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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 them 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, have just completed 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 (CICU, PICU, NICU, and Adult Congenital Heart Disease ICU) 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 2023, the ECMO team cared for 99 patients with a total of 108 ECMO runs, achieving survival outcomes that exceed national and international averages. This year, as of the middle of March, we have treated 26 patients with 29 runs, with very similar results. Moreover, with the COVID-19 pandemic and the long associated adult respiratory ECMO runs, we saw a dramatic increase in ECMO hours, especially in 2022. In 2023, the total hours dropped back to 2021 levels, even though the number of ECMO runs increased:
| Year | Pump Hours |
| 2019 | 15,631 |
| 2020 | 20,470 |
| 2021 | 22,245 |
| 2022 | 33,775 |
This increase in volume means that our professionals continue to acquire and maintain 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 four “fellows” complete the program and receive their first faculty appointments, with a fifth on track to finish in July. 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 fellows, one with a background in pediatric critical care and another in neonatology.
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 (see the ECMO in Latin America). Our most recent workshop, held in Cali, Colombia, brought together a multidisciplinary group of both adult and pediatric health professionals to help build an institutional ECMO team at Clínica Imbanaco. We are planning for another workshop in Mexico City this July.
The ECMO program, its impact on one family and its global reach were featured in the 2023 Annual Report of the Department of Pediatrics at Baylor College of Medicine. The story can be found here.
Texas Children's Hospital opened its newest hospital in Austin in February 2024. To compete successfully in the Austin marketplace, that new hospital will offer a complete array of subspecialty services, including pediatric critical care, neonatology, pediatric and congenital heart surgery, and ECMO. To get the new Austin team ready for opening, physicians and primers from Houston, braving a hard freeze, held a 4-day ECMO workshop that reviewed the basics of ECMO, ECMO in special cases, and lots of problem-based learning discussions and clinical simulations, for the physicians, surgeons, advanced practice providers (NP’s and Pas), perfusionists, and respiratory therapists who will make up Austin’s ECMO team.
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). In 2023, we had a quiet recognition day for our ECMO specialists in December. This year, however, we have joined forces with institutions in Maine, Oregon, Colorado and Indiana to celebrate ECMO Specialists’ Appreciation Week from April 29-May 3, 2023. Ultimately, we plan to convert this week of recognition into a national and international event recognized by the international ECMO organization, ELSO.
We have continued growing our 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 the first Thursday of every month to listen to these presentations and ask questions of the expert presenters. You, too, are free to join these sessions by clicking here every first Thursday at 1 PM CST/CDT, but please contact us to receive the login password.
Many thanks for your interest in our ECMO program and do not hesitate to contact us if you would like further information.
