When babies and kids are critically ill, sometimes their bodies need a break. That’s when our specialized team and equipment come in to provide extra-corporeal membrane oxygenation, or ECMO. One of only two children’s hospitals in the state to offer this innovative procedure, our program recently achieved a Gold Level Award for Excellence in Life Support from the Extracorporeal Life Support Organization.
ECMO treatment is used when the heart and lungs are too sick to function on their own. An artificial lung takes over to circulate blood and oxygen, allowing time for other treatments to work and the body to heal. This award recognizes ECMO programs worldwide that distinguish themselves by having processes, procedures and systems in place that promote quality and exceptional care. For families of kids like Kai’Ayshia, who underwent urgent and complicated heart surgery, it means reassurance that their child is in the best hands.
The core team includes perfusionists, who manage the ECMO circuit equipment according to the patient’s physiological and metabolic demands, and ECMO specialists, who stay by the patient’s side day and night, as long as they remain on ECMO. Both have advanced clinical training and a commitment to providing a healing environment for patients and families.
Michelle Coffey has been an ECMO specialist with us since 1997 and provides some insight into this important role in caring for some of our most vulnerable patients.
We really try to help all the family members know that we’re here for them – to answer their questions and explain what's happening in whatever detail they need at the moment. We describe ECMO to them as a marathon and not a sprint. ECMO doesn't cure the underlying problem, but allows time for the body to recover, and that time can go slowly. We never mind questions and we are focused on helping to support the patient and family however we can.
I was thriving as a critical care respiratory therapist and wanted to expand my role. I love the degree of collaboration and the high caliber expectations of working in this environment. As an ECMO specialist, you're working hand-in-hand with a nurse to care for the patient. There's a level of vigilance, coordination and integration of skills and care that have an immediate impact on the patient. You get to be a party to helping someone who is very ill have a much greater chance of meaningful recovery. It's deeply satisfying.
When things are good, it’s routine to the extent that it looks easy. It's actually part of my job to make it look easy! But things can take a turn for the worse in an instant and become extremely stressful.
A patient can require ECMO to be started at any time. There's a lot of behind-the-scenes maneuvering of equipment, supplies and staff to make it happen – a good deal of teamwork. The ECMO specialists assist the perfusionists with preparing the circuit, while the surgeon puts the ECMO cannulas into the patient. We monitor the circuit, watching the patient's vital signs, level of comfort/sedation and amount of ECMO support moment-to-moment.
Patients can be on ECMO from days to weeks, sometimes even months. The close nature of this care can lead to strong rapport with patients and their families. I look forward to seeing them each day or night that I return to work. My colleagues and I tend to take their journeys to heart.
Hands down, my favorite is being a part of making things go right! We all come to work to provide the best care possible. What the outcome will be is often unclear at the onset. We do our best so that no matter what, we give every patient the best chances.
When patients get well and go on to lead their lives, sometimes we get a glimpse of what that looks like - a photo, a letter, a visit when they come to clinic. That's a wonderful feeling! Also, on the front end, when you have a patient who needs ECMO, they are by definition incredibly critically ill. When our team of physicians, surgeons, nurses, perfusionists, respiratory therapists and pharmacists comes together and helps this extremely sick patient become stable, that's also very rewarding.
One other aspect I love about my job is teaching. I love being able to explain what we're doing and why to physicians in training, family members, nurses and other therapists. It is really meaningful to bring understanding of this complex process into perspective.
Our ECMO program was just the third of its kind in the United States. I've been humbled to learn from and work with several people who were part of its inception. I've also been here so long that I've had a part in training many of our ECMO specialists.
There is so much dedication involved in providing this care. From the outside, ECMO looks like a really cool swan gliding along, but from the inside, we have been working diligently to keep abreast of practice change and providing seamless care for decades. We deeply appreciate the accolades, and we will keep working just as hard.
We’re all motivated by our patients. There’s nothing quite like knowing that you have a role in helping someone survive and thrive.
We also have outstanding leadership. Betty Chui has been the perfusionist most responsible for training our ECMO specialists. She sets exacting standards for performance, formulates our tests and puts all the things in place needed for clinical simulations and lab practices. She helps new ECMO specialists prepare for their exams and gives detailed feedback on their strengths and areas for opportunity. She also makes food for the team and messages us in the wee hours of the morning to check on patients. Her dedication to the team and our patients is out of this world.
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