Groote Schuur Hospital continues to be at forefront of health technology
The adult Extra-Corporeal Membrane Oxygenation (ECMO) Centre at Groote Schuur Hospital assisted 36 patients since its opening in 2016. As the only public hospital in the Western Cape which has an adult ECMO Centre, Groote Schuur Hospital’s dedicated staff will continue to support these patients who have severe and life-threatening illness that stops their heart.
ECMO is a technology of pumping blood out from the body, performing the role of the lungs (oxygen in and carbon dioxide out) and then pumping it back into the body. It can be used to support patients who are unable to be safely supported by traditional mechanical ventilation. The hospital offers both VV-ECMO which supports failing lungs and VA-ECMO which supports a failing heart. It can do this because the pump has to flow the blood very fast through the oxygenator, equivalent to what a heart does in the body. ECMO works through large pipes (cannulae) placed near to the heart and takes this blood at high speed (around 3 - 5 litres a minute) through an oxygenator before returning it to the patient with carbon dioxide removed and oxygen added. Medication is continually given to ensure the pipes and oxygenator do not clot.
EMCO needs a dedicated team built around the 24-hour nursing Intensive Care Unit (ICU) nursing specialists required to look after such a patient in the ICU. The rest of the team is consisting of doctors (critical care specialists, pulmonologists and cardiothoracic surgeons) and clinical technologists and perfusionists.
“Choosing who can stand to benefit from this technology is difficult and always done by a multidisciplinary team in our centre as ECMO itself comes with its own risks and complications and the window for initiating ECMO is very time sensitive. Patients often go from being too well to benefit (where it would expose them to unnecessary risk) to too sick (where the organ failures have progressed too far to be reversible). We are reviewing the latest scientific literature published to always offer best practice,” said Dr David Thomson, who is part of the ECMO team at the hospital.
ECMO is dependent on a specialist ECMO sister trained in managing the machine in order to be able to offer this support safely. ECMO is itself risky. The specialist ICU nurses at Groote Schuur Hospital have been incredibly stretched looking after more than one patient in ICU and assisting other nurses to look after their patients.
“I have worked in ICU for the last 24 years and have been treating ECMO patients at the hospital since it started. It is very intense to treat ECMO patients compared to ICU patients because you have to be mentally aware for the patients all the time. The longest patient we had for two months. One patient survived after two weeks on ECMO and over a month in ICU while being admitted during the COVID-19 period. She is back at home and has fully recovered,” said Sister Bianca Van Rooyen, who works as an ICU nurse at Groote Schuur Hospital
ECMO is just a support therapy - it doesn't fix the disease - it allows the patient to hopefully recover.
International registry data is 55% survival in patients where the outcome is known. There are a large number of cases still ongoing so that number may change when the outcome of these patients is known. Available at https://www.elso.org/default.aspx. Groote Schuur Hospital researchers contribute to this international registry.
Groote Schuur Hospital
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