Patients with severe heart or lung disease sometimes need a mechanical intervention much like heart-lung bypass in a form of treatment known as extracorporeal membrane oxygenation (ECMO). ECMO pumps blood throughout the body, sometimes for weeks, delivering oxygen to tissue while the heart/lungs heal or while waiting for transplant.

However, during this lifesaving process it is difficult to closely monitor the brain to ensure it gets a sufficient blood supply. The dangers can be extreme. The brain naturally maintains adequate blood flow in healthy people. In critically ill patients on ECMO, those control mechanisms can be disrupted, leading to injury from blood flow that is too high or too low.

With support from The Hartwell Foundation, Dr. David Busch is applying optical spectroscopic tools in an effort to change dire statistics and consequences.

More than 30,000 children in the United States have received ECMO. Tragically, only about 1 in every 3 of these young patients survive without some long-term brain damage, said Dr. Busch, Assistant Professor of Anesthesiology and Pain Management at UT Southwestern. Many of the fatalities suffer catastrophic brain injury. Our study seeks to provide clinicians a tool to enable real-time individualized adjustment of ECMO settings to optimize the health of the patient’s brain.

Dr. David Busch

Dr. Busch’s ECMO autoregulation work was one of 12 investigations selected to receive a 2018 Hartwell Individual Biomedical Research Award from the private Foundation based in Memphis, Tennessee. The award provides support for three years at $100,000 direct cost per year.

We are very pleased but not surprised by The Hartwell Foundation’s selection, said Dr. Charles Whitten, Chairman of Anesthesiology and Pain Management. Dr. Busch, a Fulbright and Whitaker scholar, is a physics researcher who is bringing basic science into the clinical arena – the true definition of a translational researcher.

The Hartwell Foundation annually invites a very limited number of U.S. institutions to nominate candidates from their faculty who are involved in early stage, innovative, and cutting-edge biomedical research that has not yet qualified for significant funding from outside sources.

In last year’s competition, 17 institutions were invited to participate, with proposals from only 10 chosen. Selection criteria include the compelling and transformative nature of the proposed innovation, the extent to which a strategic or translational approach might accelerate the clinical application of research to benefit children, the extent of collaboration involved, the institutional commitment to provide encouragement and technical support to the investigator, and the extent to which funding the investigator will make a difference.

The 2018 cohort was very competitive, with diversity in strategic innovation and translational research that offers the potential to impact directly health care outcomes to benefit children, said Dr. Fred Dombrose, President of The Hartwell Foundation. Our approach is to be unique, selective, thorough, and accountable. We provide an opportunity for those we support to make a difference and to realize their hopes and dreams.

Dr. Busch, who holds a secondary appointment in Neurology and Neurotherapeutics, said he plans to initially deploy this new technology at Children’s Health for children on ECMO and then expand his studies to other critical and chronic pediatric illnesses with compromised blood flow.

Blood flow in the brain may be critically dependent on the ECMO pump settings, yet currently there are no good ways to monitor the adequacy of flow during ECMO. Clinicians fall back on measurements like blood pressure of the whole body instead of measuring brain health directly, he said. If you cover your hand with a flashlight in a dark room, you can see red light easily penetrates tissue, but you can’t see the bones as the light is heavily scattered. I model the light transport in tissue to enable direct measurement of the blood flow, volume, and oxygen content in the brain or other organs. This technology, ‘diffuse correlation spectroscopy,’ is available at only about five pediatric hospitals worldwide.

By receiving an Individual Award, UT Southwestern also has qualified to receive a Hartwell Fellowship that provides postdoctoral support for two years at $50,000 direct cost annually to a worthy candidate who holds a Ph.D. and/or equivalent doctorate and will pursue further specialized training in biomedical research rather than extend or complete clinical training.

Dr. Whitten said The Hartwell Foundation’s support was appreciated and appropriate. Federal grants are essential to ‘big science,’ but medical research was built on the foundation of individual, private resources provided by dedicated patrons of advancement in science and medicine, he said. Dr. Busch’s recognition is emblematic of the rapid progress of the Department in becoming one of the nation’s finest centers for anesthesia research, teaching, and patient care.