Stanford’s Neonatal Extracorporeal Membrane Oxygenation (ECMO) program opened in 1988 and was among the first on the west coast. Used on newborns that suffer from cardiorespiratory failure, ECMO is a modified form of heart lung bypass that supports oxygenation, ventilation and cardiac output allowing injured lungs and hearts to rest and recover.
The Neonatal ECMO program is directed by Krisa Van Meurs, MD and William Rhine, MD and coordinated by Arlene Sheehan, RN, NNP, MS. It has helped hundreds of babies and has a survival rate in excess of 80 percent for newborns with respiratory failure. When they fail to repsond to other conventional medical treatments, ECMO is used on newborns suffering from pneumonia, meconium aspiration syndrome, congenital diaphragmatic hernia, sepsis, and cardiac failure. For newborns with critical illness, ECMO is often the therapy of last resort and is often life saving.
Past and Present
ECMO was developed by surgeon Dr. Robert Bartlett who first used it in caring for a newborn with meconium aspiration syndrome. He developed this technique when he was at the University of California Irvine and spent the majority of his career at University of Michigan in Ann Arbor perfecting its use. The technique gained wide acceptance in the 1980s as a treatment for newborn respiratory failure. The number of hospitals offering ECMO has increased dramatically in the U.S. and abroad, and now there are over 300 hospitals performing ECMO around the world. Its use is now common beyond the neonatal population for life-threatening illnesses in adults and older pediatric patients.
Dr. Bartlett formed the Extracorporeal Life Support Organization (ELSO) in 1989. ELSO is an international consortium of health care professionals and scientists who are dedicated to the development and evaluation of novel therapies for support of failing organ systems. The primary mission of the Organization is to maintain a registry of patients treated with ECMO at member institutions with data on survival and complications that can be used for quality improvement. Dr. Van Meurs has been an active member of ELSO since its formation. She served on the ELSO Steering Committee for 10 years. In addition, she was elected Chair of the Logistics and Education Committee and in that role was editor for the 2nd Edition of the ELSO Specialists Manual. As Chair of the Publications Committee, she was senior editor for the 3rd edition of ELSO “Redbook” entitled ECMO: Extracorporeal Cardiopulmonary Support in Critical Care.
The ECMO program at Lucile Packard Children's Hospital Stanford has been awarded the ELSO Award for Excellence in Life Support in 2011 and 2013. This two-year award recognizes and honors programs that reach the highest level of performance, innovation, and quality and signifies to patients and families a commitment to exceptional patient care.
A designated Center of Excellence has demonstrated extraordinary achievement in the following three categories:
- Excellence in promoting the mission, activities, and vision of ELSO
- Excellence in patient care by using the highest quality measures, processes, and structures based upon evidence
- Excellence in training, education, collaboration, and communication that supports ELSO guidelines and contribute to a healing environment
Because ECMO therapy is complex, labor-intensive, and has potentially significant complications, its use is restricted to only those babies with few or no alternatives. Development of newer therapies and changes in medical practice have reduced the use of ECMO. Alternative therapies include high-frequency oscillatory ventilation, surfactant replacement, and inhaled nitric oxide, and changes in medical practices include avoidance of post-date pregnancies and the use of antibiotics during the intrapartum period in at-risk pregnancies.
Neonatal ECMO Team
The Neonatal ECMO team at LPCH includes 6 neonatologists and 40 nurses who are trained in ECMO. Fellows in neonatal-perinatal medicine are trained in July before the start of their fellowship. Training is classroom-based, followed by equipment training and drills, and simulation-based learning at the Center for Advanced Pediatric and Perinatal Education (CAPE). Following the initial training, drills are scheduled regularly for physicians and nurses to maintain their expertise.