Published on in Neonatology Update
The Extracorporeal Membrane Oxygenation (ECMO) Program at Children’s Hospital of Philadelphia is one of the most active programs in the country, recently surpassing 1,000 patients treated since its creation in 1990. The program has been recognized as a Center of Excellence by the Extracorporeal Life Support Organization (ELSO) since it first applied in 2008.
Ten complete ECMO systems are available to support 50 to 60 neonates and children each year. The Newborn/Infant Intensive Care Unit (N/IICU), Cardiac Intensive Care Unit (CICU), and Pediatric Intensive Care Unit (PICU) all care for patients receiving ECMO support; 45% of ECMO patients are seen in the N/IICU, 45% in the CICU, and 10% in the PICU. In the N/IICU, ECMO is used for patients with medical conditions such as meconium aspiration syndrome, persistent pulmonary hypertension of the newborn, and respiratory distress syndrome, and surgical conditions such as congenital cystic adenomatoid malformation and congenital diaphragmatic hernia (CDH).
ECMO Center Earns Highest Honor
The program’s first and 1000th patient were both treated for CDH. Much has changed about ECMO care since that first patient. Improved medical management—including different ventilation techniques, the development of high frequency oscillators, and better medications such as nitric oxide and surfactants—and the creation of the Center for Fetal Diagnosis and Treatment in 1995 have been instrumental in improving CHOP’s survival rates for neonates in need of heart and/or lung bypass.
“Because of our interaction with the maternal-fetal medicine program, we’ve been better able to identify the patients who could do well after being supported with ECMO,” says Program Coordinator Jim Connelly, BS, RRT-NPS, who has been with the ECMO Program since its inception.
More than 25 CHOP respiratory therapists and nurses are trained as ECMO specialists. With a minimum of 2 years of ICU experience prior to learning the skills of an ECMO specialist, each 1 has volunteered to undergo vigorous training, adding to their skill sets. The 10 members who make up the ECMO Core Team have acquired additional ECMO skills and function as the in-house technical resource.
Each child on ECMO is monitored by a specialist and bedside nurse at all times. In the N/IICU, in addition to this regular ECMO care team, each patient has around-the-clock access to an attending neonatologist familiar with ECMO through a specialized “ECMO Resource MD” position.
“The establishment of the ECMO Resource among the neonatologists has been extremely helpful in the selection and management of patients,” notes Connelly.
Connelly has seen care evolve from the pre-ECMO days of rushing neonates with CDH immediately into the operation room, to early ECMO days of operating on neonates while on bypass, to the present day.
“The latest preference is to get these kids off ECMO before they operate, so they’re not anticoagulated when they have their repair,” says Connelly. “This puts them in a much better position for surgery.”