Mobile ECMO programs

Penn Medicine offers patients with life-threatening heart or lung conditions the option of transport with mobile extracorporeal membrane oxygenation (ECMO).

Penn is uniquely equipped to dispatch a mobile team and travel to referring hospitals to initiate ECMO and stabilize patients before safely transferring them to Penn Presbyterian Medical Center or the Hospital of the University of Pennsylvania in Philadelphia, where their condition is then further managed.

Penn Medicine performs more mobile ECMO procedures than any institution on the East Coast. 

ECMO has evolved at Penn Medicine beyond bridge to lung transplant to include an increasing number of patient populations and disease states. 

Lung 

Bridge-to-lung-transplant  

ECMO as bridge-to-lung-transplant remains a keystone therapy at Penn Medicine.

The objectives at Penn for critically ill patients on ECMO include support for lung function and improvement of muscle strength through physical therapy and early ambulation. Ambulatory ECMO can turn the bridge period from a risky waiting time into an opportunity for active rehabilitation and prevention of deconditioning. Studies suggest that the long-term survival of lung transplant patients a year following ECMO is comparable to that of patients who did not need perioperative ECMO support. 

COVID-Related ARDS (CARDS)  

Penn Medicine is the third leading transplant center in the country for patients on ECMO support experiencing COVID-related ARDS (CARDS).  

ARDs is also associated with a heightened risk for coagulopathies, infections, multi-organ failure, and other complications among patients on ECMO support. As a consequence, prior to 2020, lung transplant was rarely offered to ECMO patients with ARDS.

This practice was modified at Penn and other institutions in 2020 during the COVID pandemic.

Three years later, a Penn ECMO Program study determined that one-year survival post-lung transplant for patients on ECMO for COVID-19 lung failure is similar to that of patients with non-COVID-19 restrictive lung failure, and that prolonged pre-transplant ECMO support had the potential to confer adequate clinical and functional status post-transplant.

Lung rescue  

The thriving Lung Rescue Mobile ECMO Program has transported >700 patients since its inception in 2014. Notably, since this time, the survival rate for mobile venovenous (VV) ECMO at Penn Lung Rescue has exceeded the Extracorporeal Life Support Organization (ELSO) average, including the pandemic years 2020-2022.

Pulmonary embolism 

With close to 80 patients supported in the presence of massive pulmonary embolism, Penn has one of the largest uses in the world for ECMO in pulmonary embolism as a bridge to recovery or percutaneous or surgical embolectomy.

Heart

Bridge to LVAD | Cardiac Arrest  

ECMO as a bridge to LVADs for left ventricular support, and Oxy-RVAD devices, which support the right ventricle, are now mainstays at Penn for bridging therapy in patients with advanced acute or chronic cardiac conditions and ventricular failure.

Additionally, extracorporeal cardiopulmonary resuscitation (ECPR), a form of ECMO, is now in use in patients with cardiac arrest who have not responded to conventional cardiopulmonary resuscitation, and in patients with pulmonary embolism. 

ECMO patient candidacy is dependent upon a patient’s unique case, medical history and current conditions.

Lung rescue

Penn Lung Rescue uses ECMO to support patients with severe but potentially reversible respiratory failure, such as acute respiratory distress system from flu, pneumonia, drowning, or pancreatitis.

Patient selection criteria

VV ECMO Selection inclusion criteria:

• Severe, reversible lung disease 
• PaO2 < 80 on 100% FiO2 or pH < 7.2 with hypercarbia unresponsive to conventional management 
• No contraindications to heparinisation 
• Mechanical ventilation for ≤ 10 days 
• Age ≤ 70 
• BMI ≤ 45 

VV ECMO Selection inclusion criteria for patients with COVID-19:

• Mechanical ventilation for ≤ 7 days 
• Age ≤ 50 
• BMI ≤ 35 
• No renal failure 
• No pneumothorax or pneumomediastinum