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ECMO: Our history, references

We were the second ECMO center on the West Coast and one of the first three facilities in the nation to achieve a “Center of Excellence” designation. We are the only center in the Pacific Northwest to provide a formal, immediately available and experienced transport team; we are by far the busiest and most experienced center in the region.

Our first experience with multiple casualties needing cardio-pulmonary bypass (CPB) support was due to the Mt. Hood climbing disaster in 1986. Thirteen climbers on a high school outing became trapped at altitude (9,000 feet) in a blizzard and suffered severe hypothermia. Nine of these adolescents died. The four climbers found three days later were profoundly hypothermic. (<24 C), and the media generated an expectation that hypothermic patients are not dead until “they are warm and dead.” Because of the limitation of CPB teams and equipment at our hospital, we organized and coordinated with three other Portland hospitals to distribute the patients so that every patient had the opportunity to be revived by this technology1. There were several survivors, and our ECMO program was born.

Over the course of years, Jonathan Hill, M.D., and William Long, M.D., from the Legacy Emanuel trauma team, continued to use ECMO for a variety of indications, particularly patients suffering from “un-resuscitate-able” trauma. The extremes of hypothermia, acidosis, hypoxia and shock could be stabilized and corrected by acute ECMO. Cardiopulmonary bypass technology (and ECMO) can restore adequate blood flow, improve oxygenation, and re-warm the patient.

It has been our experience that these profoundly compromised patients require a period of total support while their extreme physiologic derangements and injuries are corrected. Frequently they require extracorporeal support for a relatively short period of time before their native function begins to return.

Some of these patients are too unstable for transport by normal means; therefore, in 1985 the Mobile Surgical Transport Team (MSTT) was formed to address the logistical problems of transporting patients in extremis from referring institutions. The program was designed to take a team to the patient and provide additional personnel, resources, capabilities and experience at the referring institution and en route back to the level I trauma center.

With the development of miniature, simple CPB or ECMO systems and heparin bonded circuits; this technology was added to the MSTT missions. Selected members of the operating room, critical care, trauma resuscitation, perfusion, and surgical teams were trained and credentialed to function on an MSTT A strong transport capability is essential for a regional ECMO referral center to be effective.

The neonatal and pediatric ECMO programs developed simultaneously, beginning in 1987 and 1998 respectively. In 1998, with the addition of Andy Michaels, M.D., who was trained by Dr Bartlett in Michigan, we began using ECMO for isolated ARDS more frequently and added protocols to our approach to severe lung injury. We have been early adopters of new technologies in critical care, perfusion science, vascular access and resuscitation and continue to have a state-of-the-art clinical program.

During the H1N1 “swine flu” pandemic of 2009–2010, we were among the busiest centers in the world and treated the second highest volume of patients in the nation9. Since then, our regional impact has grown and our volume of patients and outcomes have been excellent.

In January 2013 we instituted a focused ECMO service integrating the neonatal, pediatric and adult programs with our critical care services to create the Randall/Emanuel Severe Cardio-pulmonary Failure and ECMO (RESCUE) Center. It is our goal to treat the most compromised patients in our region with standards of care and outcomes that are consistent with the best international practices.