title: Rapid Development and Implementation of an ECMO Program.
abstract: Extracorporeal membrane oxygenation (ECMO) is an established therapy in the management of patients with refractory cardiogenic shock or acute respiratory failure. In this report, we describe the rapid development and implementation of an organized ECMO program at a facility that previously provided ad hoc support. The program provides care for patients within the Emory Healthcare system and throughout the Southeastern United States. From September 2014 to February 2015, 16 patients were treated with either venovenous or venoarterial ECMO with a survival to decannulation of 53.3% and survival to intensive care unit discharge of 40%. Of the 16 patients, 10 were transfers from outside facilities of which 2 were remotely cannulated and initiated on ECMO support by our ECMO transport team. Complications included intracerebral hemorrhage, bleeding from other sites, and limb ischemia. The results suggest that a rapidly developed ECMO program can provide safe transport services and provide outcomes similar to those in the existing literature. Key components appear to be an institutional commitment, a physician champion, multidisciplinary leadership, and organized training. Further study is required to determine whether outcomes will continue to improve.
authors.affiliation: From the *Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; †Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; ‡Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; §Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; ¶Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; ‖Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; #Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and **Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Moll
authors.forename: Elrond Y L
authors.initials: EY
authors.lastname: Teo
authors.forename: David S
authors.initials: DS
authors.lastname: Grenda
authors.forename: Cindy D
authors.initials: CD
authors.lastname: Powell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Connor
authors.forename: Bryce T
authors.initials: BT
authors.lastname: Gartland
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Zellinger
authors.forename: H Bruce
authors.initials: HB
authors.lastname: Bray
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Paciullo
authors.forename: Craig M
authors.initials: CM
authors.lastname: Kalin
authors.forename: Jean M
authors.initials: JM
authors.lastname: Wheeler
authors.forename: Duc Q
authors.initials: DQ
authors.lastname: Nguyen
authors.forename: James M
authors.initials: JM
authors.lastname: Blum
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy; D012770:Shock, Cardiogenic / Q000628:therapy