Amanda Wilde (Host): This is Maimo Med Talk. I'm Amanda Wilde. And with me today is Dr. Paul Saunders, Chief of Cardiothoracic Surgery and Director of the ECMO program at Maimonides. We're exploring ways of making ECMO mobile, bringing advanced cardiac care to the New York City Marathon and beyond. Welcome to the podcast, Dr. Saunders.

Paul Saunders, MD: Oh, thanks for having me.

Host: Can you explain first of all what ECMO is and how it works?

Paul Saunders, MD: Sure. So, ECMO stands for extracorporeal membrane oxygenation, so the ECMO. And essentially, it's a form of emergency life support. It can be configured for patients a bunch of different ways for a bunch of different problems. But the focus we're talking about today is basically in the setting of a cardiac arrest, where ECMO can be applied to a patient who's suffered a cardiac arrest and help stabilize them to get them to definitive care.

Host: Does it take over for the heart or the lungs?

Paul Saunders, MD: So, yeah. So, what ECMO does is it basically takes the blood out from the patient. It runs it back to the patient having been run through an oxygenator, which basically adds in oxygen, and then it pumps it back in. So, it basically takes over the work of the heart and the lungs.

Host: That is amazing. What inspired you to bring this ECMO technology to a marathon event?

Paul Saunders, MD: So, the medical team that supports the New York City Marathon reached out to our program to see if there's a way that we could help provide ECMO services at the race. As you know, there is a small but definable incidence of sudden cardiac death associated with marathons and half marathons. That incidence is low. And actually, the survival has been improving over the years, but it's still not zero. And there have been a couple of instances in the last few years of some sudden cardiac deaths at some races. So in the overabundance of caution, in the interest of providing the absolute most proactive safety plans for runners running these races, they reached out to our program to see how we could help. And what we came up with was a very novel means of providing the ability to place a patient on ECMO at the finish line, essentially of the New York City Marathon. So, the New York City Marathon runs a very large medical operation with over 2,000 volunteers and medical staff from medical students to nurses, to physical therapists, to physicians, to paramedics and EMS crews-- a very robust medical operation. So, this was adding basically another layer of very high level support for any runners who got themselves in a very difficult predicament.

So, in a short amount of time, we staged a plan essentially to have my team with equipment to place a patient who suffered a cardiac arrest on ECMO minutes after that might have happened if they were close to the finish line. Obviously, in a time of a cardiac arrest, minutes count. And so, the goal is to reduced the amount of time from a patient who suffers a cardiac arrest until they get return of blood flow.

Host: Now, this is making ECMO adapted for mobile use. What challenges did you face doing that for such a large scale event?

Paul Saunders, MD: It is a challenge. So most of the times, patients are placed on ECMO in a hospital setting, obviously. Our team for a number of years has been able to provide ECMO services to other hospitals in our borough in Brooklyn, where we'll take our team in our equipment and go to another hospital that doesn't have that capacity and place the patient in ECMO and then bring them back to our hospital.

So, we have a pretty robust set of protocols for how to bring our equipment outside of the hospital, our equipment, our team. So, we didn't have that down pretty well. So, staging this at a forward positioned medical tent was not too much of a difficulty for us. We had a large team of myself, nurses, physician assistants, perfusionists who could set up and work through the procedure of putting someone in ECMO, and then run the circuit, and then basically be able to bring the patient back to a medical center for definitive care.

Host: You mentioned that the New York City Marathon event leaders reached out to you. What was their reaction once you got this all in place?

Paul Saunders, MD: They were really excited to have this capability, because the race obviously wants to provide a safe experience for all the participants. With almost 60,000 runners in the marathon this year, they really want to have a good experience for all those who participated, who run in it. And obviously, keeping them safe is paramount. So, providing this sort of additional layer of service and a layer of protection really helped everyone feel a lot more confident that they could do that.

Obviously, the incidents of this a very small and the likelihood of needing this is very low. However, if in that unfortunate situation, obviously minutes and seconds count, so everything possible you could do to help save someone's life is really important and really paramount.

Host: You've mentioned you've taken ECMO on the road, so to speak. So, could this mobile ECMO concept be beneficial in other emergency settings outside of sporting events?

Paul Saunders, MD: Certain cities and certain medical systems have looked into this and have done this on smaller scales of providing ECMO in the field. Certain places around the country, around the world have done this as pilot programs where a sort of mobile ECMO team could be dispatched to the site of a cardiac arrest. Those are still in very early stages. And obviously, logistics of those are very challenging.

For there to be benefit, you really want to provide ECMO, initiation as quickly as possible after a cardiac arrest. So, the logistics of that timing wise are difficult. But certain places that have tried this, again, I said is in sort of pilot programs.

Host: What are the next steps for your ECMO program following this successful deployment at the marathon?

Paul Saunders, MD: So, it's very interesting. It all came about quickly. And since the initial discussions and having us be available there on site, we've really have been just starting some discussions about providing this for other races and potentially other events, the likelihood of needing it is still very low. But the importance of it, if it were called for, could be really dramatic and especially in the goals of saving someone's life. So, we're exploring the potential options of doing this more frequently and staging it in a more proactive way in the future.

Host: This is really a pioneering initiative. Would you say Maimonides leads or fosters innovation in cardiac care?

Paul Saunders, MD: We do. I mean, Maimonides has always been very supportive of innovation of cardiovascular services. The first heart transplant in the United States was performed at Maimonides. And obviously, in the much more recent period, we've been able to add a lot of different pioneering procedures and techniques that offer patients in Brooklyn access to care that they really can't get anywhere else.

Host: Well, Dr. Saunders, thank you for explaining ECMO and sharing this exciting development for this life-saving technology. And thank you for implementing it to give people a better outcome when heart problems happen.

Paul Saunders, MD: Sure. My pleasure.

Host: Dr. Paul Saunders is Chief of Cardiothoracic Surgery and Director of the ECMO Program at Maimonides. For more information, visit maimo.org. To make an appointment with the Heart and Vascular Institute, call 718-476-2328. Follow us on social at Maimo Health. And to listen to episodes of Maimo Med Talk, please visit maimo.org.