Innovation Brings More Chances for Critically Ill Patients
Caring for the sickest patients is a balancing act requiring the sharpest minds and latest technology. At TriStar Centennial Medical Center, a multidisciplinary team is working to give patients on extracorporeal membrane oxygenation (ECMO) a second chance.
ECMO provides prolonged cardiac and respiratory support to patients whose hearts and lungs are unable to sustain life. Once considered an attempt to prolong life by a few hours, ECMO is now being used to help critically ill patients reach full recovery.
Bridge to Recovery
"ECMO can be used for any type of acute pulmonary failure, isolated cardiac failure, isolated respiratory failure or combination of the three," explained Elliott Cohen, MD, who serves as ECMO medical director for TriStar Centennial. "That can stem from respiratory failure from the inability to exchange oxygen in the lungs, as with pneumonia, or the inability to get rid of carbon dioxide, as with severe asthma patients."
ECMO has proven a welcome alternative to the ventilator, which can be especially problematic for patients with pneumonia. "While the ventilator can keep patients alive, it's also likely contributing to their lung injury," Cohen said. "We see patients with severe enough injury that may get enough oxygen from the vent, but the vent itself is too injurious, so we add ECMO."
By using ECMO for cardiac failure, doctors are able to restore perfusion and keep blood flowing to organs until the heart heals. "ECMO offers a bridge to recovery to more definitive treatment," Cohen noted.
While 14 days is the average time for a respiratory patient on ECMO, some have utilized the technology for up to a year while lungs recover. Cardiac patients rarely exceed seven days on ECMO, since patients have typically suffered damage or decreased blood flow to multiple organs.
While ECMO technology has been around for nearly 40 years, its use was typically limited to neonatal care. It wasn't until 2008's H1N1 outbreak that ECMO's potential was fully realized in adult care.
"We saw then how well viral pneumonia patients did with ECMO, thanks to significant technology improvement," said Cohen.
Despite ECMO's proven track record, Cohen said misconceptions still abound in the medical community. "There's still this idea around a lot of physicians that ECMO is a last ditch effort for dying people," he said. "In order for this to really work, we have to get patients on it very early, before cardiac failure leads to a lack of perfusion and keeps patients from recovering. We have a window where organs start to fail, but we can still re-establish blood flow to get them back."
Duc Nguyen, MD
Duc Nguyen, MD, a cardiothoracic surgeon with deep experience in LVAD, heart transplantation and ECMO, joined TriStar Cardiovascular Surgery last year. He credits TriStar's unique, multidisciplinary team approach for the program's success. Their formal ECMO program celebrated its one-year anniversary in January and continues to thrive thanks to a team of cardiologists, cardiac surgeons, critical care specialists, pulmonologists, cardiac nurses and ECMO coordinators working together for best outcomes.
"Our team effort involves a lot of providers with a plan, and we have the infrastructure to be able to treat the sickest patients," Nguyen said. "We do a lot of heart surgeries, and ECMO allows us to take care of the sickest patients up to the point of heart transplantation instead of having to send them elsewhere while they're already critically ill."
The team also has established a 24/7 call line (1-833-TN-SHOCK) to allow any community providers to speak to an ECMO physician for consultation or referral. As TriStar's ECMO program grows, Nguyen said plans are also underway to build infrastructure and invest in capital equipment to support a mobile ECMO team. "Some patients can't be transferred and a lot of hospitals can't provide ECMO, so this will allow us to reach out to the community," he said.