Berlin Heart and its effects When a child has been determined to need a heart transplant, doctors give the parents all available options to better the child’s survival rate. The most recent common options are the Berlin Heart and ECMO. Even though both seem to provide the same result, medically they are extremely different and can provide a wide range of different results. Parents who are force to make these decisions, tend to question the effects that the two would have on their child. Whether it is the physical, emotional or the overall health effects, the decision is still a hard one to make. With the clock ticking and a life in the hands of medicine, the decision has to be reached immediately. The Berlin Heart is an external device that helps the right ventricle of the heart pump blood to the body. With surgery, Doctors implant tubes to both the left and right ventricle of the heart. These tubes are connected to the Berlin Heart and Pump to assist with the flow of blood and oxygen to both the lungs and heart. See below diagram
[pic]Figure 1. 1. The deoxygenated blood flows from the body into the right atrium. ( Red Line) 2. Since the right ventricle can not pump blood into the lungs, the blood goes into the Berlin Heart (yellow circle). 3. The blood is pumped out of the Berlin Heart and goes into the pulmonary artery (Purple Line) and into the lungs. 4. Once the blood is oxygenated in the lungs, it flows into the left atrium of the heart. (Brown Line) 5. Since the left ventricle is not able to pump blood into the aorta, the blood goes from the left ventricle into the Berlin Heart again ( Green Circle) 6. The Berlin Heart pumps blood through the aorta (Blue Line) and into the body.
All of the Berlin Hearts rhythms are controlled by a computer. This computer is monitored closely by doctors to assure that the Berlin Heart is pumping regularly and that no clots within the tubes are forming. The Berlin Heart has been developed many times over the past 40 years. In the 1960s and 1970s, mechanical hearts were being developed by the National Institutes of Health (NIH) but were not known to the public. In 1969, Dr. Denton Cooley performed the first implantation of a temporary artificial heart which succeeded three days until a heart was made available to the patient. However this was a temporary heart and trials were still in place as to the effect of them being used permanently for long periods of time. Dr. Robert Jarvik in 1982, was the inventor of the Jarvik Heart 7 and was the first to create and use the successful internal permanent heart replacement unit. Over time and lots of research, many more successful internal heart replacement units were created. In 1997, the Mediport Berlin Heart GmbH Kardiotechnik of Germany announced their creation of the first external heart ventricular assistance device known as VAD or Berlin Heart. The first successful use of the Berlin Heart in the United States was June 10, 2000 in Tuscon, Arizona. The heart was commonly used within Europe however was not approved by the FDA in the United States. The Doctors of the Sarver Heart Center of Tuscon, Arizona had to appeal the FDA to allow the use of the Berlin Heart. The appeal is known as the Compassion Use Option. If the appeal is approved it allows the Doctors to perform the procedure, however all parties involved are not held legally liable for any complications or death that may occur. The Doctors are required to place the patient under “Research Status” and are required to submit an excessive amount of paperwork of the trial to the FDA with the results of the process. To this day the FDA has approved the Berlin heart to be used more frequently. The FDA has approved this device to be used for any amount of time for an adult but for a child it has only been approved up to a year of use. ECMO also known as the Extra Corporeal Membrane Oxygenation is the other most common transplant used while a child waits heart transplant. Though the functions of the ECMO as the same as the Berlin Heart, the status of the child is different. If a child is placed on ECMO they are placed in a medically seduced coma. Because of the medically seduced coma, it is difficult for doctors to determine whether the other organs and brain are functioning completely. The doctors can not determine the status of the rest of the body unless the child is placed off ECMO which can lead to complications of the treatment. See below diagram for function of ECMO.
[pic] Figure 2
Due to the complex of the machine, wires and the sedated child, movement of the child can be detrimental to its recovery. Even though ECMO main purpose is to assist with the function of the lungs and heart, with the amount of oxygen being inputted into the child’s body can be fatal if not monitored correctly. ECMO was being developed between the years 1935 and 1954. Dr. John Gibbon and Dr. Clarence Dennis were the first to pursue the development of a device that could take over the function of the heart and lungs to permit immediate surgery on the heart and great vessels. However their project was determined lethal and was forbidden to use until further research was conducted. In 1957, after long research and studys FDA approved the use of ECMO however with label of the survival rate 3:1. In 1996 there were over 100 active centers using ECMO across the United States. Now ECMO is very commonly used and is highly recommended to patients, when the heart and lung need to rest. Both the Berlin Heart and ECMO are used for the same purposes but what are the real differences between the two? When a child is placed on the Berlin Heart they are only sedated for the period of the surgery to insert the tubes to the heart. Once the child has completed the surgery, they are as active as any child can be. A baby can be held, cuddled, feed by the mother and can play like any other healthy child. The computer used to monitor the Berlin Hearts rhythm, can be moved to wherever the child is with the smallest amount of possible damage to the Berlin Heart. In a recent phone interview with Dr. Juan Allegos of UCLA Hospital, who specializes in Child Development after treatment and is the Head of the Cardio Children’s Unit at UCLA he states, “It is very important for a child to have a lot of hands on attention and touch from their parents, to help the child develop regularly. If a child is restricted to the normal development, it can cause a delay in development later in the child’s life. For example, speech, social skills, and interactive development with others are just a few development issues that could occur. With the Berlin Heart it gives a child the opportunity to live their life like any other child. However with the ECMO, a child is so sedated, their mind and body functions do not develop regularly which can cause developmental delay.” He continues to say, “With ECMO, it is rare for a child to be on ECMO for longer than two weeks. There has been some isolated cases of children being on it longer, up to a few months, but have come out with a lack of motor skills, almost a sense of retardation. Because a child is on ECMO, there are chances of muscle wasting; Doctors can not monitor the neurological side of the baby and they will not be able to determine whether the child has had a stroke, or a major neurological damage.” If a parent had to choose between the ECMO and Berlin Heart, it more beneficial for the child’s health and survival rate to be on the Berlin Heart. The child is not the only one who is affected with the procedure. Parents are also affected, especially mothers. It is very important for both the mother and child to have both physical and emotional development together. A baby going through development needs to have the bond with their mother. This helps the child develop attachment. With out it, it can cause detachment issues and a form of Post Traumatic Stress Disorder also known as PTSD. A mother needs to bond with her child to help eliminate this and to eliminate her developing Post Partum Depression or PPD. According to MSW Donna Weisman, who specializes in child development and has studied several cases of both PTSD and PPD, states, “The first few months are very crucial for a child to bond with their mother. Especially if they are under going a huge medical surgery, they mentally need to feel the love and touch of their mother. Not only is a child already aware to the physical changes that their body is undergoing, they can feel the stress and fear from others. It is important to both the child and mother to connect to eliminate any forms of detachment issues or development issues later in life.” If a child is placed on ECMO, the needed bond between a child and mother is limited. It may be beneficial for a short term solution but long term can cause multiple issues to both the child and parents. The overall health effects of the Berlin Heart vs. ECMO is clear. It is more beneficial if given the option to place your child on the Berlin Heart instead of ECMO. Not only are you able to give your child the ability to function and develop as a regular child, you are also giving them an option that can be used longer with less effects. Doctors will be able to monitor the child’s development more effectively as well. It appears that the survival rate is higher with the Berlin Heart vs. ECMO. A child is already going through enough stress with the failure of the heart, why deprive it of any chance of life as well. According to Dr. Cohen, of Seattle Children’s Hospital, he states, “That a lot of medical technology has been out for years, however due to our FDA constraints we are the last in the world to start using them.” As we move further into the future and the advancement of technology we are sure to see more effective methods of heart transplant assistance. ECMO and the Berlin Heart will be far more sophisticated than it is today. The survival rates will increase and need to question which procedure is better will eliminate. However we are in the here times and have to face the facts of the two. It is important that no matter what decision is made, that it is made with both thought and knowledge. To go into such a huge procedure not knowing can lead to the result of pain and loss. We can only hope that we will continue to move forward towards perfection with medical technology so that any one who is in the need of a heart transplant will be able to successful receive one and survive the process.

Works Cited Childrens Hospital of Stanford, Lucile Packard. Berlin Heart. Digital image. Lane.stanford.edu/portals/cvicu/HCP_CV_Tab_1/BerlinHeart.pdf. Web. 27 Nov. 2010. Figure 1

Childrens Hospital of Stanford, Thomas Jefferson. ECMO Circuit. Digital image. Http://ats.ctsnetjournals.org/cgi/content-nw/full/76/6/S2224/FIG1. Web. 15 Nov. 2010. Figure 2

Education, Perfusion. "Berlin Heart." Perfusion Education Online. 2008. Web. 23 Nov. 2010. .

Bankston, John. Robert Jarvik and the First Artificial Heart. Bear, DE: Mitchell Lane Pub., 2003. Print.

Stolte, Daniel. "Boy's Operation at UMC Marks First Use of 'Berlin Heart' in the United States." The University of Arizona Sarver Heart Center (2000). Print.

University Of Michigan. "Department Home." University of Michigan Health System. 2010. Web. 26 Nov. 2010. .

Allegos, Dr. Juan. Telephone interview. 24 Nov. 2010.

Weisman MSW, Donna. Personal interview. 15 Nov. 2010.

Cohen, Dr. David. Telephone interview. 16 Nov. 2010