Today's Edition
(THE NEW YORK TIMES)
Robert H. Bartlett, a surgeon who helped to develop a transformative life-support system that temporarily assumes the work of a patient’s heart and lungs when they are failing because of illness or injury, died October 20 at his home in Ann Arbor, Michigan. He was 86.
His daughter, Karen Fischer, said his death followed a long illness.
Bartlett, a professor of surgery emeritus at the University of Michigan, was widely referred to as the father of extracorporeal membrane oxygenation, or ECMO.
An ECMO machine consists of an external circuit of tubes, a pump that functions as a heart, and a membrane that serves as an artificial lung. The device continuously pumps blood out of the body, adds oxygen, removes carbon dioxide, warms the blood, and returns it to the body.
ECMO treatment can continue for days or weeks or longer, allowing the heart and lungs to rest and try to heal from traumas like acute respiratory distress, a blood clot, a heart attack, or an injury from a car crash. It can also be used for patients awaiting a heart or lung transplant, and it is increasingly being used in emergencies for people experiencing cardiac arrest.
According to a registry kept by the Extracorporeal Life Support Organisation, which Bartlett founded, more than 260,000 critically ill newborns, children and adults around the world have received the treatment, and roughly 800 medical centers in 66 countries offer the procedure. About 54% of patients treated with ECMO survive to leave the hospital, and more than 100,000 lives have been saved.
"At its core, it is keeping the brain alive until you can fix the body,” Helen Ouyang, an associate professor of emergency medicine at Columbia University, said in an interview.
Ouyang, who wrote about Bartlett and the use of ECMO in cardiopulmonary resuscitation in 2024 for The New York Times Magazine, added, "He really advanced the field and never stopped believing in it and continued to push the boundaries for what it could be used for.”
ECMO as an Idea
The idea for ECMO treatment emerged in 1965, when Bartlett was a surgical resident working with Robert Gross, a leading paediatric heart surgeon at Boston Children’s Hospital. In those days, patients could be placed on heart-lung machines for only about an hour during heart surgery, because the prolonged transmission of oxygen to the blood with the device could damage blood cells.
Bartlett proposed that a membrane oxygenator - a gas-permeable artificial lung that added oxygen to the blood and removed carbon dioxide - could manage blood circulation outside the body for days, and could therefore be used to treat heart and lung failure.
The project became Bartlett’s lifework, although there were initial setbacks.
In 1971, the first adult patient survived ECMO treatment. But an early clinical study involving multiple medical centers was awkwardly designed, relying on variable protocols and, in some cases, involved medical personnel who lacked experience in administering ECMO treatment. The study concluded that ECMO treatment was no more successful in saving lives than conventional care.
"That set aside ECMO for adult patients for the next 30 years,” Bartlett told The Times Magazine in 2024.
Newborn Interventions
The treatment was more effective with newborns who had underdeveloped or damaged hearts or lungs. In 1975, while he was at the University of California, Irvine, Bartlett and his surgical team, including Alan Gazzaniga, successfully used ECMO treatment for the first time on a newborn who was experiencing lung failure, and had been left at the hospital by her mother, an immigrant without permanent legal status.
The infant recovered after spending six days on the machine. Over the years she remained in touch with Bartlett, joining him at conferences and attending University of Michigan football games with him, one of his favorite activities.
Thanks to ECMO, what had once been a mortality rate of 80% in newborns struggling to breathe became a survival rate of 80%.
ECMO treatment for adults gained greater acceptance in last-resort attempts to save lives during the 2009 H1N1 swine flu outbreak and the 2020 COVID-19 pandemic.
A Full Life
Robert Hawes Bartlett was born May 8, 1939, in Ann Arbor, where his father, Robert Meade Bartlett, was a surgical resident at the University of Michigan. His mother, Elizabeth (Hawes) Bartlett, managed the household.
Robert played hockey at Albion College in Albion, Michigan, where he received his undergraduate degree in 1960. He continued to play on amateur teams, often at night with other physicians, until he needed a hip replacement when he was 50.
At Albion, he also formed a big band, the Charlie Brown Band. The night before he took his medical school entrance exam, he finished a gig, drove until morning, and arrived to take the exam wearing his white dinner jacket from the concert, his daughter, Karen, said in an interview.
He received his medical degree from the University of Michigan in 1963 and returned to perform surgery and conduct research at his alma mater in 1980. His laboratory there continues his work on developing lifesaving devices, including wearable artificial lungs and artificial placentas; reducing the risk of blood clotting and inflammation during ECMO intervention; and prolonging the viability of organs before transplant.
Apart from his work in medicine, he wrote two novels: "The Salem Syndrome” (2005), about medicine and the law, and "Piece of Mind” (2007), about medicine and philosophy.
In addition to his daughter, Bartlett is survived by his wife, Wanda (Read) Bartlett, whom he married in 1960; their sons, Karl and Keith; and four grandchildren.
