ECMO to the Rescue
A specialized pediatric team at Yale New Haven Children’s Hospital celebrated a memorable 20th anniversary in 2012. This multidisciplinary group of pediatric specialists goes into action when newborn babies and children develop life-threatening heart and/or lung issues. After all other treatments have been exhausted, a sophisticated life-support therapy, known as ECMO, is administered. During the past 20 years, ECMO has helped bring numerous children back from the brink, which makes the celebration around those success stories all the happier.
ECMO is the acronym for extracorporeal membrane oxygenation, a complex procedure that utilizes a compact, high-tech “heart-lung” machine that adds oxygen to the blood via a series of sterile tubes. The life-support treatment provides time temporarily for the child’s heart and lungs to rest and heal.
The YNHCH ECMO program, established in 1992, recently received its second consecutive “Center of Excellence in Life Support” award from the Extracorporeal Life Support Organization, an international consortium of healthcare professionals and scientists.
The need for ECMO support is extreme. In the neonatal intensive care unit, the procedure is typically necessitated within days after the baby is born. It requires the combined skills of a rapid-response, specially trained team led by neonatologists and pediatric physicians who exclusively care for newborns. YNHCH is fortunate to have seven neonatologists dedicated to the ECMO challenge, including Matthew J. Bizzarro, MD, FAAP, and Yeisid Gozzo, MD, FAAP.
“One reason ECMO is so specialized is that it takes a great deal of training and a large staff across several different medical disciplines,” says Bizzarro, the director of the program. “These include physicians, pediatric surgeons, certified perfusionists, respiratory therapists, nurse practitioners, registered nurses and physician assistants—all coming together to care for the same patient at the same time.”
Gozzo was drawn to the ECMO program by the nature of its critical consequences. “These are the sickest patients we take care of,” she says. “It’s a rewarding experience to take babies who are so near death and be able to support them as they heal and convalesce from their illness.”
Because ECMO cases are relatively infrequent, members of the team work diligently to preserve their expertise. “In order to maintain our skills in between cases, we attend education sessions and conferences,” Gozzo says. The hospital also conducts periodic ECMO simulation training.
The team puts together an emergency scenario and practices clinical procedures on a lifelike, computerized baby mannequin.
Owing to this preparedness, when a real-life crisis situation arises, the ECMO team is always ready to rally quickly. “Communication between the various disciplines is vital,” Bizzarro says. “There’s no other team dynamic that comes close to this. It’s a lot of separate but coordinated events going on at once—and we’d better be ready when the call comes in.” After 20 years and counting, the ECMO team remains ready, willing and able.