Tomorrow they do the ECMO trials

Lucas had a stellar day.

Here is his Xray from the morning.

And here it is from this afternoon

Here is a bit better view of the lungs

Notice all that black area.  It turns out his lungs are pretty much back up and running as you can see from the ventilator monitor.

One thing they had considered of interest was using Surfactant to get his lungs to open up faster.  Its sort of like lubrication for the lungs and put directly into the lungs.  Apparently premature babies don't have this before week 24 and since they have learned how to make it they have been able to do away with more evasive ways of inflating premature babies lungs.  Super awesome advancement but, Lucas never needed it.

His kidneys have worked great and he urinated about 1 liter of water.  He was nearly -.5 liters.  So he was moving way more fluid than they had thought.  His heart did great as well and he is shrinking down (not so puffy) and getting feisty with them.

They also got the PICC in and will probably remove the IV from his umbilical cord tomorrow.  It can't be in there for more than a week because of risk of infection.  But, its a big enough tube that they can deliver platelets, drugs, and read his blood pressure and take blood for running into the gas equipment to see how much CO2 and O2 he has.

Because he is so awesome, tomorrow they are going to try some "trials" on the ECMO.  What that will entail is splitting the heparin being used in the circuit.  So he will get half and the machine will get the other half.  This is so heparin is running into the lines running to his heart via 2 Cannula.  The Cannula are the two tubes that run to his heart.  They look about the side of a stirring straw for coffee.  These are what the ECMO are hooked to and will be scheduled to be removed if everything is going well.  That gets us way closer to things being normal.

So the trial could last an hour where they reroute the ECMO circuit and physically clamp it off.  They have to vent it every 3 minutes or it could start to develop clots.  The heparin is being run from both sides so on the venting both sides will get flushed with more heparin to prevent clotting.

If this is successful then he will only be on a ventilator.

Just so you folks know what this looks like.  Here is a picture of the ECMO blood circuit.

That white box is where oxygen and CO2 are passed through the blood in some sort of clever matrix that does the gas exchange with the blood.  The blue can is a centrifugal pump, like off of a turbocharger, that pushes the whole system.  You can't run it too high because it will damage the blood.  But, its way better than the old roller pumps which would destroy the blood much faster by crushing it.

The whole setup looks like this.

And the history of this practice is pretty fascinating. Some weird facts I learned by talking to Nurse Ian

• Originally this was done by hooking the parent to the child directly. 
• They can use this as treatment in Arizona for Ebola.  Turns out you can keep a patient on it while Ebola destroys their lungs.    

Something else.  On Wikipedia they say you can't do this for more than 23 days.  But, Dr. Christine says they have done it for 41 days no problem.

Anyway, its cool but, will be great to be done with this.

So wish us luck, I will tell you how it goes.  Here is a picture of him peeking out at me.