Selected Podcast
Adult ECMO Program at UAB Medicine
Keith Wille MD, MSPH gives us an update on the adult ECMO Program at UAB Medicine. He discusses some of the new and exciting devices. He shares why it is so important to have an experienced team initiating and monitoring the course of ecmo and he reiterates why UAB Medicine is so unique in that regard.
Featuring:
Learn more about Keith Wille, MD, MSPH
Release Date: May 20, 2021
Expiration Date: May 20, 2024
Disclosure Information:
Planners:
Ronan O’Beirne, EdD, MBA
Director, UAB Continuing Medical Education
Katelyn Hiden
Physician Marketing Manager, UAB Health System
The planners have no relevant financial relationships with ineligible companies to disclose.
Speakers:
Keith Wille, MD, MSPH
Associate Professor in Critical Care Medicine, Pulmonology, Sleep Medicine
Dr. Wille has no relevant financial relationships with ineligible companies to disclose.
There is no commercial support for this activity.
Keith Wille, MD, MSPH
Keith Wille, MD, MSPH is the Medical Director, Lung Transplantation.Learn more about Keith Wille, MD, MSPH
Release Date: May 20, 2021
Expiration Date: May 20, 2024
Disclosure Information:
Planners:
Ronan O’Beirne, EdD, MBA
Director, UAB Continuing Medical Education
Katelyn Hiden
Physician Marketing Manager, UAB Health System
The planners have no relevant financial relationships with ineligible companies to disclose.
Speakers:
Keith Wille, MD, MSPH
Associate Professor in Critical Care Medicine, Pulmonology, Sleep Medicine
Dr. Wille has no relevant financial relationships with ineligible companies to disclose.
There is no commercial support for this activity.
Transcription:
Melanie: Welcome to UAB MedCast. I'm Melanie Cole. And today we're updating and revisiting the adult ECMO program at UAB Medicine. Joining me is Dr. Keith Willie. He's the Medical Director of Lung Transplantation at UAB Medicine. Dr. Willie, it's a pleasure to have you back with us again. Revisit for us a little bit about the history of ECMO, how it was developed and how you're using it at UAB medicine.
Dr Keith Willie: So I think as we've discussed in the past, ECMO largely started in the pediatric and neonate area. And over time, it's grown into the adult world. Really since about 2009, the number of patients that have been supported and the number of programs that use ECMO to support patients with heart and lung failure. It's really grown exponentially.
And we like other programs are interested and capable of trying to support and help patients that present with advanced heart or lung problems.
Melanie: Well, then what's different now than say even a few years ago? What's exciting? Are there any game changers you want to let other providers know about?
Dr Keith Willie: I think we, like many programs, have gained more experience with supporting a broad variety of patients. So these, for example are patients with heart failure patients with respiratory failure. Obviously in the last several months, COVID has been a particularly bothersome problem and one that's relatively common and we had to rely on ECMO support for these patients as well. But there are groups of other patients as well. So patients with thromboembolic disease, other forms of shock might benefit from ECMO support as well.
Melanie: Expand for us a little bit, Dr. Willie, how COVID has affected what you're doing at UAB Medicine, as far as patients that are coming in, ECMO use, tell us a little bit about what you've seen and how, maybe you've had to be a little more innovative and creative in what you're doing.
Dr Keith Willie: So I think it's fair to say that ECMO and COVID, or I guess I should say that COVID has really changed the landscape of how UAB is providing critical care and particularly ECMO support. It's true that a minority of patients that have COVID ultimately require ECMO support, but we've always stood by to consider ECMO for patients that really get to the limits of conventional mechanical ventilatory support.
At UAB, we've supported over 20 patients with ECMO at this point who have COVID. And I think our results and outcomes have mirrored the results that have been reported by ELSO, which is the Extracorporeal Life Support Organization. I think it's fair to say that those outcomes are a little bit inferior to patients that are supported who have respiratory failure not related to COVID, but still considering how sick these patients are, we and many other centers have had successful outcomes for a number of patients.
Melanie: So, how are you recognizing then those expected quality metrics, since this is all such a mystery? And we know that ECMO can lead to improved outcomes, how are you really recognizing this? It still seems to be such a complex, mysterious situation. How do you all go about this day to day?
Dr Keith Willie: So for patients with COVID, the first step is really establishing the diagnosis. And, our colleagues in the intensive care unit are providing optimal conventional critical care supports. This is mechanical ventilatory support, it's use of fluids, it's use of the accepted medical interventions, including a medication called Remdesivir and a particular corticosteroid. But by and large, it's largely conventional and traditional ICU support for these patients. And unfortunately, it's the ones that don't improve and, in fact, get quite sick or where their oxygen levels are low despite maximal settings on the ventilator where ECMO could have a role for some of these patients.
And so ECMO as we've discussed in the past is just an alternative way to provide oxygen. And in some cases, depending on the configuration, blood pressure support for patients that need it. So these are patients that for example have severe ARDS related to COVID or even non-COVID situations or patients that developed shock, they can be considered for ECMO support.
Melanie: Dr. Willie, what's exciting as far as advances in radiologic imaging that has augmented your diagnostic capabilities for respiratory failure? Is there anything exciting you'd like to share?
Dr Keith Willie: I think we're learning to use a number of radiologic techniques more regularly with patients that receive ECMO support. One of the challenges in the past has been transportation of these patients, for example, to radiology departments in part, because when you think about moving these patients, they take a ventilator, they take an ECMO circuit, they have to transport in bed. Many of them are sometimes attached to other ICU support devices. And so it really takes a full team of nurses, respiratory therapists, ECMO specialists, to transport these patients. But we've been able to develop a strategy and algorithmic approaches move these patients to radiology in a safe manner, and really haven't had any adverse outcomes with these kinds of practices. And I think as you imagine, the ability to have radiologic imaging, CAT scanning, for example, has really augmented the ability to assess patients and try to implement the appropriate care for them.
Melanie: Well, I certainly imagine that it has. Is there anything new with the design of the equipment for ECMO? Anything else or even some of the research or initiatives that you're doing at UAB that you'd like to share with other providers?
Dr Keith Willie: Yeah, I think so. I think there are some newer cannulas, for example. We're studying a number of outcomes related to ECMO including for example, anticoagulation management strategies. We're studying the optimal use of antibiotics and other medications with ECMO. We're actually participating in an international registry trial right now for patients with COVID who require ECMO support. And so hopefully, these and a number of other studies that we're partaking in will continue to help us to make this technology better and easier to use for patients that need it.
Melanie: As we wrap up, Dr. Willie, how important, and please reiterate this for us, is having that experienced team initiating and monitoring the course of ECMO? Why is UAB so unique in this regard?
Dr Keith Willie: I think one of the things that's been very nice is that the institution has been highly supportive of the ECMO program, such that we've been able to grow our patient numbers to over 100 patients per year, and this year we should hit somewhere between 150 and 200 patients that have been supported with ECMO.
And with that kind of volume just comes experience for the entire team in managing and taking care of patients and hopefully getting patients better. So I think one of the nice features about UAB is just the experience with ECMO care that comes.
Melanie: Well, I certainly agree with you and thank you so much, Dr. Willie for coming on and updating us and a community physician can refer a patient to UAB medicine by calling the MIST line at 1-800-UAB-MIST.
That concludes this episode of UAB MedCast. To refer your patient or for more information on resources available at UAB medicine, please visit our website at UABMedicine.org/physician. Please also remember to subscribe, rate and review this podcast and all the other UAB Medicine podcasts. I'm Melanie Cole.
Melanie: Welcome to UAB MedCast. I'm Melanie Cole. And today we're updating and revisiting the adult ECMO program at UAB Medicine. Joining me is Dr. Keith Willie. He's the Medical Director of Lung Transplantation at UAB Medicine. Dr. Willie, it's a pleasure to have you back with us again. Revisit for us a little bit about the history of ECMO, how it was developed and how you're using it at UAB medicine.
Dr Keith Willie: So I think as we've discussed in the past, ECMO largely started in the pediatric and neonate area. And over time, it's grown into the adult world. Really since about 2009, the number of patients that have been supported and the number of programs that use ECMO to support patients with heart and lung failure. It's really grown exponentially.
And we like other programs are interested and capable of trying to support and help patients that present with advanced heart or lung problems.
Melanie: Well, then what's different now than say even a few years ago? What's exciting? Are there any game changers you want to let other providers know about?
Dr Keith Willie: I think we, like many programs, have gained more experience with supporting a broad variety of patients. So these, for example are patients with heart failure patients with respiratory failure. Obviously in the last several months, COVID has been a particularly bothersome problem and one that's relatively common and we had to rely on ECMO support for these patients as well. But there are groups of other patients as well. So patients with thromboembolic disease, other forms of shock might benefit from ECMO support as well.
Melanie: Expand for us a little bit, Dr. Willie, how COVID has affected what you're doing at UAB Medicine, as far as patients that are coming in, ECMO use, tell us a little bit about what you've seen and how, maybe you've had to be a little more innovative and creative in what you're doing.
Dr Keith Willie: So I think it's fair to say that ECMO and COVID, or I guess I should say that COVID has really changed the landscape of how UAB is providing critical care and particularly ECMO support. It's true that a minority of patients that have COVID ultimately require ECMO support, but we've always stood by to consider ECMO for patients that really get to the limits of conventional mechanical ventilatory support.
At UAB, we've supported over 20 patients with ECMO at this point who have COVID. And I think our results and outcomes have mirrored the results that have been reported by ELSO, which is the Extracorporeal Life Support Organization. I think it's fair to say that those outcomes are a little bit inferior to patients that are supported who have respiratory failure not related to COVID, but still considering how sick these patients are, we and many other centers have had successful outcomes for a number of patients.
Melanie: So, how are you recognizing then those expected quality metrics, since this is all such a mystery? And we know that ECMO can lead to improved outcomes, how are you really recognizing this? It still seems to be such a complex, mysterious situation. How do you all go about this day to day?
Dr Keith Willie: So for patients with COVID, the first step is really establishing the diagnosis. And, our colleagues in the intensive care unit are providing optimal conventional critical care supports. This is mechanical ventilatory support, it's use of fluids, it's use of the accepted medical interventions, including a medication called Remdesivir and a particular corticosteroid. But by and large, it's largely conventional and traditional ICU support for these patients. And unfortunately, it's the ones that don't improve and, in fact, get quite sick or where their oxygen levels are low despite maximal settings on the ventilator where ECMO could have a role for some of these patients.
And so ECMO as we've discussed in the past is just an alternative way to provide oxygen. And in some cases, depending on the configuration, blood pressure support for patients that need it. So these are patients that for example have severe ARDS related to COVID or even non-COVID situations or patients that developed shock, they can be considered for ECMO support.
Melanie: Dr. Willie, what's exciting as far as advances in radiologic imaging that has augmented your diagnostic capabilities for respiratory failure? Is there anything exciting you'd like to share?
Dr Keith Willie: I think we're learning to use a number of radiologic techniques more regularly with patients that receive ECMO support. One of the challenges in the past has been transportation of these patients, for example, to radiology departments in part, because when you think about moving these patients, they take a ventilator, they take an ECMO circuit, they have to transport in bed. Many of them are sometimes attached to other ICU support devices. And so it really takes a full team of nurses, respiratory therapists, ECMO specialists, to transport these patients. But we've been able to develop a strategy and algorithmic approaches move these patients to radiology in a safe manner, and really haven't had any adverse outcomes with these kinds of practices. And I think as you imagine, the ability to have radiologic imaging, CAT scanning, for example, has really augmented the ability to assess patients and try to implement the appropriate care for them.
Melanie: Well, I certainly imagine that it has. Is there anything new with the design of the equipment for ECMO? Anything else or even some of the research or initiatives that you're doing at UAB that you'd like to share with other providers?
Dr Keith Willie: Yeah, I think so. I think there are some newer cannulas, for example. We're studying a number of outcomes related to ECMO including for example, anticoagulation management strategies. We're studying the optimal use of antibiotics and other medications with ECMO. We're actually participating in an international registry trial right now for patients with COVID who require ECMO support. And so hopefully, these and a number of other studies that we're partaking in will continue to help us to make this technology better and easier to use for patients that need it.
Melanie: As we wrap up, Dr. Willie, how important, and please reiterate this for us, is having that experienced team initiating and monitoring the course of ECMO? Why is UAB so unique in this regard?
Dr Keith Willie: I think one of the things that's been very nice is that the institution has been highly supportive of the ECMO program, such that we've been able to grow our patient numbers to over 100 patients per year, and this year we should hit somewhere between 150 and 200 patients that have been supported with ECMO.
And with that kind of volume just comes experience for the entire team in managing and taking care of patients and hopefully getting patients better. So I think one of the nice features about UAB is just the experience with ECMO care that comes.
Melanie: Well, I certainly agree with you and thank you so much, Dr. Willie for coming on and updating us and a community physician can refer a patient to UAB medicine by calling the MIST line at 1-800-UAB-MIST.
That concludes this episode of UAB MedCast. To refer your patient or for more information on resources available at UAB medicine, please visit our website at UABMedicine.org/physician. Please also remember to subscribe, rate and review this podcast and all the other UAB Medicine podcasts. I'm Melanie Cole.