A heart-lung bypass machine, or venoarterial extracorporeal membrane oxygenation machine—VA-ECMO for short—provides temporary circulatory support when heart and/or lung functions are compromised due to events such as cardiac arrest or pulmonary embolism. It is a life-saving technology that was first successfully used for a cardiopulmonary bypass in 1930.
ECMO machines are now commonplace in operating rooms and intensive care units around the world. However, the use of ECMO in the emergency department was unheard of prior to 11 years ago when a team of pioneering emergency physicians used the technology to save the life of a patient who had been in full cardiac arrest for nearly 60 minutes.
The team at Sharp Memorial Hospital in San Diego led by Drs. Joe Bellezzo and Zack Shinar were the first in the world to implement this life-saving procedure in the ED. Both physicians serve the Sharp Memorial community through an ED staffing partnership with Synergy Health Partners.
“The problem with a lot of causes of a cardiac arrest is that it often takes a bit of time from diagnosis to the place that gets the patient fixed,” says Dr. Bellezzo. “The problem there is that traditional chest compression CPR only gives us about 60 minutes max to keep profusion to the brain. Beyond that, a patient will become brain dead. So the VA-ECMO allows us to put a patient on a heart-lung bypass machine to take them from the beginning of their arrest to the solution to the problem.
“It buys us all that time because we are now bypassing the heart and the lungs. That’s the beauty of this. And that was July 28, 2010, which was the beginning of what has now become the remarkable emergency department ECMO program here at Sharp Memorial.”
Of course, the work required to enable Drs. Bellezzo and Shinar to utilize ECMO in the ED began years prior to the day they saved their first patient with the technique. More than 25 years ago, Dr. Arthur Gruen, who at the time was the Executive Medical Director of Emergency Services at Sharp Memorial teamed up with revered cardiovascular surgeon Walt Dembitsky to pursue the theory that ECMO would improve outcomes for cardiac patients in the ED. After the procedure was authorized by the hospital in 2010, Drs. Bellezzo and Shinar put it into practice. It was truly a team effort. Later, Dr. Gruen co-founded Synergy Health Partners and continues to work closely with the Sharp Memorial emergency medicine staff.
“Drs. Bellezzo and Shinar took the lead and never looked back, saving patients who would have otherwise perished,” said Dr. Gruen. “Joe and Zack and the rest of the Sharp Memorial emergency physicians now have many miraculous saves, certainly with profound effect on patients and their families.”
ECMO Outcomes in the ED
Without resuscitative ECMO, the survival rate for cardiac patients in full arrest who are admitted to the emergency room is bleak. With ECMO in the ED, the survival rate is 55 percent.
“Our first case series showed five out of nine patients walking out of the hospital in an otherwise expected survival of less than one percent,” commented Dr. Shinar. “Fifty-five percent is really unbelievable.”
There are now 13 ED ECMO centers in the United States and others internationally in Australia, Europe, and Asia.
“Basically, we can keep any patient alive, from hypoxic Covid-19 patients to MI patients in cardiogenic shock, until the underlying morbidity is treated,” explains Dr. Gruen.
Championing the Solution: A New Resuscitative ECMO Textbook
It has been nearly a dozen years since that first successful ECMO case in an emergency department. And now Drs. Bellezzo, Shinar and other leaders in the practice have published a new textbook that will serve as a vital educational tool and reference resource for emergency departments worldwide.
The book, ECPR and Resuscitative ECMO: A Detailed Look at Extracorporeal Life Support is a roadmap for emergency departments to create and manage ECMO programs.
The new textbook outlines how to start a resuscitative ECMO program, how to design systems and protocols, team training, clinical trial data, resuscitation room setup, management priorities, physiology, and much more.
ECPR and Resuscitative ECMO is available now and can be purchased at Lulu.com
