A Regional Referral Center for Adult ECMO

By Thomas Crocker
Monday, May 1, 2017

Twenty years after first providing extracorporeal membrane oxygenation (ECMO) to premature and critically ill infants, Crouse Health has developed an adult ECMO program that boasts a combined respiratory and cardiac mortality rate better than the national average.

David Landsberg, MD, and Wendy Fascia, Manager of Respiratory Care Services

ECMO provides cardiac and respiratory bypass support for patients in critical condition until the heart and lungs are capable of functioning on their own, allowing clinicians to address the underlying cause of dysfunction. When a patient is on ECMO, blood flows out of the body via a large cannula, typically in the neck or groin, and undergoes pressurization by a frictionless pump. It then enters a membrane to receive oxygen in a process that mimics that of the lungs.

To be a candidate for ECMO, an adult must have a potentially correctable cardiac or respiratory condition that has defied traditional means of support, according to David Landsberg, MD, Chief of the Department of Medicine at Crouse Health.

“ECMO is appropriate for individuals with reversible respiratory failure who have failed conventional mechanical ventilation, and it is indicated for cardiac patients ranging from those whose heart muscle is too weak to function on its own but is likely to improve to, potentially, individuals in cardiac arrest,” Dr. Landsberg says.

A Resource for Central New York

In addition to providing advanced ECMO support to patients who present on-site, Crouse Health serves as a regional referral center for ECMO. The decision to refer a patient for treatment with ECMO hinges on three factors, Dr. Landsberg explains.

“If a patient at an outlying hospital has good functional status at baseline and reversible disease, and clinicians are nearing the point at which they will have no other options to offer if the individual’s condition worsens, they should call our transfer center to discuss referral,” Dr. Landsberg says. “If it is determined the patient needs ECMO, we can administer it within an hour of arrival.”

“Providing ECMO presents a logistical obstacle for many institutions. However, we developed our team around the advanced needs of these patients and are able to provide around-the-clock support.”
— David Landsberg, MD, Chief of the Department of Medicine at Crouse Health

Crouse Health physicians, nurses and respiratory therapists, as well as perfusionists and cardiac surgeons from Upstate University Hospital, administer ECMO, manage patients while they are attached to life-supporting equipment, and help them transition back to independent respiration and heart function.

“Our highly specialized ECMO team is the key to successfully treating these critically ill patients,” Dr. Landsberg says. “Two providers are present at bedside 24/7 to monitor the machine and the patient.”

Above-average Outcomes

Even with advanced ECMO support, the national mortality rate of individuals who undergo this treatment is approximately 50 percent, as reported by the Extracorporeal Life Support Organization. In 2016, Crouse Health survival rates were better than the national average. Building on that success, plans are in the works to expand the availability of ECMO at Crouse Health.

“Future applications of this technology include placing small cannulas in patients who aren’t as sick as today’s candidates and put them on ‘ECMO lite,’” he says. “This technology already exists and is undergoing study. We eagerly anticipate incorporating these new applications into our program.”

To refer a patient to Crouse Health, call 315-470-1065.