departure triggered by the Samu regulation, there are strict rules. “There is a sixty minute delay between the discomfort and the activation of the pump. We intervene after failure of at least twenty minutes of resuscitation. And among the selection criteria: that the age is generally less than 65 years, that there are signs of life – sighs, movements, a reaction of the pupils – and that the cardiac massage has been performed within five first minutes “, specifies the doctor.
The Ecmo saves people who were left dead before, without any chance of getting to the hospital
Pr Pierre Carli
A single minute without blood flow is 10% less chance of getting out of it, and possibly irreversible brain damage. There are nearly 50,000 cardiac arrests each year in France, and 95% of deaths. Thanks to the Ecmo, the survival rate reaches 30%. “The Emmo allows people to be saved who were left dead on the spot, without any chance of arriving at the hospital,” says Professor Carli. People who were recovering from the cardiac arrest opened their eyes and their hearts. They would stop again. We held them by the hand, by a thread, and they escaped us, “he laments.
Forty interventions in the year only
Return to the metro. Dr Lamhaut is on his knees, in sterile clothes, assisted by an emergency doctor from Lariboisière. It is 2:37 p.m. The operation can begin: it is necessary quickly incise the upper thigh, find a vein and an artery, introduce the cannulas to suck the blood, oxygenate it via the Ecmo, send it back into the body. At 2:46 p.m., the machine is finally plugged in, it is running. It only took nine minutes. In one pipe, we see dark blood pass, in another that, bright red blood, loaded with oxygen. The extracorporeal circulation is established, the man’s face gradually takes on the colors of life. An exceptional moment, a moment of grace. There are only about 40 interventions of this type in the year.
The idea is to intervene ever faster, so the research continues. We are talking about a connected watch and artificial intelligence to detect the warning signs of cardiac arrest. Hope also means training as many people as possible in saving gestures. There is only 20% of French people who are able to perform cardiac massage, against 80% of Germans. However, without cardiac massage from the first minutes, there is no miracle, with or without Ecmo.
Emergency physicians of the impossible … Report in words and photos in Paris Match this week.
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