UK leading the way in vital ECMO and ECMO transport

Extracorporeal membrane oxygenation, or ECMO, is typically used for patients with life-threatening heart conditions. But throughout the pandemic, ECMO has been a key treatment and life saver for some severe COVID-19 patients.

Julia Jones Akhtarekhavari, BSN, RN, Heart Failure Operations Director, and Thomas A. Tribble, Mechanical Circulatory Support Coordinator, Gill Heart and Vascular Institute, explain what ECMO is, what’s used for and why ECMO – and our ECMO transport team – are such life savers for Kentuckians.

What is ECMO?

Akhtarekhavari: It is an external and temporary mechanical support system made up several key components, mainly the oxygenator and the pump. 

Tribble: The therapy requires a patient’s blood volume to be circulated through a blood pump and oxygenator membrane, which acts as an artificial lung. The oxygenator removes carbon dioxide and transfers oxygen directly into the blood stream. 

What is it used for?

Akhtarekhavari: ECMO is used when patients experience acute respiratory failure and/or cardiogenic shock. It allows the care team to manage and treat the patient’s illness while still supporting the patient’s vital organs. It can also be used be used to support patients as they wait for heart and/or lung transplants.

Tribble: ECMO in the setting of acute respiratory failure due to COVID-19 is used to provide additional respiratory and sometimes cardiac support when conventional support like a ventilator or pharmacological support is not enough to support a patient. 

Who needs ECMO?

Akhtarekhavari: For adult patients, it’s primarily used for patients with severe pneumonia or patients that have had an acute myocardial infarction that causes cardiogenic shock.

Tribble: Patients who suffer from severe or acute respiratory distress or cardiac failure sometime require ECMO support to prevent further decline of vital organ performance.

How does it help COVID patients?

Akhtarekhavari: COVID patients can develop acute respiratory distress syndrome that will require the patient to be on a ventilator. When the illness becomes severe, a ventilator may not be able to provide enough support to the patient, and because of the high settings required to support the patient, the ventilator can cause additional injury to the lungs. 

In these patients, ECMO can be used to support oxygenation while also allowing ventilator settings to be reduced and the lungs to rest and heal.

Why is UK HealthCare such a leader in ECMO/ECMO care?

Tribble: UK has a long history of embracing innovative technology over several decades. ECMO was one of the therapies that our medical center dedicated resources and training towards many years ago in order to meet the needs of patients of all demographics (neonatal, pediatric and adult). The experience we gained in the deployment and management of ECMO technology allowed our team to become one of the few centers in our region to become an ECMO Center of Excellence. 

Why is ECMO such a big deal for healthcare?

Akhtarekhavari: We are here to serve the people of Kentucky, and because we are UK HealthCare, we believe it is our responsibility to provide this advanced technology and care. We take great pride in our ability to provide the most critically ill patients a chance at survival when all other treatments are failing.

Tribble: ECMO is a tool that allows healthcare providers another option when treating the most critically ill patients facing a greater than normal mortality risk.

What happens when ECMO capacity runs out?

Tribble: Unfortunately, with limited specialized equipment and the components required to run these sophisticated circuits, sometimes the demand for ECMO exceeds our capacity. During these times, our leadership team constantly monitors our program’s needs and makes every attempt to help us run at maximum effectiveness. With limited resources during this worldwide pandemic, we have to recognize our limitations and provide the best care to as many patients as we possibly can for as long as we can. 

Do we take out-of-state patients for ECMO? 

Akhtarekhavari: Typically, we do accept out of state ECMO patients. However, with increased demands from inside Kentucky we have made it a priority to help Kentuckians during this current COVID surge.

How do we decide who goes on ECMO?

Akhtarekhavari: We consider numerous factors before making a decision in an attempt to identify patients that are most likely to benefit from ECMO support. 

Sadly, some patients will not benefit from ECMO despite being very ill. In these cases, we could actually cause harm or distress to the patient and their family while not improving the chance at survival.   

What about our ECMO transport team? How does that work?

Akhtarekhavari: As mentioned before, caring for patients supported by ECMO can put a strain on our resources. It takes a well-trained team of physicians, ECMO specialists, perfusionists, nurses, respiratory therapists, pharmacists, physical and occupational therapists and many more to provide optimal care to these complex patients. 

Because of the complexity of providing care, we frequently get calls to assist outside hospitals that are able to initiate ECMO support but prefer to send the patient to UK HealthCare where we have such a highly-specialized, expert team. 

We also are contacted to coordinate use of ECMO support for outside hospitals that are not able to initiate ECMO. In these cases, we attempt to coordinate initiation at the hospital with the assistance of our transport team. 

Our transport team is comprised of a critical care nurse and paramedic with ECMO training as well as a perfusionist and EMT. Once our physician leadership accepts an outside patient to UK HealthCare, our team is activated to retrieve the patient and bring them back here.

Why is ECMO transport such a big deal for the care we can provide?

Akhtarekhavari: We developed the ECMO transport team so that we could support outside hospitals in saving the most critically ill patients. ECMO patients cannot be transported by traditional transport services, and without our team the patients would not be able to get to UK HealthCare for the specialized care they need.

Tribble: Many patients are limited to local intensive care units with little to no options due the severity of their illness and can’t be safely transferred without risk of further injury or death. Our ECMO Transport team can safely transport patients while providing adequate respiratory and hemodynamic support, thus increasing chances for a favorable patient outcome.