Robert H. Bartlett, MD, has not only witnessed the evolution of thoracic surgery over the past 50 years, but he has also been a primary influencer of that transformation. Dr. Bartlett, who received his doctor of medicine degree from the University of Michigan in 1963, developed extracorporeal life support (ECLS) from the laboratory through its first successful clinical trials to routine practice worldwide. ECLS led to new understanding of the pathophysiology of renal, cardiac, and pulmonary failure that provides the basis for much of modern critical care.
In February 2019, Dr. Bartlett received the Society of Critical Care Medicine (SCCM) Lifetime Achievement Award at the 48th Critical Care Congress in San Diego, California, USA, for his impact on the critical care profession. The award honors someone who, over the course of his/her career, has demonstrated meritorious contributions to the field of critical care through the advancement of medical science, medical education, or medical care.
“Bob Bartlett has been an inspiration to an entire generation of critical care practitioners,” said Pauline K. Park, MD, FCCM, who is co-director of the surgical intensive care unit at the University of Michigan, where she is a colleague of Dr. Bartlett’s. At the Critical Care Congress in San Diego, Dr. Park moderated a conversation with Dr. Bartlett about ECLS in critical care.
“He shepherded ECMO [extracorporeal membrane oxygenation], a complex life-saving technique, from early laboratory investigation to widespread clinical use. Over 100,000 patients have received ECMO support using his model of multidisciplinary, multiprofessional, team-based critical care, saving many who would have otherwise died.”
When Dr. Bartlett graduated from University of Michigan, cardiopulmonary bypass (a technique by which a machine temporarily takes over heart and lung function during surgery) existed, but its capabilities were limited to only a few hours.
“The original heart-lung machine worked for a short time because it exposed the patient’s blood to oxygen, and it was very damaging to the blood,” Dr. Bartlett explained. “What we did was develop a membrane oxygenator that prevented direct exposure of blood to oxygen gas.”
Dr. Bartlett was on the faculty at the University of California Irvine when he successfully treated the first patient using ECMO in 1975. ECMO provides prolonged cardiac and respiratory support to a patient with heart or lung failure by removing the patient’s blood, artificially removing carbon dioxide from it, and oxygenating red blood cells before returning the blood to the patient.
In 1980, Dr. Bartlett returned to the University of Michigan, where he continued to develop his ECMO procedure. ECMO was first used on infants but, over time, its use grew to adults as well, and it ultimately evolved to become a standard worldwide practice that offered extended cardiac and respiratory support for days or even weeks.
“It’s great to see [ECMO’s use spread around the world] because it benefits a lot of patients and it does something that we could never do before,” Dr. Bartlett said. “ECMO helps keep patients alive long enough to figure out what their problem is and hopefully treat it.” When Dr. Bartlett began to use ECMO, the survival rate of infants with lung failure was 10%. Because of ECMO, that percentage grew to 90%.
Dr. Bartlett spent the next 25 years as a professor of surgery at University of Michigan, where he served as director of the surgical intensive care unit, director of graduate education, and chief of the trauma/critical care division. He helped develop a surgical critical care fellowship and an ECLS program at University of Michigan, where he currently is professor emeritus of surgery and continues to conduct laboratory and clinical research.
Dr. Bartlett has spent his career in academia. He knew he wanted to be a teacher as far back as high school. This is why, while he is honored to see ECMO’s global impacts, he takes the most pride in knowing that he has been able to train new physicians who made and continue to make their own impact on society.
"The thing I am most proud of by far is the thousands of research fellows and students who have come through the lab and trained in the ICU and went on to take care of patients all over the world,” Dr. Bartlett said. “That’s far and away the most important thing we do.”
Dr. Bartlett has received 35 research grants during the course of his career, including grants from the National Institutes of Health for the development of a total artificial lung. His current laboratory research is focused on implantable artificial lungs and ways to preserve organs outside the body with the hope of developing organ banks.
“Dr. Bartlett’s work exemplifies the insight, vision, and hard work that allows us to make a difference for our most critically ill patients,” Dr. Park said. “It has been my extraordinary privilege and an absolute honor to work with Dr. Bartlett.”