ECMO ProgramECMO ProgramDaphne Hardison, RN BSN

ECMO Manager

Welcome to the Jungle!

What is ECMO? Cardiopulmonary bypass (CPB)

Complete cardiopulmonary support in the operating room

Extracorporeal membrane oxygenation (ECMO) Partial cardiopulmonary support

Veno-arterial: cardiac and pulmonary support Veno-venous: pulmonary support

Extracorporeal CO2 removal (ECCOR) Partial pulmonary support

Ventricular assist device (VAD) Partial cardiac support

Bubble Oxygenators 1954 First CPB – Short term support ASD

repair 1971- First Adult ECMO 1975- First Neonatal ECMO 1997 – CESAR TRIAL UK 2008 CESAR Published

From this…

TO THIS!!

Dr. Robert Bartlett

First successful ECMO patient, 1971

J Donald Hill MD and Maury Bramson BME, Santa Barbara, Ca, 1971. (Courtesy of Robert Bartlett, MD)

CESAR Trial: Extracorporeal Membrane Oxygenation Improves Survival in Patients With Severe Respiratory Failure (2008)

Why Complete an Adult Trial?

ECMO History

Esperanza, Age 1 day 1975

Slide courtesy of Gail M. Annich M.D.

ECMO History

Esperanza, age 21

Slide courtesy of Gail M. Annich M.D.

ECMO at Vanderbilt How did we get started

Dr. John Pietsch Original Team Members

Christy Worden and Cindy Thomason First Patient November 1, 1989

Dr. John Pietsch

First ECMO Patient at Vanderbilt

ECMO Volumes

Year Patients Patient Days

2009 35 276

2010 79 489

2011 75 502

2012 64 442

Vanderbilt’s ECMO Program: One of the Largest in the World

Based on ELSO data according to number of ECMO

runs/year.

Consistently in top 10 last 6 Consistently in top 10 last 6 years. years.

Have been ranked as high as #1Have been ranked as high as #1

880+ patients since 1989.

700+ patients since 2002

One of 135 ECMO Centers across the globe

One of 3 in TN

Typical ECMO Programs runs around 15 ECMO cases /year utilizing up to 20-40 ECMO Specialists

ELSO – Extracorporeal Life Support Organization ECLS Registry Report Documentation Research ELSO Formed 1989 Vanderbilt Data Submitted from the

beginning ELSO Award of Excellence

ELSO Award of Excellence

“Center has demonstrated extraordinary achievement …Patient care by using the highest

quality measures….  Excellence in training, education, collaboration”

2008-2010 2012-20142010-2012

Volumes

CONFIDENTIAL INFORMATION. This information is confidential and privileged pursuant to TCA 63-1-150, and 68-11-272 et seq., and has as one of its purposes to improve the quality and safety of patient care. Do not forward or otherwise share this information external to Vanderbilt.

Number of PatientsNumber of Patient Days

Projected 2013 on current run rate Calendar Years

Interdisciplinary Same Job Code…..ECMO Specialist Dedicated team Surgical Director - Dr. John Pietsch Medical Director – Dr. Brian Bridges

PICU/PCICU: Fleming, Smith and Mettler NICU: Walsh, Grubb, Markham SICU/TICU/MICU: Rice, Miller and May

Manager – Daphne Hardison Lead Specialists

Myron Norman Pam Purcell Marguerite Knight Christy Worden

Collaboration Daily ECMO Rounds Follow Up Until Discharge Follow Up Clinic PM&I Monthly Education

ECMO Daily Rounds Call back Goals Care Bundles Standards of Care Plan to round with the Team

ECMO PM&I Meets 2nd Thursday 5:30-6:30

Initiatives Practice Changes Research

EVERYONE IS WELCOME!!

Research iCa levels in the Circuit ACT and Heparin Assay Blood Product Usage Circuit Restructure/Collaboration Improving OR Communications ECMO Staffing Models that Work

Future Growth Adult ECMO

Trauma SICU MICU

Simulation Lab

New Cannula

Oxygenators

Quadrox D – Safeline Coating

Mini Max

Silicones

EXIT Procedure

Citrate Regional Anticoagulation

Patients Ambulating on ECMO Bridge to transplant Bridge to recovery

ECMO Reunion 2003

Pediatric patient with first and only known cat to be named ECMO!!