For two weeks in January, Vanderbilt University Medical Center hosted representatives of Ballad Health, a regional health system serving East Tennessee and Southwest Virginia, to train its team to provide a life-saving medical program called ECMO.
ECMO, or extracorporeal membrane oxygenation, is a life-sustaining mechanical system that temporarily takes over for the heart and lungs of critically ill patients, allowing them to rest and recover.
About two years ago, VUMC signed an agreement with Ballad Health to create an ECMO team at Ballad. Operating an ECMO program requires a high level of expertise, and January’s training was the first in-person ECMO training at VUMC since the COVID-19 pandemic began.
The sessions brought VUMC’s pediatric and adult ECMO specialists together to train 15 Ballad Health representatives during two four-day courses, a combination of lectures and hands-on activities.
“I am very honored to be a part of the collaboration between Monroe Carell Jr. Children’s Hospital at Vanderbilt and Vanderbilt University Hospital to share our ECMO experience with our partners at Ballad Health,” said Brian Bridges, MD, associate professor of Pediatrics and Anesthesiology and ECMO medical director at Children’s Hospital.
Topics at the sessions included the physiology of ECMO and the mechanics of different ECMO systems.
“We’ve been able to get speakers from a lot of different walks of life at Vanderbilt,” said Lynne Craig, RN, ECMO coordinator, who is helping to teach Ballad Health’s team of pulmonologists, intensivists, nurses and respiratory therapists how to care for ECMO patients at the bedside.
“It’s a really nice way for us to collaborate in-house as well as provide academic stewardship within the region.”
The ECMO program, first operating out of Children’s Hospital, has been serving patients for more than 32 years. It is the first and largest in Middle Tennessee and one of the largest in the nation, serving about 200 pediatric and adult patients per year. The ECMO 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. The system has become a lifeline for some of the sickest COVID-19 patients.
“ECMO is the ability to support a patient when they’re at their very sickest,” said Daphne Hardison, MSN, RN, manager of the Children’s Hospital ECMO, VAT and CRRT programs. “These patients either have lung failure or heart failure or a combination of the two. They are not able to support themselves. They are already on life support when we get them. They are already on the ventilator. That is not enough to support them.”
Ballad Health’s ECMO program is beginning to treat adult patients at its Johnson City (Tennessee) Medical Center, a five-hour drive from Nashville. VUMC has been offering ECMO care to such patients, but they face hours in a ground ambulance or Vanderbilt LifeFlight’s fixed-wing plane.
Now patients can be stabilized in Johnson City and are either treated there or transported to Vanderbilt if they require more complex care.
The agreement allows Ballad’s patients to have access to Vanderbilt’s health system, while allowing them continuity of care when they return to their local providers.
When Ballad Health patients are transported to Vanderbilt, their local physicians can use an Epic interface to monitor patients, examine labs and recommend care in collaboration with VUMC physicians. Ballad Health also gains access to VUMC’s quality meetings — debriefing on patient care, measuring outcomes and working to improve them.
This is as an exceptionally busy year for VUMC’s ECMO teams. The ECMO program at Children’s Hospital is preparing to host the Specialist Education in Extracorporeal Membrane Oxygenation (SEECMO) conference May 20-22, part of the Extracorporeal Life Support Organization (ELSO). The Adult ECMO team is developing an ECMO App for teams who come to VUMC for training. Additionally, the adult team has a podcast in which Whitney Gannon, MSN, MS, RN, APRN; and John Stokes, MD, discuss common troubleshooting techniques for ECMO patients.
