SIDEBAR

Jay Shiland, left,
with Dan Brodie.

Jay Shiland W’91 was already a very sick man when he arrived at New York Presbyterian-Cornell Hospital two years ago with a soaring fever, plummeting blood-oxygen levels, and pneumonia in both lungs. Within two days he was put on a ventilator, and over the next week and a half his pneumonia morphed into severe ARDS. To say that his outlook was grim is putting it gently.

At that point, the medical team at NY Presbyterian-Cornell “reached out to their counterparts at the Columbia campus of NY Presbyterian, and asked if Jay was a candidate for their ECMO program,” says Elizabeth Maringer, Shiland’s wife. ECMO is the acronym for extracorporeal membrane oxygenation, a device that circulates the patient’s blood through an external machine that oxygenates it, removes the carbon dioxide, and returns it to the body, bypassing the lungs entirely. By doing so, it allows doctors to reduce the amount of mechanical ventilation, “thereby giving Jay a chance to stabilize and his lungs time to heal.”

It was hardly an open-and-shut case, and in fact seldom is. The use of ECMO “carries many risks, and very few institutions have the ability to keep someone on ECMO for days and weeks,” says Maringer. “Even at Columbia, it has only been used for a very small number of adult ARDS patients, with only a 60 percent survival rate.”

Shiland had already been rejected for ECMO earlier that week; having been on a ventilator for 10 days already, three days longer than Columbia’s guidelines recommend, he was deemed too sick. But thanks to the persistent chief of Cornell’s medical ICU, the Columbia ECMO team reevaluated Shiland and had him in surgery for ECMO that evening.

Among the Columbia ECMO team leaders was Daniel Brodie C’91, assistant professor of clinical medicine and co-director of New York Presbyterian-Columbia’s Center for Acute Respiratory Failure (www.nyp.org/ecmo), which he and Matthew Bacchetta, a thoracic surgeon, recently founded.

“By the time I saw Jay, he had been critically ill for quite a while,” recalls Brodie. “He was going downhill so fast, and in such a bad direction, and got so much worse once he went on [the ventilator], that it is likely he would not have survived. All of our patients who go on ECMO are really sick, but he was really fading.”

For all the risks and high-maintenance staffing, ECMO can be a life-saver, says Brodie, who describes himself as both an “evangelist and a skeptic” on the subject and recently published an article on the use of ECMO for adults in The New England Journal of Medicine. Realizing that “there weren’t too many options,” he agreed that Shiland should be a candidate for the treatment.

And so, on April 10, 2010, Shiland was put on a specially adapted portable ECMO machine and transferred—in an ambulance led by a police escort—the seven miles from NY Presbyterian-Cornell to its Columbia counterpart. By then he was hanging on by a thread.

“He was described to me more than once as just about the sickest patient in the hospital,” says Maringer. “Beyond the concern about his lungs, Jay also spiked high fevers, had clotting issues, and faced the risk of additional infection due to his prolonged ICU stay and ECMO.” But finally, after 10 “very, very long days, the doctors determined that his lungs were sufficiently functional to withstand the ventilator alone, and he was taken off ECMO on April 20th.”

Following several more long weeks in the ICU, he was taken off the ventilator. When he finally came to, he says, he was “even more drug-addled” than most ARDS survivors (on account of the large amount of sedatives given to ECMO users). And finally, in the second week of May, his two young sons were allowed to see him. It was then that the enormity of what he had been through really hit him.

Amazingly, by the following September, he was able to return to work.

“Today, you’d have no idea that I was sick, except that I have a lot of holes in my body,” says Shiland, who has become something of an ECMO evangelist himself. While it’s “more invasive than a ventilator,” he allows, “ECMO allows people to not just survive but survive really well.”

There are still a lot of ECMO-skeptics out there. But there have also been a lot of improvements over the years, in both technology and technique.

True, ECMO is expensive even by ICU standards, and can only be used in the tiny number of medical centers (including Penn’s) that have the trained personnel to administer it, but Shiland says that it’s “not a loss leader” at places like NY Presbyterian-Columbia. “They actually make money on this thing now,” he says. “It’s something that is both clinically advantageous and economically advantageous for a hospital to pursue.” Given that he’s a senior managing director of MTS Health Partners—a healthcare merchant bank that provides “strategic advisory and capital raising services as well as private equity capital to companies in the global healthcare industry”—Shiland’s observations on the economics of ECMO carry more weight than those of most patients. (Four of MTS’s six partners, incidentally, have Penn degrees.)

As he recuperated at NYP-Columbia, Shiland gradually became aware of Brodie’s frequent presence in his room.

“I was wondering, ‘Why is this guy hanging out with me?’” Shiland recalls. “Turns out he was the guy who approved me for ECMO. Now he’s hanging out with me, wants to chat. For two and a half weeks he was in there almost every day. He’s just a great guy, and we became friendly on that basis.”

Some six months later, when Shiland and Maringer were having dinner with Brodie, he “asked if I knew somebody,” says Shiland. “He made the connection that I went to Penn. Then he asked me, ‘What class were you in?’” It was then that they realized that Shiland’s life had been saved by a classmate. The rest of the dinner was spent emailing mutual friends and telling the tale of that remarkable convergence of time, space, and life.

The grateful couple promptly started the Shiland-Maringer Fund for the Advancement of Adult ECMO at NY Presbyterian-Columbia. (To contribute, contact Allison Yessin at alb9020@nyp.org <mailto:alb9020@nyp.org> .) “They’ve been amazing supporters of the program,” says Brodie.

“It’s amazing that Jay and Dr. Brodie were in the same class at Penn, and there is no question that he—and many other doctors at New York Presbyterian Cornell/Columbia—saved Jay’s life,” Maringer concluded. “You just never know what a classmate might end up doing for you.” —S.H.

 


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