Meet Michigan Medicine: ECMO Program
If you weren’t familiar with the term “ECMO” before March 2020, chances are you’ve heard it once or twice (or dozens of times) in the two years since then. That’s because the devastating impact of COVID-19 on respiratory, cardiovascular and other organ systems has called for more frequent use of ECMO — Extra Corporeal Membrane Oxygenation — a last resort treatment for patients who likely would not survive without it.
What is ECMO?
“ECMO is a life support system that provides oxygenation and maintains circulation to all of the vital organs in patients who are experiencing heart or lung failure,” said Jonathan Haft, M.D., surgical director for the Cardiovascular Intensive Care Unit and Adult Heart Transplant Program, and medical director for the Extra Corporeal Life Support (ECLS) Program, which includes ECMO.
“ECMO gives those patients an opportunity to survive until we can either come to a resolution of their heart or lung failure or replace those failing organs, if appropriate,” Haft said.
Small team, big demand
Since the start of the pandemic, the small but mighty team of life-saving nurses and respiratory therapists in the ECMO Program at U-M Health has been called into action like never before.
“COVID-19 has skyrocketed our volume and our pump hours,” said Steve Robinson, R.N., clinical nursing director for ECMO. “Patients are going on ECMO more frequently, we do more runs and the patients who are on ECMO are on for an extended period — sometimes months at a time.”
“It used to be that an ECMO run would be a week or two at the most,” he said. “The average COVID-19 ECMO run is about 10 weeks. This has really driven up our workload.”
The ECMO Program has just 28 team members — a number that has not grown during the pandemic. Half of the team members are registered nurses and half are registered respiratory therapists. Despite the difference in backgrounds, all team members perform the same critical work.
According to Robinson, Robert H. Bartlett, M.D., one of the founding fathers of ECMO who started the program at U-M, wanted both professions on the team because both bring important skills to the mix. And, working together, they provide optimal life-saving support to the patients who need them.
“We provide ECMO support for little babies, for children and for adults across five ICUs throughout our institution,” said Haft. “Although the number of patients requiring ECMO has gone up during the pandemic, we support patients with many conditions beyond COVID-19.”
Joanna Maertens, R.N., B.S.N., ECLS specialist, has seen the rise in demand over the years.
“I’ve been part of the ECMO team for 10 years this June,” said Maertens. “When I started, we had 70 runs per year. In 2021, we had about 150 runs.”
Maertens said the adult population accounts for most of that increase.
“Our pediatric and neonatal runs have stayed consistent at around 35 per year,” she said. “The rest of that number has been adults.”
Steve Probst, RRT-ACCS, B.B.A., ECMO specialist, said more hospitals have become aware of the ECMO capabilities at U-M Health and send their complicated patients here for life-saving support.
“We are involved in somewhere between 12 and 20 transports a year,” said Probst. “Sometimes the ECMO team goes with Survival Flight to pick up adult cardiac patients from other hospitals. Other times we go down the road in an ambulance to transport patients nearby who need our care.”
Highly trained and skilled
Each new member of the ECMO team undergoes a year-long training, which includes a week of classroom learning followed by a 12-month orientation.
“The orientation is quite a bit longer than you would have on almost any other unit,” said Robinson. “We deal with a small set of patients, relatively speaking compared to other units, and there are a number of situations we don’t get to see very often.
“We want to be sure people feel fully prepared for those infrequent events when they come off orientation,” he said.
Spencer Hanson, R.R.T., B.A.S., ECMO specialist, is one of the newest team members who joined the program eight months ago.
“We are constantly making sure that we have the resources available, that we are perfecting our practice and our skills, and that each member of our team feels supported,” said Hanson.
Brooke Underwood, R.R.T., E.L.S., ECMO specialist, a six-year veteran of the team, is grateful for the ever-evolving knowledge she gains as a member of the ECMO Program.
“What I enjoy most about being part of the ECMO team are the many, many things I’ve learned and the people I’ve learned from — the people who have taught me and the patients I’ve had the honor of taking care of,” Underwood said.
Teamwork, resilience and perseverance are words team members use to describe each other and their work together. They are also the values the team has relied on to get them through the last two years.
Robinson said the ECMO team is completely bought into the teamwork concept.
“They care about each other very deeply,” he said. “It almost has to be that way. We’re the only 28 people in the hospital who know how to do this job, so we definitely rely on each other to a great extent.”
“We’ve had a lot of people pick up extra time and fill in the gaps so we can continue to provide the quality care that is expected of us and that our patients deserve,” said Underwood. “We are very well supported by our nursing director, Steve, who fills the holes and does what needs to be done when we are very busy,” she added. “I don’t know if we could’ve gotten through the pandemic without him and the support he provides.”
That teamwork extends beyond ECMO to include the many experts with whom the team collaborates across patient care areas.
“We coordinate with a lot of the other services,” Probst added. “Physical therapy, bedside nurses, primary care teams, consulting teams, respiratory therapists and pharmacy…. We collaborate with all of these people to get the best care we can for our patients.”
Resilience and perseverance
Despite the drastic increase in demand for ECMO services during the COVID-19 pandemic, the ECMO team remains strong, dedicated and passionate.
“I think what I’m most proud of is the perseverance,” said Haft. “We have a lot of retention of members of our ECMO team. Many of them have grown old and retired with us.
“Despite the fact that this is very hard work — it’s very challenging, it’s emotionally very stressful — they are passionate about it,” he said. “They love their job and, because of that, they stay with it.”
“The resilience and dedication of this team is what makes me most proud,” said Robinson. “This is a team that hasn’t grown but our volume has gone up almost 50 percent in the last two years due to the pandemic.
“No matter what happens, they just keep coming to work every day and providing amazing care to patients who would have probably died without them,” he said.
Physicians specializing in ECMO at Michigan Medicine and a colleague in the U-M School of Public Health are co-leading an international effort to study the use of ECMO in COVID-19 patients. Their research has shown the importance of patients receiving ECMO at hospitals with experienced providers and care teams, and addressed additional considerations for the use of ECMO in patients with COVID-19.
For more on the ECMO Program, check out the recent episode of Adult Hospitals Short Takes highlighting the critical work of the team.