ECMO (Extracorporeal Membrane Oxygenation)
Global Impact of ECMO
Extracorporeal Membrane Oxygenation is one of a handful of new therapies that has revolutionized medicine in the last 50 years. It has saved the lives of more than one hundred thousand patients worldwide (>109,000, as of this writing) since the ECMO community began compiling results. It has converted previously lethal diseases into survivable ones, redirecting the natural history of illnesses that were previously considered death sentences. It has stabilized critically ill patients and enabled the accurate diagnosis and successful treatment of diseases that before had killed patients within hours of hospital arrival. ECMO has also provided a life-prolonging bridge to heart or lung transplantation when a patient’s own organs fail to recover. Finally, because it becomes a part of the patient’s own circulatory system, the ECMO circuit can serve as a portal for other devices to supplant other failing organ systems (e.g., dialysis), remove toxic substances from the bloodstream (e.g., hemoperfusion or liver “dialysis”), or facilitate therapies otherwise unavailable without large volume blood removal and return (e.g., whole-blood phototherapy). Physicians and other ECMO team members, led by thought leaders in the field both at both Texas Children’s Hospital and across the world, are in the middle of a 2-year examination of priorities in our field that will help set the agenda for both ECMO research and clinical innovation in the decades to come.
ECMO Highlights at Texas Children’s Hospital
As befits one of the most highly regarded children’s hospitals in North America, TCH has one of the busiest and most successful ECMO programs in the world. It is available to patients in all critical care settings (PICU, CICU, Adult Congenital Heart Disease ICU, and NICU) within the hospital. And in partnership with the Kangaroo Crew transport team, it is also available to qualified patients outside the walls of Texas Children’s Hospital. In some cases, patients already on ECMO at a referring hospital but needing further care at Texas Children’s are transported on ECMO by ground or air. When a patient is too sick to risk a transfer off ECMO, the ECMO service will come to the referring hospital, place the patient on ECMO first, and then transport that patient on ECMO back to Texas Children’s Hospital.
In 2022, the ECMO team cared for a total of 95 patients for a total of 99 ECMO runs, with survival outcomes that exceed national and international averages. This year, as of August 1, we have treated 48 patients with 51 runs, with very similar results. Moreover, since the onset of the COVID-19 pandemic with its long associated respiratory ECMO runs, we have seen a dramatic increase in ECMO hours:
This increase in volume means that our professionals continue to acquire the experience necessary to ensure the highest quality care and outcomes for our patients on ECMO and that TCH will continue to rank among the best centers in the world.
In 2018, our center was designated a Center of Excellence at the Gold Level by the Extracorporeal Life Support Organization (ELSO), an international body of ECMO Centers dedicated to advancing quality, education and research in ECMO throughout the world. In 2021, we were re-designated as a Center of Excellence at the Platinum level. This is the highest level conceded by ELSO and one held by about 30 ECMO centers worldwide.
For the academic year 2019-20, we inaugurated a 1-year ECMO “Fellowship” program and successfully recruited the first pediatric subspecialist to this training program. We have had a three “fellows” complete the program and receive their first faculty appointments. Our 4th and 5th fellows are currently completing their respective stints. The fellows receive immersive experiences in both pediatric and adult ECMO, with extensive ECMO transport experience and have provided outstanding leadership both within the institution and outside our walls during their adult ECMO rotations. For the 2024-25 academic year, we will have 2 fellowship slots for interested learners. We describe that program and its mission, objectives, the application process and curriculum under the ECMO “Fellowship” tab.
In addition to the clinical service, faculty and staff from the Texas Children’s Hospital ECMO team maintain active research and teaching programs, and have been active in developing novel curricula, in Spanish, to train new teams developing ECMO programs in Latin America. With the opening of a new multispecialty hospital in North Austin that includes congenital heart surgery, a combined PICU/CICU and a NICU, the ECMO faculty and professional staff will also be building ECMO capacity there by training all professionals in the cannulation, care and decannulation of ECMO patients.
On July 20, 2022, we established the first-ever ECMO Specialists’ Day at Texas Children’s Hospital. The goal of the day was to recognize the tremendous efforts put forth by our ECMO specialists. Activities included presentations by a retired cardiac surgeon, who paid great respect to the importance of ECMO specialists, as he shared his views on his unique experience as both an ECMO surgeon and ECMO patient prior to his own lung transplant (click here to see Dr. McKenzie’s tribute), and by the perfusionist who inaugurated the ECMO specialist program here at Texas Children’s Hospital (click here to see Mary Claire McGarry’s talk). This year we will celebrate ECMO Specialists’ Day on October 18, 2023 and have invited specialists from all the ECMO centers at the Texas Medical Center to join in the celebration, with the ultimate plan to convert this day of recognition into a national and international event.
We have an extensive quality improvement program, and in 2021 inaugurated a monthly quality improvement conference that also meets an American College of Surgery requirement to review all ECMO mortalities and major morbidities. The conference is called EPIC (ECMO Performance Improvement Conference). We have also sponsored an educational conference series on Mechanical Circulatory Support that we open to anyone interested in learning. We invite a mix of local and internationally-recognized speakers to share their expertise with all who join the call. We have had attendees from around the world log in every other Thursday to listen to these presentations and ask questions of the expert presenters. You, too, are free to join these sessions by clicking here every other Thursday at 1 PM CST/CDT, but please contact us to receive the login password.
Finally, Texas Children’s Hospital is hosting the second international symposium on pediatric extracorporeal and paracorporeal technologies, entitled PPETS. This an NIH-sponsored, virtual symposium dedicated to gathering international experts in ECMO, VAD, dialysis and other renal replacement therapies, MARS and pheresis technologies to define knowledge gaps and research priorities in 6 different domains for the next 15-20 years. The domains include: Outcomes, Quality, Pharmacokinetics, Ethics, Innovation, Combined Circuits The first Summit was held on October 16-17, 2023.
Many thanks for your interest in our ECMO program and do not hesitate to contact us if you would like further information.