Though extracorporeal membrane oxygenation, or ECMO, has been around since the 1970s, it had not found its place treating adult respiratory failure patients until recently, said Gerald Weinhouse, MD, BWH Pulmonary Division.
ECMO is a technique that removes blood from the body, oxygenates and removes carbon dioxide from that blood, and then returns the blood to the body. This technique allows the patient’s damaged lungs or heart time to take a break and recover. The technique is similar to cardiopulmonary bypass used for heart surgery, but ECMO can be used for days or weeks.
Now, thanks to BWH’s ECMO service, which is celebrating its one-year anniversary, the technique not only serves adults in severe respiratory distress but can also support patients with sudden cardiac arrest. It can also serve as an advanced bridge to lung transplant.
“ECMO isn’t a cure,” said Philip Camp, MD, BWH Division of Thoracic Surgery, one of the service’s four medical directors. “It essentially provides time, or a bridge, between where a patient is and where they need to be. This may be recovery or lung transplant, or in cardiac patients, a bridge to a more durable device.”
A Team Effort
This time last year, Camp and the rest of the ECMO team expected to treat between eight and 12 patients annually with the device. In reality, 24 patients have relied on ECMO, including recovering H1N1 patients, whose oxygen levels were greatly compromised.
The service itself is multidisciplinary. It doesn’t fall under any one division or group, and it collaborates with BWH’s Cardiogenic Shock Team, which provides a rapid, coordinated response when patients whose hearts are too weak to pump blood to their organs are admitted to the hospital. ECMO medical directors Camp, Weinhouse, anesthesiologist David Silver, MD, and cardiac surgeon Gregory Couper, MD, share responsibilities for decisions about how to apply the technology and which patients are appropriate. Susan Lagambina, BWH Respiratory Care Services, and Michael Gilfeather, BWH Perfusion Services, are co-team leaders and subject matter experts. They guide a team of 15 ECMO specialists, working to train and teach care providers across BWH about the technology so that more people understand where it fits into patient care.
“The impetus to start the program was the loss of one of my transplant patients,” said Camp. “I believe that if we had ECMO technology at the time, we could have saved him. We decided to commit ourselves to developing an ECMO service, and BWH’s leaders have supported us the whole way. I am tremendously proud of the effort of each and every member of the team.”
Added Weinhouse: “For those patients who walk out our door after recovery using ECMO, and for those who can bridge to lung transplant, it’s enormously gratifying. We hope to grow the program and expand its use to serve cardiac arrest patients, high-risk OB patients and others. We want to be present for any emergency that may arise.”