After reaching its 1,000th ECMO run, Children’s Mercy team reflects on program’s life-saving past and future
It’s a scene now seared into Kelly Short’s memory: her son Hunter, newly arrived by life-flight at Children’s Mercy Hospital in Kansas City, Mo., surrounded by too many medical professionals to count, all poised to take action after a bicycle accident injury initially thought to be no more than a strain was escalating into a series of life-threatening emergencies.
Among those gathered around the previously healthy nine-year old were members of a core team of experts in extracorporeal membrane oxygenation life support, or ECMO. Hunter Short would become Children’s Mercy’s 962nd ECMO patient on that day in August 2020, the first day of a 14-week hospital stay.
The technology would be essential to Hunter’s care, and that of the 961 ECMO patients who came before him. But as Children’s Mercy marks its 1,000th ECMO run this summer, it is clear that the extensive training, deep expertise and collaborative spirit of the professionals running that technology are what makes Children’s Mercy’s ECMO program the center of excellence it is recognized to be – and helped save this little boy’s legs, lungs and life.
‘The highest form of life support’
Never heard of ECMO? Count yourself lucky.
“Not many people know about ECMO,” said Kari Davidson, RN, MSN, CCRN, ECMO Support Co-Director alongside Debbie Newton, RN, MSN, CCRN. “People know about ventilators, but ECMO is foreign to them – until they need it.”
When that need arises, life literally hangs in the balance.
Sometimes described as the highest form of life support, the ECMO machine keeps critically ill patients alive so underlying problems can be treated. It temporarily does the work of the heart and lungs outside the body, removing blood, infusing oxygen into it and eliminating carbon dioxide before returning it to the patient. ECMO is used only after other standard treatments for heart and lung problems have been attempted, and is most commonly considered for patients whose condition, such as a treatable congenital heart condition, acute respiratory infection or blood clot in the lung, offers potential for healing.
The pool of patients for which ECMO may be an option has expanded over the years. Patients with hematology/oncology conditions, for example, would not have been considered ECMO candidates in the past due to high rates of complications. But since 2015, Children's Mercy has placed several of these patients on ECMO, many of whom have been success stories – like the 1,000th patient who required ECMO support for complications after a bone marrow transplant.
Hunter’s underlying issue was sepsis, a response to inflammation caused by blood that had pooled and clotted in his hip. Because his accident caused no visible injury – he had even continued to play after his fall – the infection went undetected until intensified hip pain and labored breathing sent him from the emergency room in his hometown of McPherson, Kan., to a Wichita hospital, then to Children’s Mercy.
Hunter would spend 63 days on ECMO support as care teams worked to treat a cascade of complications. He endured dialysis, bleeding pulmonary anuerysms requiring high-risk interventional procedures and multiple blood transfusions, nearly requiring amputation of his leg and a double lung transplant, before returning home two months later as one of the ECMO team’s growing list of success stories.
Extraordinary expertise
Children’s Mercy introduced its ECMO program in 1987, one of the first pediatric hospitals in the country to do so. It initially served only neonatal surgical patients, adding older pediatric intensive care patients in 2007. It has since grown to be one of the highest-volume neonatal and pediatric ECMO programs in the country as staff resources, the team’s ability to manage complications and diagnoses for which ECMO has proven to be appropriate have expanded.
John Daniel, MD, MS, and Marita Thompson, MD, are Neonatal and Pediatric ECMO Medical Directors respectively. Pediatric Intensivist Jenna Miller, MD, FAAP, is involved in ECMO research, education and simulation for the Children’s Mercy program.
Today the team conducts between 40 and 50 ECMO runs a year, serving patients from Denver to St. Louis, Omaha to Tulsa. Children’s Mercy is recognized as a Platinum Center of Excellence by the Extracorporeal Life Support Organization (ELSO), one of only 10 pediatric centers in the nation to earn the distinction, for its quality standards and processes, specialized equipment and supplies, carefully defined protocols and advanced staff education. Survival rates frequently exceed national averages, a point of pride its leaders attribute to the consistency of team members whose skills are well practiced and trusted after extensive time working together.
The ECMO team provides 24/7 coverage. All team members must participate in high-fidelity simulations – once a year for physicians, twice annually for nurses, APRNs, cardiac perfusionists, respiratory therapists and other bedside staff. Each session covers several scenarios so participants are able to work through multiple concepts.
The team also has contributed to advancing medical knowledge. News reports about an earlier ECMO patient’s mysterious lung infection caught the attention of parents of other children who died of similar complications, spurring Children’s Mercy’s Dr. Miller to look into possibility of a rare, but deadly reaction to the commonly prescribed antibiotic Bactrim and its generic equivalents. Her research led to current efforts to confirm the potential link and understand what can be done to prevent its consequences.
Deep appreciation
While Kelly’s memory of medical professionals assembled around her critically ill son in August remains intense, so does her memory of a far more jubilant event 63 days later. Throughout Hunter’s treatment Kelly had set up Facetime sessions to connect family in Kansas City with family back home, all too often sharing worrisome developments.
But on this day – Oct. 12 – Kelly turned the camera to face Hunter, showing his seven older siblings that their little brother was finally off the ECMO machine.
“There were lots of tears,” she said.
Home since mid-November, Hunter is doing well. He continues occupational therapy to restore mobility lost during time on life support, has follow-up visits with Children’s Mercy physicians in Wichita and Kansas City, and will soon undergo repair of a heart valve that was damaged during his procedure while on ECMO support. He has regained 55% of his lung function and is being home-schooled until doctors feel confident about the strength of his immune system.
But he’s home, and his mom is grateful for the care he received.
“The Children’s Mercy people were all amazing,” Kelly said. “They were straightforward with us, answered all our questions, never sugar-coated anything, warning us several times that he might not make it,” she said.
“And I always said, ‘just save my kid,” Kelly added. “I just want him to come home with me.”
And he has, thanks in no small part to the ECMO team, who will work to do the same for patient #1,001 and beyond.
Learn more about the ECMO program at Children's Mercy.