Adult ECMO Hybrid Configurations Allow More Forms of Cardiopulmonary Failure to be Treated

At a Glance

  • One of only three adult centers worldwide to be designated ELSO Platinum Center of Excellence
  • Hybrid configurations can provide differential support for various forms of cardiopulmonary failure
  • In 2015, NewYork-Presbyterian had 177 ECMO cases almost equally divided between respiratory and cardiac

"We’re one of the largest ECMO programs in the world for adult respiratory failure. Our team strives each day to deliver the very best treatment to every patient in need."

— Dr. Daniel Brodie

NewYork-Presbyterian Columbia University Irving Medical Center’s ECMO (Extracorporeal Membrane Oxygenation) program gives physicians the advanced technology needed to sustain life during the most critical situations. Physicians use these tools to provide immediate cardiopulmonary support while resting the damaged native heart and lungs, improve perfusion and oxygenation of end organs, and allow ample time for diagnosis, treatment, and recovery from the primary injury or disease.

While always looking for novel applications to treat adult patients, NewYork-Presbyterian Columbia clinicians also balance ethical considerations and cost/benefit factors.

A Recognized World Leader in Adult ECMO

The Medical ECMO program at the Center for Acute Respiratory Failure at NewYork-Presbyterian/Columbia is one of the largest and most successful ECMO programs in the world.

In 2017, our program was designated Platinum Level Center of Excellence in Life Support by the Extracorporeal Life Support Organization (ELSO*). Worldwide, only three adult ECMO centers were awarded platinum status, and this is the first time this status was awarded.

Key features of our program include:

  • Extensive experience managing critically ill patients with ECMO
  • A multidisciplinary team, with each member trained specifically in the treatment of advanced respiratory and cardiac failure and the appropriate use of ECMO and other extracorporeal technologies
  • Cutting-edge surgical techniques pioneered by our surgical team
  • A highly-skilled mobile ECMO transport team with specialized ambulance and air transport ability

Innovative Approaches to ECMO: “Central Sport” ECMO Configuration

The “Central Sport” model was developed at our institution to allow for the use of upper body venoarterial ECMO in patients with severe cardiopulmonary failure whose small stature or vasculopathy may limit the use of other upper body ECMO configurations, such as the “Sport Model,” which was also pioneered at our center. Upper body venoarterial support minimizes differential hypoxemia between the upper and lower body and allows for significant patient mobility.1

Prasha Tuladhar

Prasha Tuladhar

Prasha Tuladhar was a 27-year-old woman with a husband and young child who developed systemic sclerosis with severe interstitial lung disease and pulmonary hypertension. She was listed for lung transplantation but before transplant experienced cardiovascular collapse due to a pulmonary hypertensive crisis.

Given her small stature, Raynaud’s and vasculopathy, she was unable to receive our upper-body venoarterial ECMO via the subclavian artery (“Sport Model”) and placed on an innovative configuration with arterial anastomosis to the innominate artery (“Central Sport Model”). On this ECMO configuration, Prasha was able to work with physical therapy and ambulate in the ICU where she was supported with ECMO for nearly one month until she received a successful double lung transplant.

  • 1Chicotka, S, Rosenzweig, E, Brodie, D, and Bacchett, M. The “Central Sport Model”: Extracorporeal Membrane Oxygenation Using the Innominate Artery for Smaller Patients as Bridge to Lung Transplantation. ASAIO J. 2016 Aug 22

ECMO supports pregnant and postpartum patients

ECMO has been used with increasing frequency and success to support pregnant and postpartum patients with severe cardiac or pulmonary failure. Our center has the largest published experience of using ECMO for pregnant and postpartum women worldwide.

ECMO for pregnant and postpartum women

ECMO for pregnant and postpartum women

  • Agerstrand C, Abrams D, Biscotti M, Moroz L, Rosenzweig EB, D’Alton M, Brodie D, Bacchetta M. Extracorporeal Membrane Oxygenation for Cardiopulmonary Failure During Pregnancy and Postpartum. Annals of Thoracic Surgery, 2016.

Innovative ECMO support for COPD exacerbations

Research into evolving applications of ECMO is paramount for growth and evolution of the field. We assessed the safety and feasibility of using single-site extracorporeal CO2 removal (ECCO₂R) for patients endotracheally intubated with severe, acute exacerbations of chronic obstructive pulmonary disease (COPD). We achieved early extubation and ambulation in all study subjects.

  • Abrams D, Brenner K, Burkart K, Agerstrand C, Thomashow B, Bacchetta M, Brodie D. Pilot study of extracorporeal carbon dioxide removal to facilitate extubation and ambulation in COPD exacerbations. Ann Am Thorac Soc. 2013;10(4):371-377

Extensive ECMO transport experience

NewYork-Presbyterian/Columbia has performed over 250 ECMO transports, including both ground and aeromedical transports. We have traveled as far as the Middle East to transfer patients receiving ECMO and have extensive experience and an exceptional safety record.

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