ECMO program, saving lives for 20 years
by Jonathan Ewart
Twenty years ago, Joshua Guion was an infant suffering from an acute respiratory condition that probably would have killed him without the intervention of Extracorporeal Membrane Oxygenation (ECMO).
After seven days on this life-saving apparatus, Guion became the first infant in South Carolina successfully treated with ECMO, a heart-lung machine that oxygenates and purifies the blood outside the body for an extended period of time.
MUSC’s ECMO program requires the skill and discipline of many people from different areas.
Since then, MUSC’s ECMO program has treated 332 patients of whom 212 were neonates, 86 were pediatric patients and 34 were adults.
Though it is not a cure, it gives the patient's lungs or heart a chance to heal by allowing them to rest. ECMO is one of the most advanced forms of life support available to patients experiencing acute failure of the cardio-respiratory system. It has advantages over long-term use of ventilators and respirators, which mechanically keep the lungs and heart functioning, but can be very stressful on the organs.
“Using ventilators and respirators is like someone pounding on your head when you have a headache,” said Dilip Purohit, M.D., ECMO medical director at MUSC. Although ECMO helps relieve this extra stress, use of the treatment has been considered a last resort to save a person’s life.
Purohit has been the medical director for ECMO since 1988 when it was first used in the Neonatal Intensive Care Unit. At that time, he started the program with John Toomasian, then perfusion program director; Sandy Ballard, then ECMO specialist; and Mary McCall, then ECMO coordinator.
“Our program was started to fill a need for specialized treatment for babies in South Carolina needing respiratory and/or cardiac support,” said McCall, R.N., now a cardiovascular perfusionist working with the program.
Unlike many new technologies and treatments, which first targeted adults and are then applied to younger patients, ECMO began as a treatment for neonates and has since expanded to care for pediatric, and then adult patients. “This is a transformation worth mentioning,” said Purohit. “It has become a technology available to patients throughout the hospital.”
Neonatal ECMO cases are more straightforward in comparison to pediatric and adult cases, because they usually involve cardio-respiratory problems limited to two or three disease processes, according to Joel Cochran, D.O., medical director of the Pediatric Intensive Care Unit.
Meanwhile, children and adults can be placed on ECMO for many different reasons, which can complicate the treatment process. “Children have been placed on ECMO for trauma, infection, irregular heartbeat, influenza and almost anything else you can think of,” Cochran explained.
In 1992, MUSC saw its first pediatric ECMO case. “It was more of an accident than anything else,” said Stacey Laws, R.N., ECMO coordinator. A small child went into cardiac failure after ingesting a large dose of his grandmother’s heart medicine. He was given a compound containing charcoal to absorb the medication, which affected him adversely. The compound attached to the chemicals in the heart medicine, releasing them slowly over time into the child’s body.
His heart was failing and, as a last resort, was placed on ECMO. This gave his heart a chance to rest while the drugs cleared from his system, saving his life and setting a new national standard for ECMO usage.
“The PICU realized it worked and they have used it ever since,” recalls Sandy Ballard, R.N., one of the original ECMO specialists. Soon after the first case, Cochran led a team that developed the criteria and protocol for the pediatric program.
A similar situation occurred in 1999 when, according to Cochran, “a surgical resident suggested that a severely injured motorcycle-accident victim might be a good candidate for ECMO treatment. With it, he survived.” This paved the way for the adult ECMO program. After the first six adult patients were treated successfully, this application of ECMO began to gain acceptance as a viable form of treatment.
Since the beginning, and as the EMCO program expanded, teamwork has always been a central theme. “Our program is successful due to the wonderful multidisciplinary team effort available at MUSC,” said McCall. “We are blessed to have highly-skilled professionals personally dedicated to patient care.
“Each team member has responsibilities, but it is not unusual to see ECMO specialists helping with pump setup, and perfusionists helping with patient care. Physicians are quick to offer their help—especially Dr. David Habib (director of the Division of Pediatric Emergency Medicine and Critical Care) who always wants to help,” she said.
“Maintaining the program is labor-intensive and requires the skill and knowledge of many specialists throughout many disciplines,” said Laws. Physicians, surgeons, nurses, ECMO specialists, perfusionists, pharmacists, nutritionists, respiratory therapists and the blood bank all have to come together for this treatment to work.
ECMO has done things beyond the realm of patient care. It has enabled further research and education for neonatal fellows and perfusion technologies. “Every case is different and we always learn something new; it is an ongoing process,” said Ballard.
“This technology allows us to continue to provide excellence in clinical care,” said Purohit. He sees potential for this technology and not just as a last resort to save a person’s life.
In 2007, MUSC was one of 10 international centers to receive the Excellence in Life Support Award from the Extracorporeal Life Support Organization (ELSO), an international consortium of health care professionals and scientists dedicated to the development and evaluation of novel therapies for support of failing organ systems.
The Excellence in Life Support Award recognizes those centers that demonstrate an exceptional commitment to evidence-based processes and quality measures, staff training and continuing education, patient satisfaction and ongoing clinical research. MUSC is one of two ECMO centers in South Carolina, and the only one to offer this service to pediatric and adult patients.
Friday, Sept. 26, 2008