October 3, 2008

Rapid response team’s efforts lauded

Featured Image

The ECMO team includes, from left, Alice Mason, Andy Bledsoe, Theresa Rogers, Christy Worden, Sabrina Sheppard, Daphne Hardison, Cindy Thomason, Amanda Carter and Lee Ann Hossler. (photo by Neil Brake)

Rapid response team’s efforts lauded

A few weeks ago, a 13-month-old boy went into respiratory failure at the Monroe Carell Jr. Children's Hospital at Vanderbilt because of an overwhelming strep infection.

When even the top life support measures began to fail in the Pediatric Critical Care Unit (PCCU), the ECMO (Extracorporeal Membrane Oxygenation) team was called.

“We have a deadline of pulling the team together and preparing the machine within 15 minutes, but this time — like most times — it only took five minutes,” said Cindy Thomason, R.N., co-manager of ECMO services at the Children's Hospital.

Rapid responses like that, along with the quality and success rates achieved by the 18-member, rigorously trained ECMO team have earned it international recognition. This month, the ECMO service at Children's Hospital was named a Center of Excellence by the Extracorporeal Life Support Organization (ELSO), which monitors quality standards for 151 member ECMO services around the world.

Pat Givens, R.N., chief nursing officer at Children's Hospital, cheered the award for the nearly 20-year-old program. “ELSO uses the highest quality standards. We celebrate this achievement and every member of this team,” she said.

“The team approach is really the key and at the core of this program,” said Mary Taylor, M.D., one of the physician directors of the ECMO service, citing the team's top-level training. ”All members of the team must be ready to react immediately and give 100 percent.”

“Our team has more than 300 years of critical care experience combined, with 100 of those years of experience in ECMO,” said co-manager, Daphne Hardison, R.N. ”We have consistently been one of the busiest ECMO programs in the United States, frequently among the top 10.”

An ECMO machine is similar to a heart-lung bypass machine, but it is used outside the operating room, often for weeks, to take the place of an ineffective heart or lungs (or both), until medical treatments can restore the organs' function.

Most ECMO patients, like the 13-month-old in the PCCU, are young children or babies. As is often the case, the ECMO team worked quickly and in tandem with a surgical team to insert the ECMO tubes, and “bypass” the toddler's lungs, right in the patient's room. The team monitored the boy 24 hours a day, supporting his lungs for a total of 166 hours. He ultimately recovered.

“The goal is to take a patient who has a 60 or 70 percent chance of dying without ECMO, and flip those numbers. We want 60 or 70 percent of patients to survive the episode with ECMO support and return to full function,” said John Pietsch, M.D., surgical director of ECMO services.

The Children's Hospital ECMO team has an excellent record of meeting that goal with between 45 and 60 pediatric patients, and about 2 adult patients, every year. The service is one of just two in the state and is the largest in the region.