Pursuing Excellence in ECMO

Monday, June 13, 2016

In 2014, WellSpan York Hospital began reporting outcomes relating to its extracorporeal membrane oxygenation (ECMO) program to the Extracorporeal Life Support Organization (ELSO) in an effort to provide the best possible care and practices for its heart patients.

Currently at the silver level on ELSO’s “Path to Excellence,” the ECMO program at WellSpan York Hospital is well on its way to receiving Center of Excellence accreditation in 2016, which requires a minimum three-year membership to obtain.

“Our program is reviewed by ELSO in terms of practices, policies and outcomes,” says Dave Kaczorowski, MD, Director of Mechanical Circulatory Support. “It’s a multi-step accreditation that is good for our patients and our program.”

ECMO is a short-term, lifesaving technique used for patients suffering from acute respiratory and/or cardiac failure. Similar to the cardiopulmonary bypass circuit used in operating rooms every day, ECMO replaces the natural function of the heart and/or lungs, allowing those organs to recover and buying valuable time for diagnosis and treatment of underlying conditions.

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A basic ECMO circuit consists of cannulas, tubing, a pump and an oxygenator. An ECMO circuit can be used in two ways: veno-venous (VV) or veno-arterial (VA).

VV-ECMO is used in patients with acute pulmonary failure and provides only gas exchange support — moving blood from the patient to an oxygenator, which removes carbon dioxide and oxygenates the blood. These patients rely on their natural cardiac function to circulate the oxygenated blood throughout their bodies.

VA-ECMO provides full cardiopulmonary support for patients requiring both oxygenation and circulation. This method allows the blood to bypass both the heart and lungs.

“While ECMO was once a last resort, advances in technology have improved outcomes, lowered complications and made it a viable intermediate option,” Dr. Kaczorowski explains. “There has been such a surge in this area — research into pumps, oxygenators and cannulas will only continue to improve patient care and outcomes.”

“This is life-and-death technology,” adds Rich Zacour, Chief Perfusionist and Coordinator of WellSpan’s ECMO program. “The survival rate for those receiving ECMO is around 56 percent, which is a huge benefit to patients who would otherwise not have a favorable outcome.”

Not all institutions are able to offer ECMO because it relies heavily on having a cardiac surgery program as well as specialized practitioners and technology. All these pieces were in place at WellSpan when the program began in 2012, making it one of the only centers in the region to offer this type of lifesaving procedure. Last year, the program performed 57 ECMO runs, and it continues to grow as its benefits are realized.

According to Dr. Kaczorowski, there is a very short time frame for using ECMO technology once a patient is in distress. This led WellSpan York Hospital to partner with STAT MedEvac to provide safe, efficient air transport for patients requiring this intervention.

“STAT MedEvac has a very skilled staff and all the equipment necessary to bring these patients to us so we can provide optimal care in a timely manner,” Dr. Kaczorowski says. “Further, if a patient is too critically ill to be transported, a team from WellSpan can travel to the hospital where the patient is located and initiate ECMO. The patient would then be transported back to WellSpan York Hospital for ongoing management.”

Since its inception, the ECMO program at WellSpan York Hospital has continually increased the number of procedures performed each year and maintained the highest standards in the industry.

“ECMO is a niche type of technology, and we’re always looking to improve what we’re doing,” Zacour says. “We don’t have blinders on. Our view is 360 degrees, and we want to make sure we’re always on the cutting edge.”

To refer a patient for ECMO, call 717-851-BEDS (2337). For more information about ECMO, call WellSpan Cardiothoracic Surgery at 717-851-6454, or visit www.WellSpan.org/HV