1. Daphne Hardison, RN BSN ECMO Manager Welcome to the Jungle!

2. What is ECMO?  Cardiopulmonary bypass (CPB)  Complete cardiopulmonary support in the operating room  Extracorporeal membrane oxygenation (ECMO)  Partial cardiopulmonary support  Veno-arterial: cardiac and pulmonary support  Veno-venous: pulmonary support  Extracorporeal CO 2 removal (ECCOR)  Partial pulmonary support  Ventricular assist device (VAD)  Partial cardiac support

3. Bubble Oxygenators  1954 First CPB – Short term support ASD repair  1971- First Adult ECMO  1975- First Neonatal ECMO  1997 – CESAR TRIAL UK  2008 CESAR Published

4. From this… TO THIS!!

5. Dr. Robert Bartlett

6. First successful ECMO patient, 1971 J Donald Hill MD and Maury Bramson BME, Santa Barbara, Ca, 1971. (Courtesy of Robert Bartlett, MD)

7.  CESAR Trial: Extracorporeal Membrane Oxygenation Improves Survival in Patients With Severe Respiratory Failure (2008) Why Complete an Adult Trial?

8. ECMO History Slide courtesy of Gail M. Annich M.D.

9. ECMO History Slide courtesy of Gail M. Annich M.D.

10. ECMO at Vanderbilt  How did we get started  Dr. John Pietsch  Original Team Members  Christy Worden and Cindy Thomason  First Patient November 1, 1989  Dr. John Pietsch

11. First ECMO Patient at Vanderbilt

12. ECMO Volumes YearPatientsPatient Days 200935276 201079489 201175502 201264442

13. Vanderbilt’s ECMO Program: One of the Largest in the World Based on ELSO data according to number of ECMO runs/year. Consistently in top 10 last 6 years. Consistently in top 10 last 6 years. Have been ranked as high as #1 Have been ranked as high as #1

14. 880+ patients since 1989.  700+ patients since 2002  One of 135 ECMO Centers across the globe  One of 3 in TN  Typical ECMO Programs runs around 15 ECMO cases /year utilizing up to 20-40 ECMO Specialists

15. ELSO – Extracorporeal Life Support Organization  ECLS Registry Report  Documentation  Research  ELSO Formed 1989  Vanderbilt Data Submitted from the beginning  ELSO Award of Excellence

16. ELSO Award of Excellence “Center has demonstrated extraordinary achievement …Patient care by using the highest quality measures…. Excellence in training, education, collaboration” 2008-20102012-20142010-2012

18. Volumes CONFIDENTIAL INFORMATION. This information is confidential and privileged pursuant to TCA 63-1-150, and 68-11-272 et seq., and has as one of its purposes to improve the quality and safety of patient care. Do not forward or otherwise share this information external to Vanderbilt. Number of Patients Number of Patient Days Projected 2013 on current run rate Calendar Years

19. Interdisciplinary  Same Job Code…..ECMO Specialist  Dedicated team  Surgical Director - Dr. John Pietsch  Medical Director – Dr. Brian Bridges  PICU/PCICU: Fleming, Smith and Mettler  NICU: Walsh, Grubb, Markham  SICU/TICU/MICU: Rice, Miller and May  Manager – Daphne Hardison  Lead Specialists  Myron Norman  Pam Purcell  Marguerite Knight  Christy Worden

20. Collaboration  Daily ECMO Rounds  Follow Up Until Discharge  Follow Up Clinic  PM&I Monthly  Education

21. ECMO Daily Rounds  Call back Goals  Care Bundles  Standards of Care  Plan to round with the Team

22. ECMO PM&I  Meets 2 nd Thursday 5:30-6:30  Initiatives  Practice Changes  Research  EVERYONE IS WELCOME!!

23. Research  iCa levels in the Circuit  ACT and Heparin Assay  Blood Product Usage  Circuit Restructure/Collaboration  Improving OR Communications  ECMO Staffing Models that Work

24. Future Growth  Adult ECMO  Trauma  SICU  MICU

25. Simulation Lab

26. New Cannula

27. Oxygenators Quadrox D – Safeline Coating Mini Max Silicones

28. EXIT Procedure

29. Citrate Regional Anticoagulation

30. Patients Ambulating on ECMO  Bridge to transplant  Bridge to recovery

31. ECMO Reunion 2003

34. Pediatric patient with first and only known cat to be named ECMO!!