UT Southwestern has provided extracorporeal membrane oxygenation (ECMO) to patients in need since 2012, and now serves more than 50 patients each year. This program supports heart and lung transplant teams that rank among the top 25 in volume nationally. So, during the pandemic, when patients whose lungs were failing due to COVID-19 presented at William P. Clements Jr. University Hospital, UT Southwestern had the infrastructure in place to serve the needs of the Dallas community. In recognition of these achievements, and following a review of the program’s systems of care, UTSW was named a Platinum Center of Excellence by the Extracorporeal Life Support Organization (ELSO).

A strong ECMO team

Amy Hackmann, M.D., Surgical Director of the ECMO program, was recruited to UTSW in September 2019 for her experience with ECMO and other temporary support devices. Throughout her career, she has taken care of more than 1,000 ECMO patients and is in her ninth year directing an ECMO program, including more than six years at Keck Hospital of USC in Los Angeles. One of her main achievements has been to further protocolize the care of ECMO patients to improve consistency. She has also bolstered nurses’ education to empower their involvement during all aspects of ECMO including cannulation.

After the cannulation is done by Dr. Hackmann or another cardiac surgeon, ECMO patients continue to be supported by a highly trained team. Each patient has their own bedside nurse who has received classroom and hands-on training for managing the ECMO machine. Patients are also assigned an ECMO nurse specialist who is responsible for only two or three patients and has additional training, especially for responding to emergencies. “Stellar nursing involvement in patient care is a big part of why we received ELSO’s Platinum Center of Excellence recognition this year,” Dr. Hackmann said.

Other members of the team include perfusionists, intensivists, hematologists, infectious diseases specialists, gastroenterologists, pulmonologists, and cardiologists, as appropriate. “It’s common sense that each service needs acuity and has to be ready for expedited help whenever they’re called, but it’s easier said than done,” said Fernando Torres, M.D., Professor of Internal Medicine and Medical Director of Lung Transplantation at UT Southwestern. He also directs UTSW’s Pulmonary Hypertension Program, which is one of the largest in the U.S. “At UT Southwestern, the departments really do collaborate well,” he said, adding that all involved departments review their cases at monthly meetings and think about how to streamline the care they offer.

Jennifer Thibodeau, M.D., a cardiologist who is Medical Director of the Heart Failure Program and Medical Director of the ECMO program added, “We have also built a formal cardiogenic shock team to expedite assessment of patients with cardiogenic shock, evaluate their need for temporary mechanical support, and optimize their care in order to improve outcomes.”

Already, the team’s survival rates are better than ELSO benchmarks for both respiratory and cardiac support.

Sharing expertise

Through ELSO, Dr. Hackmann, an Associate Professor in the Department of Cardiovascular and Thoracic Surgery, shares the team’s collective experience by training doctors all over the world on cannulation and patient care. She also leads the UT Southwestern team in their outreach and support of local hospitals, including Parkland Health and Hospital System, where UTSW physicians provide care.

“Working with [UT Southwestern pulmonologist] Matthew Leveno, we started an ECMO program at Parkland in April 2021 in response to COVID-19,” said Dr. Hackmann. Being at a public safety-net hospital, “patients [at Parkland] don’t usually have the option to go to another hospital and would otherwise have died without ECMO support,” she said.

“Our support to the community during the pandemic has been significant,” said Dr. Torres. “We have collaborated with several institutions to help them develop their ECMO programs and better care for patients in need of this technology.”

Future plans include creating a patient-retrieval program that would equip members of the ECMO team to cannulate a patient at a nearby hospital that lacks the technology, stabilize the patient, and bring them to UT Southwestern for continued care. There is also significant commitment from the UT Southwestern administration to grow the program, including the creation of dedicated ECMO space in the ICU.

Challenging case ends well

Of course, the most important hallmarks of a platinum ECMO program are the patients who wouldn’t be alive without it. So, we close with the story of a man in his early 60s. According to Dr. Torres, COVID-19 had destroyed this man’s lungs; he couldn’t oxygenate, and he had major bleeding in his chest. ECMO was his only hope. It took a few months on ECMO, but the team was eventually able to convert him to mechanical ventilation. Then, he went through several months of rehabilitation until he was strong enough to undergo a lung transplant. Amazingly, he is now doing well.