The new year is bringing a life-saving program to the Rio Grande Valley for the first time.
Two of the largest healthcare systems in the Valley will each be launching extracorporeal membrane oxygenation, or ECMO, at their respective hospitals early this year.
Both South Texas Health System and DHR Health have been preparing to bring an ECMO program to the Valley and, in doing so, eliminate the need to transfer patients to bigger metropolitan areas to access it.
ECMO is a type of life-support used for patients experiencing heart or lung failure. It works by essentially pumping blood out of the body, oxygenating it externally and then pumping it back into the body.
This allows the blood to bypass the heart and lungs and thus allow those organs to heal.
It gained considerable attention during the COVID-19 pandemic when complications from the disease resulted in lung failure in severe cases.
One McAllen teen wrote to Gov. Greg Abbott in January 2021 pleading for help in getting his 48-year-old mother, who had been hospitalized with COVID-19 at DHR Health, on ECMO.
“At this very moment, she is on a ventilator, hanging on for dear life,” Emilian Sosa wrote. “I beg of you to please make it possible for my mother to receive the Extracorporeal Membrane Oxygenation (ECMO) therapy.”
Abbott responded and Sosa’s mother, Erika Calderon Reyes, spent 106 days on ECMO at Memorial Hermann Texas Medical Center in Houston before dying on May 13, 2021.
But the need for ECMO began long before COVID-19.
“If you have cardio-pulmonary arrest, if you need CPR, if your heart stops beating, the doctor may decide that your heart needs to rest a little bit,” said Deborah Meeks, the chief nursing officer at STHS Heart in McAllen.
“So there’s a need beyond COVID that has been recognized,” Meeks said. “I think COVID gave it a lot of attention and certainly a lot more interest in the world about this process and so it was something that we had been looking at, and the time was right for us and we were able to execute that this year.”
Meeks joined STHS Heart in July and, since then, two patients were transferred north to receive ECMO.
But with the arrival of ECMO devices here, eligible patients won’t have to be moved far away from their families.
“Having an ECMO program in our institution will enable us to provide state of the art technology to help our patients in the RGV when they have the most critical heart or lung failure,” Dr. Juan Pablo Rey Mendoza, a pulmonary disease specialist with STHS, said via email.
He noted that the mortality rate for patients in these conditions could be as high as 50%, meaning one in every two patients will die.
“The ECMO machine can help us buy time for the patient in order to provide a bridge to recovery, or a bridge to a transplant,” he said. “As critical care physicians, this opportunity is exciting, since it allows us to provide one of the most advanced therapies, already available in some of the best centers of the country, on our own doorstep.”
The road to launching the program here has been long and involved a lot of training.
At DHR Health, Dr. Andrew Phillips has been working on putting the program together for about 10 months.
Born and raised in Mission, Phillips left to complete his training but returned to bring ECMO to the Valley at DHR Health. Currently, they are in the simulation stage and conducting drills.
“We have put together a full team and there was a training from ELSO, the Extracorporeal Life Support Organization, earlier in the fall,” Phillips said.
At DHR, Phillips says they have 15 ECMO specialists whose role is to manage the patients on the ECMO machine.
“It is a residential program so the patients will actually stay at DHR for both the VA and VV types,” he said referring to venoarterial (VA), which is used for patients with cardiac failure, and venovenous (VV), which is used in patients with respiratory failure.
The challenge with launching ECMO here, Phillips said, is that no one on staff had ever done it before.
“We have physicians who’ve done it before but none of the staff have,” Phillips said. “We’re starting from scratch so that’s been a big part of it — ensuring their education.”
Meeks said the training was about bringing that concept of a large team — with anesthesiologists, perfusionists, etc. — out of the operating room.
“The nurses and physicians and staff at McAllen Heart are just tremendous and were very receptive,” she said. “We would go through some intensive training so tons of didactic learning, different philosophies, different pathologies, how the machine operates, different mechanics so a lot of book learning.”
They would also set up the machine and practice with it.
“Run it just as if it was on a patient,” Meeks said, “troubleshoot it, go through different scenarios — how to react, how to intervene or how to initiate the procedure on the patient.”
Like any life-saving treatment, ECMO carries risks and so health care providers will have to take certain factors into consideration in deciding on whether to place a patient on ECMO.
Phillips said they’ll be using ELSO guidelines, which means age and comorbidities — other illnesses they may have — will be considered.
“There’s a rubric that gives you the probability of survival and so we’re going to take those recommendations,” Phillips said.
“These are patients who without ECMO would, for the most part, die. And so picking the patients who still have an opportunity for this machine to help them — it is a little bit tricky,” he said.
Mendoza also cited guidelines and requirements from ELSO that STHS will follow.
“There is a medical organization called ELSO that provides standard requirements that a patient has to meet for us to consider using ECMO, such as probability of death (more than) 50%, maximal mechanical ventilator support (aka life support) despite using other advanced therapies,” Mendoza said.
He hopes that patients won’t need ECMO and will recover with conventional therapies.
“But having ECMO available is like having extra insurance on the table,” Mendoza said. “It can give additional hope in a grim situation.”
