ECMO Team Approach Improves Odds for Critically Ill Patients

Published in Cardiovascular Report - Cardiovascular Report Winter 2019

For the 6.5 million adults in the U.S. with heart failure, implantable devices offer the potential to extend their lives. And, as time goes on, cardiac surgeon Chun “Dan” Woo Choi appreciates the increasing role of extracorporeal membrane oxygenation (ECMO).

“The implantable left ventricular assistive device (LVAD) has made a tremendous difference in quality of life,” says Choi, The Johns Hopkins Hospital’s ECMO surgical director. “Now we’re learning a lot more about the benefits of more temporary devices — like ECMO — as supportive therapy.”

Often used as a last resort following cardiac arrest or trauma, ECMO employs a pump to circulate blood through an artificial lung and back into the bloodstream. Granted, risks remain high for infection and blood clots (mortality averages about 47 percent nationally), but the process allows organs the best chance to recover function or as a bridge to transplant, says Choi. He notes that the technology continues to improve.

The Johns Hopkins Hospital manages about 65 ECMO cases per year. That number is expected to rise, says Choi, as more people suffer with chronic obstructive pulmonary disease and respiratory as well as heart failure. Two portable ECMO units enable the transport of patients from other hospitals to Johns Hopkins for further observation on the circuit.

The hospital has long been recognized as an ECMO Center of Excellence by the Extracorporeal Life Support Organization, an international nonprofit consortium of health care institutions dedicated to the evaluation and development of novel therapies to support failing organ systems. Choi leads Johns Hopkins Medicine’s ECMO Focus Group. The team of specialists across disciplines meets regularly to assess the machine’s potential, reviewing concerns and progress, case by case. Experts include a physician champion, nurse champion, intensivists, cardiologists, pharmacists and nutritionists.

Choi has also been working to promote E-CPR, extracorporeal cardiopulmonary resuscitation, in hopes of reducing fatalities in emergency departments. He and his colleagues are collaborating with Baltimore’s Mercy Hospital to come up with an algorithm to coordinate the three-part placement of femoral artery and vein catheters and life support cannulas — ultimately transitioning patients to ECMO. “We want to get the quickest access to the groin vessel, so we can stabilize the patient and find out what’s killing him or her.”