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CHOP's ECMO Program Awarded

With the potential to save lives, the ECMO program provides lung and heart support for days to weeks if needed.

Having supported more than 1100 patients since it was established in 1990, the Children's Hospital of Philadelphia's (CHOP) extracorporeal membrane oxygenation (ECMO) program is now one of the most active in the country. Recognized for its achievements, CHOP's ECMO program has recently been presented the "Award for Excellence in Extracorporeal Life Support."

CHOP was presented this award by the Extracorporeal Life Support Organization, an international association of centers which offer ECMO for the support of failing organ systems in infants, children and adults. Able to assist all of these age groups, the CHOP program has a multidisciplinary team made up of skilled pediatric surgeons, neonatologists, intensivists, perfusionists, specially trained nurses and respiratory therapists.

"Our experts, at the ECMO Center at the Children's Hospital of Philadelphia, who have experience in treating patients in cardio-pulmonary failure, work together during initial stabilization and continue to treat patients during extracorporeal support using an evidence-based approach backed by the latest advancements in research," explained Todd J. Kilbaugh, M.D., Anesthesiologist, Critical Care Physician and Co-Director of the ECMO Center at The Children's Hospital of Philadelphia.

Together, these medical professionals have worked to earn this international designation of a Center of Excellence in Life Support, distinguishing their facility's strategic processes, procedures and systems - which all promote excellence and exceptional care in extracorporeal life support. Receiving this award also assures to the healthcare community that the CHOP ECMO program upholds the highest quality standards while using specialized equipment and supplies, defined patient protocols and maintaining the advanced education for multi-disciplinary staff members.

What is the Purpose of ECMO?

ECMO is used as a treatment bridge for patients who are faced with life-threatening heart and/or lung failure. With the potential to save lives, the ECMO program provides lung and heart support for days to weeks while a patient's underlying illness is determined and treated by medical professionals, according to CHOP News.

SEE ALSO: ECMO: A Last Chance At Life

"ECMO programs have expanded over the years because of technology. The actual circuit itself is smaller so that it's easier to run and place near the bedside," explained David Roe, M.D., a pulmonologist with Indiana University Health and Medical Director of Lung Transplantation at Indiana University Health Methodist Hospital in Indianapolis. "Technological advances in regards to cannulation make it possible to support the patient with a smaller, more efficient ECMO circuit. Also, it works to help treat many diseases and disorders."

Improvements in size and technology of extracorporeal circuits continue to advance the field and have allowed the ECMO Center to develop an ECMO transport program to support infants and children beyond the walls of CHOP. The transport program is used to transport patients from referring institutions to CHOP for further management and treatment of diseases and disorders which can lead to heart and lung failure. The treatment method allows patients to be awake and active while the machine takes over the function of the heart and/or lungs.

The diseases and disorders supported by ECMO vary, but can include those in newborns and older children with respiratory failure, patients with congenital heart disease, sepsis, cardiac arrest and patients awaiting heart and lung transplant.

How Does it Work?

Performed using a heart-lung bypass mechanism, an ECMO machine is similar to the ones utilized during open heart surgery. It contains sterile plastic tubing which is used to circulate blood through an artificial lung back into the bloodstream. The ECMO circuit mimics the functions of a healthy lung, as it adds oxygen to the blood while simultaneously removing carbon dioxide. In addition, the ECMO circuit can support blood flow to vital organs when the heart is failing.

There are two types of respiratory support. The first type, Venovenous (V-V) ECMO, is used when the heart is functioning well and only the lungs need to rest and heal. Alternately, the second type, Venoarterial (V-A) ECMO, is used when both the heart and lungs need time to rest and heal.

When making a comparison between the two types, it is important to note that Venovenus ECMO achieves lower PaO2 levels and necessitates higher perfusion rates than Venoarterial ECMO. Venovenus ECMO also requires only venous cannulation, elevates mixed venous PO2 levels, maintains pulmonary blood flow and does not provide cardiac support to assist systematic circulation, whereas Venoarterial ECMO requires arterial cannulation, decreases pulmonary artery pressures, bypasses pulmonary circulation and provides cardiac support to assist systemic circulation.

CHOP ECMO Progression

As of 2014, 10 complete ECMO systems have been available to support 50 to 60 neonates and children at CHOP. Overall, 45% of ECMO patients at CHOP are seen in the Newborn/Infant Intensive Care Unit, 45% in the Cardiac Intensive Care Unit and 10% in the Pediatric Intensive Care Unit. Indications for heart and lung rescue continue to expand and the number of patients supported on extracorporeal life-support will likely continue to rise.

Each child relying on an ECMO machine is monitored by a specialist and bedside nurse at all times. In each intensive care unit, the patient also has full-time access to an attending physician who is a member of the ECMO Center at CHOP. These physicians aid the primary team with daily care and ECMO management.

According to a CHOP Neonatology Update, the ECMO program started in 1995 to support critically ill neonates and has expanded for heart and lung rescue for children of all ages who are suffering from life-threatening illnesses and has now surpassed over 1000 patients.

"Our ECMO program first started to support critically ill neonates and over the last 25 years has expanded to one of the largest pediatric programs in the world providing services to newborn, pediatric and cardiac patients in all three intensive care units at the Children's Hospital of Philadelphia," highlighted James T. Connelly, BS, RRT-NPS, ECMO Center Coordinator at CHOP.

CHOP also established the Center for Fetal Diagnosis and Treatment, paving the way toward instrumental improvements in the survival rates of neonates in need of heart and/or lung bypass at the facility, also according to the CHOP Neonatology Update.

Piloting these success stories, more than 25 respiratory therapists and nurses at CHOP are trained as ECMO specialists. These medical professionals possess advanced skill sets due to a required minimum of two years of ICU experience prior to being considered for an ECMO specialist position. Furthermore, each ECMO specialist has volunteered to undergo vigorous training, enabling them to function as in-house technical resources.

"In 2015, our program has developed into a Center at the Children's Hospital of Philadelphia that crosses departments in a hospital-wide, multidisciplinary approach to the most critically ill patients. This Center will focus on advancing education, research, clinical care and outreach," Holly H. Hedrick, M.D., Pediatric Surgeon and Co-Director of the ECMO Center at The Children's Hospital of Philadelphia told ADVANCE.

ECMO is a worthwhile and perhaps invaluable medical therapy option for children with acute heart and lung failure. As success rates of ECMO programs, such as CHOP's, continue to rise and demonstrate effectiveness, their usage and acceptance as a life-saving therapy will surely expand throughout the medical community.

Lindsey Nolen is a staff writer. Contact: lnolen@advanceweb.com.

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