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ECMO program expanding to more intensive care units

Sep. 12, 2019, 10:28 AM

VUMC’s ECMO program has expanded to areas outside of the Cardiovascular Intensive Care Unit.
VUMC’s ECMO program has expanded to areas outside of the Cardiovascular Intensive Care Unit. (photo by Anne Rayner)

by Matt Batcheldor

For more than 25 years, Vanderbilt University Medical Center has offered ECMO, a life-sustaining mechanical pump that temporarily takes over for the heart and lungs of critically ill patients, allowing them to rest and recover. Its ECMO program is the first and largest in Middle Tennessee and one of the largest in the nation.

This year, for the first time in a systematic way, VUMC has expanded its ECMO program from its longtime home in the Cardiovascular Intensive Care Unit (CVICU) to the Medical (MICU) and Trauma Intensive Care units. That means more patients can benefit from the life-saving treatment and patients and families can benefit by staying with their initial care team, rather than shifting to the CVICU when ECMO is necessary.

VUMC is now one of only a few hospital systems in the country that regularly offers ECMO outside the CVICU.

“It allows people to receive optimal care from nurses, advanced care practitioners and physicians who manage medical and trauma patients every single day,” said Matthew Bacchetta, MD, MBA, MA, associate professor of Thoracic Surgery. “And that makes us different from every single program in the region. There’s no program in the Southeast region that offers such diverse and expansive coverage.”

“It provides the patient more continuity of care,” said Todd Rice, MD, MSCI, associate professor of Medicine and director of the MICU. “I think the model is pretty unusual. We may not be the only center in the U.S. doing medical ECMO, but there aren’t very many of them.”

ECMO stands for extracorporeal membrane oxygenation. The machine’s external pumps and oxygenators remove carbon dioxide from the blood, replace it with life-saving oxygen and then return it to the patient’s circulatory system. Rice said Vanderbilt delivers ECMO to more than 100 patients each year.

Since Bacchetta’s arrival last year, Vanderbilt has expanded the use of ECMO in keeping patients alive who are waiting for a lung transplant, and the heart transplant program has made similar progress under the leadership of Ashish Shah, MD, professor and chair of Cardiac Surgery.

The expansion of ECMO was the culmination of a multidisciplinary educational outreach campaign led by Whitney Gannon, MSN, MS, assistant in Medicine. Gannon created curriculum and helped teach physicians, surgeons, advanced practice providers, nursing leaders and educators about ECMO. More than 300 nurses completed basic ECMO training and another 100 received subsequent advanced training. An additional 100 physicians and advanced practice nurses received training, including classroom and simulations.

“This model allows real integration of ECMO into the usual critical care by disease state,” Gannon said.

Vanderbilt LifeFlight is also the first health care provider in Middle Tennessee to provide ECMO via transport. LifeFlight’s helicopter, fixed-wing aircraft and ground ambulances provide ECMO, ensuring that patients requiring ECMO from distant locations can be safely transported to Vanderbilt.

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