With seasoned operators, ECMO’s lifesaving uses grow

For decades, hospital operating room staff have used heart-lung bypass machines to keep blood flowing to patients’ vital organs during extensive surgeries. Today, the descendants of those devices, ECMO (extracorporeal membrane oxygenation) machines, provide that same essential life support, but for much longer durations.  

For days, weeks or months, these machines can circulate oxygenated blood to keep people alive as they recover from a host of conditions.  

“Depending on where you put the cannulas (tubes that circulate oxygenated blood), it can take the place of both the heart and lungs or support just one of those organs. A patient can have zero function of their heart or lungs, and we can keep them alive with ECMO,” said Dr. Jenelle Badulak, an emergency-medicine specialist and associate ECMO program director at UW Medicine in Seattle. 

In 2012, when the healthcare system bought its first three ECMO machines, the focus was on facilitating organ transplants. 

“If you put an organ in someone and it doesn’t work right away, ECMO could buy the patient time. Now it’s used for a broad swath of heart and lung diseases that may or may not involve transplants,” she said. 

Today, 13 machines are deployed across Harborview and UW Medical Center – Montlake. As well, UW Medicine’s new mobile ECMO team can be dispatched via Airlift Northwest to Alaska, Hawaii, Montana, Wyoming, Idaho and Oregon to start patients on ECMO at referring hospitals and bring them back to Seattle.

That was the case this summer for Kelli Gehrke, 32. She and her husband had gone to Madigan Army Hospital in Fort Lewis, Washington, joyously expecting to welcome their third child into the world. But childbirth came with profound bleeding and complications leading to cardiorespiratory failure and ultimately cardiac arrest. The mobile ECMO team rescued Gehrke and transported her to UW Medical Center – Montlake.  

Also this summer, Tacoma General Hospital transferred patient Ethan Noack, 19, to Harborview Medical Center, where doctors discerned that he had experienced a severe reaction to an antibiotic, which had caused his lungs to fail.    

For both patients, ECMO machines and expert medical responses were lifesaving. 

The cases also exemplify how clinicians are expanding the machines’ use in different circumstances where a patient’s ability to recover is tenuous.  

The machines’ distinct capability is to help support patients — gradually — while their organs recover function, Badulak explained. By contrast, ventilators, the instruments typically used to assist patients’ breathing, force air into the lungs and, if used too long, can further injure the damaged lung tissue.  

“Ventilators also often require that patients are sedated and bedbound. If they’re awaiting transplant surgery, they can become too weak to receive a transplant and die,” Badulak explained.  

“ECMO has changed the game where, if someone decompensates like that from their chronic lung disease, then we can put them on the machine and walk them around while they’re waiting for a pair of donor lungs, which can take a month or more,” she said.  

For instance, Noack was tethered to ECMO for 32 days. But with escorts from his care team and his machine rolling alongside, he walked along hospital corridors to build stamina as his lungs began to recover.  

Incorporating ECMO into patients’ rehabilitation plans and launching a mobile team are examples of the proficiency that recently earned UW Medical Center – Montlake recognition from the Extracorporeal Life Support Organization. The consortium maintains a global registry of ECMO centers, distinguishing them by staff competency and training with the machines. The Montlake hospital was awarded the platinum-level (highest) award of excellence, joining 15 other U.S. adult hospitals. 

The designation, Badulak said, reflects a deep understanding of the machines and how they can be calibrated to support patients’ injured organ systems in myriad medical circumstances.  

These include COVID-19 and flu. As fall and winter bring their usual influx of hospital admissions for acute respiratory infections, ECMO use for lung failure will again shift into high gear, she predicted.  

“Influenza and other infections cause pretty bad respiratory failure in adults. So the volumes are traditionally pretty high for ECMO. It's something we can anticipate every year now.”  

For details about UW Medicine, please visit https://uwmedicine.org/about.