Extracorporeal Support Program

Turning Heads, Saving Lives

Extracorporeal Membrane Oxygenation (ECMO) provides temporary support of heart or lung function using mechanical devices. The process involves continuous drainage of venous blood to an extracorporeal circuit, removal of carbon dioxide and addition of oxygen via an artificial lung, and returning blood to the patient using a mechanical heart. There are two types of ECMO, Veno-venous where the blood is removed and returned to the veins or Veno-arterial where the blood is taken from vein/s and returned to an artery.

ECMO treats infants and children with respiratory failure, heart failure, septic shock and cardiac arrest. Patients with respiratory failure secondary to ARDS, meconium aspiration, persistent pulmonary hypertension,  status asthmaticus and others respiratory illnesses can be treated with Veno-venous ECMO. Patients with cardiac failure, septic shock and cardiac arrest are usually placed on Veno-arterial ECMO.

ECMO “run” is the time period when a patient is on ECMO support.  The four stages of the run are cannulation when a patient is placed on ECMO, recovery stage when patient is resting on ECMO, weaning when the patient’s ECMO support is decreased and decannulation when patient is detached from ECMO support. The duration of an ECMO run cannot be accurately predicted in advance as it depends on multiple disease and patient factors. Since this is a high risk therapy, we follow international guidelines for the use of this therapy. The care of the patient on ECMO is by a multidisciplinary team consisting of intensivists, surgeons, ECMO specialists, nurses and other medical specialists.

ECMO Leaders at Le Bonheur 

At Le Bonheur Children's Hospital, utilization of ECMO has contributed to saving the lives of the most critically ill children. Dr. Mark Bugnitz and Deborah Chyka, RN initiated our ECMO program in March, 1990 and we have treated more than 380 patients to date. The other medical directors to lead the program since its inception are Dr. Mike Quasney and Dr. Samir Shah.

Current leaders of the ECMO team are Dr. Hitesh Sandhu (Medical Director), Dr. Samir Shah (Associate Medical director), Samantha Ransone, RN (ECMO/Apheresis Coordinator) and Morgan Melancon, RN (ECMO/Apheresis Coordinator). The ECMO team also includes 8 ECMO primers and 31 specialists (26 RNs and 5 RRTs).

The other extracorporeal therapies provided by the ECMO team are continuous renal replacement therapy (CRRT) and Apheresis. The principles and indications of CRRT are similar to dialysis, i.e. it is used to treat renal failure and fluid overload. It is a steady continuous procedure in a sick patient who might not tolerate intermittent dialysis. Apheresis involves separation of plasma from the rest of the blood and its replacement with other fluids. This therapy can be used to treat Renal, Neurological, Cardio, Rheumatological and other diseases due to abnormal antibodies or absence of certain blood factors.

Extracorporeal Life Support Organization

The Extracorporeal Life Support Organization (ELSO) is an international consortium of health care professionals who promote collaboration in the development and evaluation of therapies to support failing organ systems. Currently there are over 170 centers internationally that contribute data to the ELSO registry.

Each year, ELSO awards international ECMO programs that showcase the highest level of performance, innovation, and quality with their “Center of Excellence” Award. This prestigious award is given for a three year period.  Le Bonheur has the distinction of receiving this recognition three times in a row. This award is based on the exceptional and extraordinary achievement in three categories:

• Excellence in promoting the mission, activities, and vision of ELSO
• Excellence in patient care by using the highest quality measures, processes, and structures based upon evidence
• And excellence in training, education, collaboration, and communication that supports the ELSO guidelines and contributes to a healing environment

In an environment now focused on outcomes, the ELSO Award for Excellence in Life Support provides evidence of the commitment of the institution to high quality state of the art healthcare. Le Bonheur Children's Hospital is a “great example of a center that has been in practice for a while, seizing new opportunities for enhancing outcomes” (Hines, 2010).