Transporting life support

Heart and lung function is essential to life, but what happens if one of these organs becomes compromised? And how do you access life-saving care when you’re in an isolated part of the country? Luckily for young people across Australia, the RCH is home to a dedicated ECMO retrieval service, featuring a life support system essential to keeping the most acute patients alive.

ECMO stands for extracorporeal membrane oxygenation and this vital piece of technology acts like a heart-lung support, pumping blood around the bodies of even the tiniest babies until their own heart and lungs are strong enough.

“ECMO plays a major role in how we care for some of the most acute patients in the intensive care unit (ICU). From children with heart failure who are needing a heart transplant, to severe cases of pneumonia and the flu, ECMO can provide essential support to the heart and lungs to help aid repair,” said Martin Bennett, Paediatric Perfusionist at the RCH.

A dedicated system designed to support both the heart and lungs, either independently or together, ECMO is part of the cutting-edge care that the RCH provides for some of the sickest respiratory and cardiac patients from around Australia. And how to get patients safely here is an essential part of the service.

“Previously when a request for retrieval came, we would need to piece together a portable ECMO system from parts around ICU and theatres, potentially compromising emergency patient care, and with multiple screens, tubes and machinery, it added a lot of bulk to the transport,” said Martin.

Thanks to support from the Finnan’s Gift community, the RCH now has access to a purpose built portable ECMO device called Cardiohelp. Combining multiple monitoring technology into the one unit, the device is speficially designed for travel, and features a lock-in system to safely attach to the aircraft. Most importantly, the device, and all of its necessary supportive equipment is pre-packaged and ready to go at a moment’s notice.

“The ECMO retrieval team are on call 24/7, and an integral part of the service is ensuring easy access to the equipment, so at 3am when the emergency call comes, you’re not running around the hospital trying to piece together parts,’’ said Paediatric Perfusionist Brad Schultz, who was on call the night the first time Cardiohelp was used.

Although retrieval requests are somewhat rare, with only five to eight performed each year, the team must be ready to go at a moment’s notice. Featuring specialised surgical staff including a perfusionist, cardiac surgeon, intensive care doctor and a scrub nurse, the ECMO retrieval team are specially trained to be able to connect the patient to life support at the bedside, and provide an expert level of care throughout the transport process, which can include multiple bed changes, ambulance transport and flights.

For the first retrieval with the Cardiohelp device, the call came from Adelaide. A young patient’s lungs were failing, and she urgently needed to be placed on ECMO and to be transported to the RCH to for her best chance of survival.

“By the time the call came through to us with the decision to go onto ECMO, there had already been hours of planning and preparation between the RCH team and the patient’s care team. Retrievals are incredibly complex; surgical and care situations need to be navigated at both the RCH and the treating hospital, as well as the exact specifics of the steps for transportation. Within a matter of hours, we were on a medical retrieval jet with a thorough understanding of the patient’s condition so that when we landed, the surgical team were able to immediately get to work,” explained Brad.

And for 14 month old Charlotte, they were just in time.

“Charlotte’s lungs were shutting down, and her care team in Adelaide had reached their limits in terms of the support they could provide her.

The Cardiohelp device was the perfect equipment for her support, we were able to connect her with the confidence that we had all the right parts, and that the upcoming road and air transport would be carried out in the safest possible manner. The Cardiohelp was then also able to support her through the first stages of care at the RCH,” said Brad.

When Charlotte first arrived at the RCH, she was taken immediately to ICU where ECMO support is currently playing an integral part of her care plan acting as her lungs, while the specialised team is working towards making them strong enough to function on their own.

“Charlotte still has a long journey ahead of her, and we’re not sure what that looks like yet, but what we do know is that, thanks to the expert teams at the RCH and support of the Cardiohelp device, she’s receiving the best level of care. Thank you to everyone for making this device possible for the teams and patients at the RCH,” said Martin.