20 » A magazine for and about Oregon Community Hospitals. The ECMO machine’s tubes, or cannulas, were threaded into the large veins and arteries in Castro’s neck and groin. Through them, the machine continuously pumped blood out of his body, adding oxygen and removing carbon dioxide before returning the blood via the cannula. He was on ECMO in the CCU for 108 days, the longest ever at PPMC. Along with his lungs, heart, and liver, Castro’s kidneys also failed, so he was also put on dialysis. “Every day on ECMO, the risk of dying goes up,” says Tara Tuepker, RN and ECMO specialist, one of a large team of CCU staff who took care of Castro. 50 of the 130 PPMC critical care nurses are trained on the complex ECMO technology that kept Castro alive. To avoid muscle atrophy and brain trauma, Alex was not sedated. Javiera Pobanz, a nurse and ECMO specialist, described the routine. “Since before COVID, we’ve been doing what we call ‘awake-mo,’ so the patient can stay alert,” she said. “That helps them keep track of time and process what’s going on, and not get delirious. But it’s risky because the cannulas could move.” The tubing also means a liquid diet, Castro preferring orange sherbet and milk with protein powder. ECMO patients are susceptible to the occasional infection, and Castro was no exception. The infections were further setbacks to his recovery, but Alex fought them off each time. Since early 2018, PPMC also had been walking their ECMO patients, a relatively unusual practice in American hospitals. “Those in Europe have been doing it for years and have standards for it, so we thought we should do it, too,” said Pobanz. “Walking helps patients sleep, sticking to a routine night-day cycle. At first it was scary, though, because the cannulas can get pushed in further or
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