Spotlight_Bryan Guevara_ECMO

Life-Saving Support

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ECMO treatment gives critically ill patients a second chance

Bryan Guevara, a 7-year-old from Suffolk, was being treated in CHKD’s cancer and blood disorders program for leukemia when he came down with a fever and body aches.

His immune system, weakened by his disease and its treatment, couldn’t defeat the bacteria making him sick. As the infection spread, he was admitted to CHKD for aggressive antibiotic therapy.

It wasn’t enough.

Bryan’s condition deteriorated. His blood pressure dropped. His lungs began to fail. Even a breathing tube and respirator couldn’t supply his body with the oxygen he needed.

Spotlight_ECMO Docs

“He was in septic shock,” says Dr. Lara Mamikonian, a pediatric critical care specialist at CHKD. “Neither his heart nor his lungs were working properly.”

The intensive care medical team knew that Bryan’s only chance of survival was to try extracorporeal membrane oxygenation therapy, or ECMO, to take over the work of his heart and lungs. If successful, ECMO could buy Bryan some time, giving the antibiotics a chance to work and his immune system an opportunity to recover.

A highly specialized treatment, ECMO uses a pump to circulate blood from the patient’s body through an artificial lung – removing carbon dioxide, adding oxygen, and then returning it to the body. By taking over the work of the lungs, or both the heart and lungs, ECMO can support extremely ill children while other therapies help them recover from serious, but reversible, medical conditions. At CHKD, patients who benefit from this therapy range from newborns with life-threatening circulatory problems to children fighting pneumonia or waiting for a lung transplant. CHKD is the only hospital in Hampton Roads with the ability to offer ECMO to pediatric patients.

It takes a multidisciplinary team of specially trained providers – doctors, nurses, respiratory therapists, and ECMO specialists – to put a child on ECMO and monitor their progress. In Bryan’s case, the CHKD team included Dr. Mamikonian, medical director of ECMO; Walter Williford, director of respiratory care and ECMO; and Dr. Philip Smith, chief of cardiac surgery.

To save Bryan’s life, the team would have to act fast. Dr. Smith placed tubes called cannulas into Bryan’s right carotid artery and his right internal jugular vein. One tube transported Bryan’s blood to the oxygenator; another led the blood back into his body.

Once the cannula placement was complete, Bryan remained sedated while the ECMO support stabilized him under the constant watch of his medical team.

His mother, Eliana Sosa, sat by his side and prayed Bryan would get better.

Over the next few days, Bryan’s blood pressure and lung function slowly improved. On the fifth day, Bryan was well enough to breathe on his own. Dr. Smith removed the tubes and repaired his vessels.

Dr. William Owen, Bryan’s oncologist at CHKD, credits the ECMO team for saving his young patient’s life that day in the hospital.

“Bryan was minutes away from death,” Dr. Owen says. “What they did was very heroic and lifesaving. ECMO allowed his body to heal and his white blood cells to come back and fight the infection.”

Today, Bryan, now 8 (pictured on Page 1), is in remission from his leukemia. When he’s not busy with school or his outpatient appointments, he’s begging his mom to take him to the park.

“We are so thankful to all the doctors at CHKD,” Eliana says.


This story was featured in the Fall 2019 edition of Kidstuff magazine, a quarterly publication from CHKD that features inspiring stories about patients, physicians and friends of CHKD.

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