Scott Webb: On our Heart Speak podcast today, the podcast from Baylor Scott & White Heart and Vascular Hospital, Dallas and Fort worth, Dr. Dan Meyer, a cardiothoracic who's the chief of heart transplantation and advanced circulatory support at Baylor University Medical Center, part of Baylor Scott & White Health is going to discuss ECMO, a versatile machine that replaces lung and heart function by pumping the body's blood supply.

I'm Scott Webb. And Dr. Meyer, ECMO has gained national and international attention in the past few years because of its usage to treat patients with COVID-19. But ECMO has been around for a long time, long before the pandemic. So what is ECMO?

Dr. Daniel Meyer: Well, ECMO, it stands for extracorporeal membrane oxygenation and, basically, it's a machine that gives the body oxygen and pumps the blood just like if you're on a heart-lung machine in the operation room. So it's a device that supports the lungs when the lungs are the issue and it supports the heart when the heart's the issue. So there's a couple types of ECMO that we use and depending on this particular patient's situation. But you're right, with COVID-19, the use of ECMO has Been well-recognized internationally and we've been quite busy in leading the charge here in the Texas region.

Scott Webb: Yeah, I've been reading that the ECMO program at Baylor University Medical Center has been in existence for 10 years. You've treated over a thousand patients with ECMO. Maybe you could just tell us a little bit more about that as sort of life-saving technology.

Dr. Daniel Meyer: Yes. Well, it's been around for a while, but not used as much in adults. It started really with neonates. And then there was some use in adults for respiratory failure, you know, over 10 years ago, but then it really started to have a better outcome because of a technology that is used and patient selection. And so the program really started, like you said, 10 years gone and really has built up and initially mostly for support of our quite large heart transplant program and cardiac surgery program. And then with the COVID-19, as you said, the program really became even larger.

In the Baylor Scott & White system, there's four major medical centers that do ECMO and so, we developed a collaborative coalition of all our four main ECMO centers. And it's been pretty interesting because all the experts from these different centers get together on a monthly basis on a call. And we have developed over the years protocols and the guidelines, best practices for the management of these patients. And it's really helped patients all throughout the region because we share our practices and look at our outcomes very closely and it has been really a good learning experience for all the clinicians and, again, a great plus for the patients.

Scott Webb: Yeah, I'm sure. And it could never hurt to have everybody on the same page. So great to hear that you guys get together, you know, frequently and talk ECMO, if you will. And you know, it sounds like you're very familiar, lots of patients over the years, you touched on it a little bit, maybe you can go through and tell us when ECMO is really needed.

Dr. Daniel Meyer: Well, when we think about ECMO, we divide it kind of into two categories and one is ECMO to support the heart. And so that's called arterial ECMO. And that's where we take blood from the patient out of their veins, run it through our pump and our device. It gives the blood the oxygen and then run it back to the patient in their arterial system to really take over the function of the heart while the heart is able to recover. And so this is in situations where perhaps they had open-heart surgery and they had a weak heart going into the surgery and they just needed some extra support afterwards. And this is when ECMO is used for that. Sometimes it's when we have unexpected issues during heart surgery and we need support afterwards to get off the heart-lung machine. So there's a number of time to use it. Sometimes it's in patients who have known heart failure, and this is kind of a big area that we use it in who have heart failure. They're may be being evaluated for our transplant or a support device, and then they get worse and we have to urgently place them on ECMO until we can either recover them or get to the next step, which would be transplant or what we call a ventricular assist device.

And then recently with, again, this venoarterial ECMO is a big kind of a push and kind of a new technique. It's used in patients that have heart attacks and it's called ECPR, so ECMO CPR. And it's not done at very many places. And again, Baylor has been the leader in the region for this as well. And working with our EMS or emergency medical services teams, the fire department, to bring patients to us that they have chest pain, the paramedics figure out that they have had a heart attack. And if they're very unstable, they sometimes contact us ahead of time, so our ECMO team is waiting for them in the emergency department. And if necessary, we can put them on ECMO immediately and get them to the cath lab. And we've saved many patients in this manner. So that's called ECPR and again, that's really a new area of ECMO support. So that's the arterial side. Pretty complicated as you can see.

But then, there's what we called the lung support, the veno-veno ECMO, and that takes blood from the venous system again, but brings it back to the venous system, but closer to the lungs. And so it actually takes over the function of the lungs. Instead of just taking over the function of the heart and lungs, it's just taking care of the lungs. And this is is where the COVID-19 usage really flourished. Everyone has learned a lot over the last two, two and a half years in taking care of these patients. And it has been a lifesaver for many patients, supporting them until the COVID-19 lung inflammation has resolved and it was used even before that, before COVID with just regular pneumonia and then a lot of the viral pneumonia, the H. flu is where it really got a lot of use later in the 2015, 2016 time period. So that's where that's used. Again, that's called the veno-veno ECMO.

Scott Webb: It's really amazing how versatile ECMO is. And I'm sure it's one of these things that, you know, when ECMO started, everyone was like, "Okay, well, how do we use this thing? What are we going to use it for?" And over the years, it's just broadened and expanded all the way up through the present with COVID-19. I'm sure there are some risks, especially with removal of ECMO. Maybe you can take us through that.

Dr. Daniel Meyer: Yeah, the one other thing about the VV ECMO with COVID, many of the patients all over the region, all over the country, were in a difficult situation because they first were managed just with supplemental oxygen and then they have to go on a ventilator if they get worse. And if there's nothing that can be done short of the ventilator, that's when the ECMO would be needed, but not many places would have it. And so we would have to use our team to go and put the patients on ECMO at the site. So we'd send a team of surgeons and perfusionists to different sites to put the patients on ECMO and then transport them back to our center. And so Baylor really has led the charge in this onsite ECMO cannulation and transport. And so that's been a really big part of our program as well.

But in terms of complications, they start from the beginning, from placing the cannula. There's fewer complications nowadays with that because of the techniques we use. But every day you're on ECMO is a day unfortunately you can have complications, even though again, in the majority of patients, it helps. With every day on ECMO is a day you can have bleeding complications, which is kind of the main problem that we see, and then, more infections just by having so many different tubes in the patient's circulation. From the COVID population, we really learned that all the healthcare providers had to be pretty patient, because these patients could be on ECMO for over a month. They could be on for two months. And there's places that have had patients on for three to four months just waiting for those lungs to recover. So as you can imagine, being in the ICU for that long, a lot of opportunity for infections.

But another area again, where I think I have to give credit to the team where Baylor took the lead is an early mobilization of the ECMO patients in the COVID-19 population And patients on these devices, you know, usually they're lying flat in the bed because they've got these giant catheters in their vascular supply system. But, over time, we moved these two different areas like in their upper body, so they can mobilize better. And, even on the ventilator and even on ECMO, we get these patients walking. That's been a big part of the recovery and survival in this population.

Scott Webb: Yeah. And you mentioned the team there. As we wrap up here, I want to have you talk a little bit about your team there at Baylor Dallas. I know it's one of 12 ECMO programs in the US that received the highest award possible from the Extracorporeal Life Support Organization. Pretty cool. So what sets BSW dallas and the program apart?

Dr. Daniel Meyer: Well, like you said, we're one of the few what they call platinum centers where it's a designation that's based on a number of factors that, you know, just shows a dedication to the ECMO technology and support it. It looks at your outcomes, your infrastructure, your innovation, research that's done, and the community education. All these things are taken into account and, based on this, if, you know, you have all these components in place, you can be fortunate enough to become platinum status. And it just takes a really dedicated team of physicians, nurses, respiratory therapists, physical therapists, administrators, the whole team, a nutritionist, to run a program like this and to have the outcomes that we've been fortunate enough to see.

Scott Webb: Yeah. Well, it's really amazing. And I've appreciated learning more about ECMO today and just how versatile it is and how great your team is that you've assembled there, getting together, getting on the same page, best practices and so on. So doctor, thanks so much for your time and you stay well.

Dr. Daniel Meyer: Okay. Thank you.

Scott Webb: To find an advanced heart failure, cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital, Dallas and Baylor University Medical Center, call one 1-844-BSW-DOCS. To learn more about the advanced heart Failure Program, visit bswhealth.com/heartdfw Or download the Baylor Heart Center app on your Apple device.

Scott Webb (Host): Thanks for listening to Heart Speak, the podcast or Baylor Scott & White Heart and Vascular Hospital in Dallas and Fort Worth. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest. I'm Scott Webb. Thanks for listening.

Host: Baylor Scott and White Heart and Vascular Hospital, Dallas and Fort Worth, joint ownership with physicians.