Bill Klaproth (Host): Welcome to Pediatric Insights, Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. Today's episode is a special edition featuring our In the Know Series, a new edition to our podcast lineup that brings you insightful conversations with our Chief Medical Executive, Dr. Dai Chung, and expert physicians from across Children's Health. We'll be sharing these special episodes regularly to keep you informed on emerging trends and advancements in pediatric care straight from the leaders who are shaping it. In this episode, Dr. Chung is joined by Dr. Lauren Gillory, Pediatric Surgeon at Children's Health and Assistant Professor at UT Southwestern and Dr. Abhishek Makkar, Neonatologist at Children's Health and Associate Professor at UT Southwestern. Together, they discuss the neonatal ECMO program and how it's providing lifesaving support to the smallest patients.

Let's dive in.

Dai H. Chung, MD, MBA: I'm Dai Chung. Welcome to the In the Know video series.

We, as a system are excited about what's all happening since the launching of the neonatal ECMO. Can you tell us, uh, about what you do as a co-director of the neonatal ECMO, working closely with our neonatology colleagues and what our surgeons actually play a role?

Lauren Gillory, MD: Extra corporeal membrane oxygenation or ECMO, as you just mentioned, is obviously a very advanced life support technique that we use for our most critical patients with respiratory and cardio respiratory failure.

Abhishek Makkar, MD: It's basically artificial advanced modality that is doing the job of the lungs and heart when the heart and lungs are too sick to take care of a baby. So in that case, the artificial pump is basically pulling out the blood from baby's body, and that goes through this artificial oxygenator where the CO2 is taken out and oxygen is added in, and then that blood is basically warmed up and is being returned to the body.

Lauren Gillory, MD: And the neonatal ECMO program here, since its beginning, we've really tried to focus on how we choose the perfect candidate for ECMO.

Abhishek Makkar, MD: So a very specific patient population with physiology, which is quite different from children and adults. If I have a neonate who needs ECMO, first thing we look at is, is that baby big enough where the smallest available cannula on the market can fit the vessel size and we can offer ECMO.

Lauren Gillory, MD: The smallest patient we have ever successfully, cannulated was just a little less than two kilograms.

Dai H. Chung, MD, MBA: And it was important for us to stand that program up in the NICU. Why was that so important for our system?

Abhishek Makkar, MD: We are at a level four NICU. That's the highest level of care that's out there for any NICU to attain. There is a saying in medicine, children are not like small adults. And similarly, neonates are not small children, so neonates have this specific physiology that does require the expertise.

Lauren Gillory, MD: As one of the co-directors, what we've really emphasized is getting the whole team together right at the outset, and that team obviously includes our ECMO specialists and our neonatologists, and the folks that help us to manage pulmonary hypotension as well as pharmacist and you know, our radiology team and everyone that's necessary to safely take care of that patient.

Abhishek Makkar, MD: Once the patient goes on ECMO, our surgery colleagues, along with our neurologist, hematologist, nephrology, they have then regular input on daily basis on our patients so we can provide the best care that the patient deserves.

And also along with our surgeons, they're available to us 24/7. Our outcomes so far have been outstanding. Again, ECMO program is not just about putting patients on ECMO, but also looking at the overall outcomes.

Dai H. Chung, MD, MBA: I think for a very established NICU like ours to have adopt an ECMO which has been around since 1986. It really goes, it says a lot about your thoughtfulness and having coordination and making sure that was the right thing to do for the patient care and absolutely to the highest level, wanting to deliver the best care.

Lauren Gillory, MD: One of the advantages of having an ECMO program is truly that there are patients that may not have survived or have optimal neurodevelopmental outcomes if they hadn't received this advanced support when they were having respiratory compromise. And as an institution, particularly since initiating our NICU ECMO program for neonates, every patient has successfully come off of the ECMO circuit, and then 80% of those patients have successfully advanced to discharge from the hospital, which is exemplary numbers.

Abhishek Makkar, MD: In fact, we are one of the few centers internationally that has this award of center of excellence at a platinum level, which is a great honor. That's the award, which some of the centers are recognized based on certain criteria. Patient outcome is one of the major factors in it. Additionally, how actively we are involved in quality improvement projects and the metrics related to that and how when we are practicing medicine, if it's evidence-based or not.

So all those factors are taken into account when a center is awarded as platinum level of center of excellence.

Dai H. Chung, MD, MBA: Is that like the highest level?

Abhishek Makkar, MD: It is the highest level that you can achieve. So I'm honored to be part of the group, which is at the highest level, and we'll continue to work hard to maintain that level.

Dai H. Chung, MD, MBA: So your partnership with UT Southwestern and Children's Health, what has that been like?

Lauren Gillory, MD: I'm definitely excited to be a part of the group as we move towards that new pediatric campus, and I think that will give us the opportunity to continue to do what we've already been doing, which is building out all of the programs that pediatric surgeons are already a part of, whether that is ECMO or even some of our outpatient that convert into surgery type of programs.

Abhishek Makkar, MD: I think it, it is a great partnership because it does open access for tremendous research opportunities that we have on hand, and it's a robust academic environment. The future of medicine is we need to invest in our trainees, so that gives access for the trainees. We have our fellows coming, learning about the ECMO program, and I think this new Children's Hospital that we'll havea few years from now, I'm looking forward to it.

I feel like there is tremendous growth on horizon.

Dai H. Chung, MD, MBA: I think that's what separates us is the academic focus. It isn't about having a group of surgeons who are technically capable of cannulating or putting babies on ECMO; it's this sort of academic approach and a mindset, uh, can we always sort of push ourselves to be better or, or safer or more efficient, right?

I think that's what kind of brings this partnership with UT and Children brings.

Lauren Gillory, MD: Together. I agree.

Bill Klaproth (Host): Thanks for listening to Pediatric Insights, Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. We'll be back soon with another special edition featuring our In the Know Series with Chief Medical Executive Dr. Dai Chung, where he interviews expert physicians from across Children's Health.

You can find out more at children's.com. And if you found this podcast helpful, please rate and review or share this episode and please follow Children's Health on your social channels.