SEPTEMBER - 20229ECMO procedures gained significant publicity during the pandemic related to respiratory use with COVID-19 patients. But from a cardiovascular perspective in our heart hospital, our most frequent use of ECMO tends to be with patients experiencing cardiogenic shockskill required to use ECMO, only a few hundred hospitals nationwide currently have the ability to perform ECMO, including Medical City Heart Hospital, Medical City Children's Hospital and Medical City Plano, which have survival rates 18 percent -30 percent better than ELSO national ECMO registry outcomes.A recent example of the successful use of VA-ECMO demonstrates the difference this therapy can make with cardiac patients. The Medical City Heart Hospital ECMO transport team, consisting of Brian Lima, MD, surgical director of heart transplantation and mechanical circulatory support, and ECMO Coordinator Omar Hernandez, RN, traveled recently to a nearby hospital to initiate ECMO therapy for a patient who had undergone emergency triple-bypass surgery. The patient, Leo, was in post-cardiotomy shock (PCS) and not responding to treatment. PCS occurs in 3 percent -5 percent of cardiac operations and is associated with substantial morbidity and mortality, according to a 2021 article in Anesthesiology magazine. PCS is characterized by heart failure that occurs immediately postoperatively or when patients cannot wean off cardiopulmonary bypass. These situations provide the most common indications for mechanical circulatory support such as ECMO, according to an article in General Thoracic and Cardiovascular Surgery.When VA-ECMO is used in cardiogenic cases, there is typically an instant response. The patient's blood pressure will rise immediately, which is what happened with Leo. With his organs stabilized, Leo was transferred to Medical City Heart Hospital for a successful heart transplant.In the hospital, ECMO requires two staff specialists at the patient's bedside 24/7, as well as a team of surgeons, perfusionists, ECMO nurse specialists, cardiologists, neuro-radiologists, respiratory care practitioners and numerous other staff who provide support along a patient's journey of care.Although ECMO itself will not cure or treat the disease that led to heart or lung failure, it is a life-sustaining treatment that can allow more time to fix the problem. It also gives the patient's organs time to rest and recover. In Leo's case, ECMO helped stabilize him so that a heart transplant could be performed.
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