TY - JOUR
T1 - Implementation of Extracorporeal Membrane Oxygenation Without On-Site Cardiac Surgery or Perfusion Support
T2 - A Tale of Two County Hospitals
AU - Bilodeau, Kyle S.
AU - Badulak, Jenelle
AU - Bulger, Eileen
AU - Stewart, Barclay
AU - Mandell, Samuel P.
AU - Taylor, Mark
AU - Condella, Anna
AU - Carlson, Michelle D.
AU - Kohl, Louis P.
AU - Simpson, Nicholas S.
AU - Heather, Beth
AU - Prekker, Matthew E.
AU - Johnson, Nicholas J.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Patients with refractory respiratory and cardiac failure may present to noncardiac surgery centers. Prior studies have demonstrated that acute care surgeons, intensivists, and emergency medicine physicians can safely cannulate and manage patients receiving extracorporeal membrane oxygenation (ECMO). Harborview Medical Center (Harborview) and Hennepin County Medical Center (Hennepin) are both urban, county-owned, level 1 trauma centers that implemented ECMO without direct, on-site cardiac surgery or perfusion support. Both centers 1) use an ECMO specialist model staffed by specially trained nurses and respiratory therapists and 2) developed comparable training curricula for ECMO specialists, intensivists, surgeons, and trainees. Each program began with venovenous ECMO to provide support for refractory hypoxemic respiratory failure and subsequently expanded to venoarterial ECMO support. The coronavirus disease 2019 (COVID-19) pandemic created an impetus for restructuring, with each program creating a consulting service to facilitate ECMO delivery across multiple intensive care units (ICUs) and to promote fellow and resident training and experience. Both Harborview and Hennepin, urban county hospitals 1,700 miles apart in the United States, independently implemented and operate adult ECMO programs without involvement from cardiovascular surgery or perfusion services. This experience further supports the role of ECMO specialists in the delivery of extracorporeal life support.
AB - Patients with refractory respiratory and cardiac failure may present to noncardiac surgery centers. Prior studies have demonstrated that acute care surgeons, intensivists, and emergency medicine physicians can safely cannulate and manage patients receiving extracorporeal membrane oxygenation (ECMO). Harborview Medical Center (Harborview) and Hennepin County Medical Center (Hennepin) are both urban, county-owned, level 1 trauma centers that implemented ECMO without direct, on-site cardiac surgery or perfusion support. Both centers 1) use an ECMO specialist model staffed by specially trained nurses and respiratory therapists and 2) developed comparable training curricula for ECMO specialists, intensivists, surgeons, and trainees. Each program began with venovenous ECMO to provide support for refractory hypoxemic respiratory failure and subsequently expanded to venoarterial ECMO support. The coronavirus disease 2019 (COVID-19) pandemic created an impetus for restructuring, with each program creating a consulting service to facilitate ECMO delivery across multiple intensive care units (ICUs) and to promote fellow and resident training and experience. Both Harborview and Hennepin, urban county hospitals 1,700 miles apart in the United States, independently implemented and operate adult ECMO programs without involvement from cardiovascular surgery or perfusion services. This experience further supports the role of ECMO specialists in the delivery of extracorporeal life support.
KW - extracorporeal membrane oxygenation
KW - extracorporeal membrane oxygenation at noncardiac surgery center
KW - extracorporeal membrane oxygenation program
KW - extracorporeal membrane oxygenation specialist
KW - extracorporeal membrane oxygenation without cardiothoracic surgery
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U2 - 10.1097/MAT.0000000000001883
DO - 10.1097/MAT.0000000000001883
M3 - Article
C2 - 36727856
AN - SCOPUS:85160969923
SN - 1058-2916
VL - 69
SP - E223-E229
JO - ASAIO Journal
JF - ASAIO Journal
IS - 6
ER -