Vanderbilt University Medical Center is one of the only centers in the country that has a clinical ECLS (extracorporeal life support) fellowship, giving new doctors two years of hands-on experience with a lifesaving critical care tool, one that has only become more important during the COVID-19 pandemic.
ECLS, also known as 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. 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.
VUMC has one of the most advanced ECLS programs in the nation, and one of the only ones in which ECLS has expanded beyond the cardiovascular intensive care unit (CVICU) to the medical intensive care unit (MICU).
“The ECLS fellows take care of the sickest patients in the hospital every day,” said Matthew Bacchetta, MD, MBA, MA, professor of Surgery and adjunct professor of Biomedical Engineering.
Bacchetta, who arrived at Vanderbilt in 2018, said he wanted to establish an ECLS fellowship as he had at Columbia University. The two-year fellowship began in 2019, just before the pandemic, with John Stokes, MD, who finished the program in 2021. Current fellows are Yatrik Patel, MD (senior fellow) and Sean Francois, MD (junior fellow).
Fellows learn every aspect of ECLS, starting with the technique of cannulation, or inserting small tubes in veins or arteries in the chest, neck or legs. They then learn techniques of managing a patient on ECLS, sometimes for weeks at a time as they manage the patient’s individual disease course. For example, patients may have end-stage heart and lung disease, acute respiratory distress syndrome, pulmonary hypertension or COVID-19.
“Having this exposure this early on in my training is extremely valuable,” Patel said. “It’s almost like a critical care fellowship combined with the ECLS fellowship.”
Ashish Shah, MD, professor and chair of Cardiac Surgery, said the fellowship has a number of unique features.
“Beyond the basic clinical demands of managing ECLS patients, these fellows are totally immersed in advanced heart and lung failure,” he said. “They collaborate at a high level with intensivists, surgeons and perfusionists, and are a key part of transporting ECLS patients from outside hospitals. Importantly, they spend time in Dr. Bacchetta’s organ rehabilitation lab where they see the future applications of mechanical support. Frankly, they are part of our cardiac surgery team. For a surgical resident only a few years into training, they get to be true experts. This was Dr. Bacchetta’s vision, and he has built something really special here at Vanderbilt.”
Fellows round with ICU teams in the individual ICU units — the CVICU and MICU. They perform other procedures on patients on ECLS, from tracheotomies to chest tube placements.
“In my first year as a junior fellow, I have never experienced such a jump in my clinical knowledge and understanding of heart and lung physiology,” Francois said. “The richness of this experience stems from the dedication and mentoring of the MICU and CVICU staff.”
Fellows work closely with multiple members of VUMC’s multidisciplinary ICU teams — both medically and surgically based teams — including nurse practitioners, attendings and perfusionists.
“The ECMO program is made of an incredible team of talented and extremely dedicated people,” Stokes said. “The experiences and learning opportunities I had while training amidst this group of people during my time as an ECMO fellow will permeate the rest of my career in medicine.”
Todd Rice, MD, associate professor of Medicine and director of the MICU, said the fellows are an integral part of the team caring for the ECLS patients. “Without the ECLS fellows, we could not maintain a highly functioning, active ECLS program in the MICU,” he said.
Whitney Gannon, MSN, ACNP, director of Quality and Education for the Vanderbilt Extracorporeal Life Support Program, described the ECLS fellows as the glue that holds the ECLS program together. “The immersive and diverse experience of the ECLS fellowship equally benefits the fellows’ learning and growth, and the patients they are helping every day.”
Vanderbilt’s ECLS program, first operating out of Monroe Carell Jr. Children’s Hospital at Vanderbilt, 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.
Bacchetta said there are very few programs that allow fellows this level of exposure to ECLS, none as extensive.
“That type of hybrid training is extraordinarily uncommon,” Bacchetta said. “It enables the fellows to develop a depth of cardiopulmonary physiology and disease management that I think makes our program unrivaled. It’s that cross-disciplinary approach.”