If it seems like a patient needs a miracle, then it’s time to engage the Temple ECMO Program. An ECMO, or extracorporeal membrane oxygenation, machine takes blood from a patient’s veins and circulates it outside their body, where it removes carbon dioxide, adds oxygen, and then returns it to the body.
As ECMO is a form of life support, it’s only used in the most serious cases, like supporting patients with acute respiratory distress syndrome and cardiogenic shock. “ECMO also plays a key role in our lung transplant program, which is leading the way nationwide in terms of transplant volume and outcomes,” explains Joseph DiMartino, RN MSN, NE-BC, CRRN, an Associate Vice President of Nursing at TUH-Main Campus. “Our ECMO Program also grew exponentially during the pandemic, as ECMO is often part of the treatment plan for patients with very severe COVID-19.”
In these critical situations, providing the highest level of care makes all the difference. That’s why it’s so significant that our ECMO Program has earned the Extracorporeal Life Support Organization (ELSO)’s Path to Excellence Silver Level Award.
“ELSO is the world’s largest ECMO registry and provides the guidelines for what ECMO care should look like,” says Daniel L. Marino, BSN, RN, CCRN, CES-A, E-AEC, East Region ECMO Coordinator for Specialty Care, a perfusion company that staffs Temple’s ECMO Program. “Registering with ELSO meant formalizing our existing program and aligning ourselves with the standards and expectations for a Center of Excellence.”
An External Quality Assessment
One of the most important steps in the application process was submitting data on Temple’s ECMO Program to ELSO. Temple first began doing so in 2021, thanks to the hard work and advocacy of Roh Yanagida, MD, PhD, FACS, Surgical Director of Heart Transplant, Associate Professor in the Division of Cardiovascular Surgery, and Director of the ECMO Program and Yoshiya Toyoda, MD, PhD, Executive Director of the Temple Heart & Vascular Institute, Chief of Cardiovascular Surgery, Surgical Director of Thoracic Transplantation, and Director of Mechanical Circulatory Support at Temple University Hospital, and Professor of Surgery and William Maul Measey Chair of Surgery at the Lewis Katz School of Medicine.
“Submitting this data was critical for our quality control,” says Dr. Yanagida. “We needed to be objectively assessed by an outside authority to see how well we were performing.”
Dr. Yanagida then worked with Marino and several other members of the ECMO Program—including Orion Garcia, BSN, RN, CCRN, Temple Health’s Director of ECMO Services and Resuscitation Services, and Brian Fox, BS, RT, CES-A, Specialty Care’s ECMO Coordinator for TUH-Main Campus—to complete the rest of the ELSO application.
Because Temple hadn’t been submitting ECMO data for a full five years by the time the application was presented, the program wasn’t eligible for ELSO’s two highest levels of recognition: the Center of Excellence Platinum and Gold Level. However, the team knew they could still earn the Path to Excellence Silver Level award—and was determined to do so.
“We wanted to show ELSO all the incredible work we’re doing,” says Garcia. She cites the contributions of the entire ECMO team, including those of Keisha Richards, a Specialty Care leader who oversees ECMO specialists and perfusionists, in significantly improving the program’s outcomes. “Over the last five years, we’ve cut our mortality rate by 50%. Our data is really positive, and we’re helping a lot of people.”
Going for the Gold (or Platinum)
Completing the ELSO application also involved assessing the ECMO Program’s procedures and identifying opportunities to improve and grow.
“So much of the application was about reviewing our processes,” Marino says. “We had to ask ourselves, ‘When a patient comes in, are we consistent with our procedures?’ ‘Is there any way we can refine our cannulation processes?’ Having to formalize our policies and align ourselves with ELSO’s standards made our program much stronger.”
When the team received news that they had earned the Path to Excellence Silver Level Award, it confirmed that their efforts had paid off. “It validates all the great work we’re doing in our ECMO Program,” DiMartino says. “It shows how far we’ve come over the last several years, and that we’re providing our patients with the highest-quality care that they deserve. It also aligns us to be a premier Center of Excellence organization, both in ECMO and in everything we do.”
Indeed, the team is already preparing to apply for the Center of Excellence designation next year. “I think we’ll 100% reach that goal,” says Garcia, who accepted the Path to Excellence Silver Award at the 2024 ELSO Conference in Detroit. “We have such a great team—our surgeons, our doctors, our nurses—and this will really help us grow our program.”
Marino agrees, while also emphasizing the significance the ELSO award holds for patients. “ELSO recognition means something,” he explains. “If you have it, patients don’t have to ask, ‘What is your ECMO program like?’ They can see that you have an ELSO award, and they know you’ve met the highest standards. They understand, ‘Oh, that’s a top-tier program.’”
