As a respected Center of Excellence in caring for patients with acute respiratory distress syndrome (ARDS), Cooper is home to South Jersey’s only formal extracorporeal membrane oxygenation (ECMO) program—giving the region’s residents access to this lifesaving therapy closer to home.
“We take more than 7,000 transfers from area hospitals each year since we’re a regional referral center for critical care,” says Nitin K. Puri, MD, Co-Director of Critical Care Services at Cooper. “We normally will put between 10 and 20 of these patients a year on ECMO, and now, with our dedicated program in place, we can keep these critically ill patients here versus sending them over the river.”
Dr. Puri explains that there are two types of ECMO: cardiac and respiratory.
“Because of our expertise in ARDS, we made the decision to focus on respiratory ECMO,” he says. Also referred to as veno-venous extracorporeal membrane oxygenation (VV-ECMO), respiratory ECMO is a form of short-term pulmonary life support that circulates blood outside the body with a mechanical pump. It infuses oxygen into the blood, removes carbon dioxide, and provides hemodynamic support. Importantly, it enables damaged or injured lungs to rest and heal.
He notes that the ECMO program at Cooper treats adults only. “We will get pediatric patients started on ECMO if it’s indicated,” Dr. Puri says, “but we’ll send them to Nemours/Alfred I. duPont Hospital for Children for ongoing management.”
He also points out that “we will put patients on cardiac ECMO on a case-by-case basis” and encourages community physicians to contact the Cooper Critical Care team at any time with questions about the appropriateness of ECMO for a specific patient.
“We have a critical care attending in the hospital 24/7,” he says.
Although this technique is still considered rescue therapy, the knowledge and technology behind respiratory ECMO have improved significantly. In fact, studies show that outcomes in patients with adult ARDS are significantly improved when patients are cared for at a specialized ARDS center, such as Cooper. Dr. Puri believes that one of the things that makes Cooper Critical Care unique is its internationally recognized critical care training program, which is the oldest in the region. The program continues to attract thought leaders in critical care, and their insight allows us to give residents of the Delaware Valley the best possible chance of survival with ARDS.”
He also notes that the chance of survival improves if severe respiratory failure is treated with ECMO before the seventh day of ventilation because ECMO allows the lungs to heal before the effects of ventilator-induced lung injury and the consequences of hypoxia occur.
“So, for the best patient outcomes, we urge clinicians to call us as soon as it is apparent that advanced approaches are not working,” he says.
The Cooper Transfer Center is available 24/7 to coordinate air and land transport and is staffed at all times by a transfer nurse coordinator.
A transfer requires physician-to-physician consultation, which the Transfer Center initiates. This single point of contact streamlines the entire transfer process.
“As we enter flu season, severe respiratory issues become more common, particularly among the elderly and immunocompromised patients,” Dr. Puri notes. “The tendency in the past has been to send these patients across the river if they need ECMO support. With our formal program in place, we can care for them here.”
For an ECMO consultation or referral, simply call 855.CUH.XFER (855.284.9337) to start the process and activate the Cooper Transport Team.