Advanced life support gives critically ill patients a chance to heal.
By Maureen Gilmer, IU Health senior journalist, mgilmer1@iuhealth.org
Members of the ECMO team at Riley Hospital for Children love the opportunity to help support patients and families who are going through some of the hardest days of their lives.
Sometimes that support comes in life. Sometimes in death.
Kathie Ratliff is a nurse who cares for critically ill children, but she is also an ECMO clinician, providing often lifesaving care to those who are out of options.
ECMO is short for extracorporeal membrane oxygenation. It is basically a life-support system giving a patient’s heart and lungs time to rest and recover from illness or injury.
The Riley ECMO team, led by clinical manager Gail Hocutt, has supported more than 1,100 patients since the technology was introduced at the hospital in 1987. It is recognized as a Platinum Level Center of Excellence by the Extracorporeal Life Support Organization.
“This is a last-ditch effort to save a life,” Ratliff said. “I love that opportunity, but sometimes it’s also about giving a family time before they have to say goodbye to their child.”
When there is no hope for recovery, families are still grateful for the chance to hold their child without tubes obstructing their little one’s face.
It’s desperately sad, of course, but also a gift to loved ones, Ratliff said.
“They are so grateful to be able to hold their child,” she said. “We are able to let them see their child’s face. I love the opportunity to give the families that.”
Penny Eldridge has been an ECMO technician for 25 years. The technology has changed, but the goal is the same – to give patients a chance at life.
“We have a lot of success stories,” Eldridge said, acknowledging that teamwork and flexibility are crucial to making the program work.
Nurse and ECMO clinician Allison Allen said apart from supporting patients and families, being part of the ECMO team has helped her form relationships with nurses, physicians and therapists in all three ICUs at Riley – cardiovascular, neonatal and pediatric – where ECMO takes place.
“I came from the NICU primarily, but it’s a good learning experience to be able to work in all three.”
Riley can support four to six patients on ECMO at one time, but having to put three on in one night is unusual. That’s what happened to clinician Paula Miller, who works nights.
“We put three patients on ECMO in one 12-hour shift,” she said, “and it was only possible because of the incredible teamwork of our dedicated Riley staff.”
Two of those patients survived.
When it was determined that the third child’s condition was incompatible with life, the team withdrew the ECMO support in consultation with the family.
“Sadly, not all of our patients survive, but for this family, ECMO gave them time to know and love their precious baby,” Miller said. “Because she was fully supported by ECMO, we were able to take her off of the ventilator and they were able to hold her for hours before we removed ECMO support.”
Multiple people came together that night to make it the best they could for that family, Hocutt said.
When the worst happens, particularly in the case of an infant, Miller and her colleagues create special memories for grieving families. Molds are made of a parent’s hands holding a child’s hand or holding tiny feet.
“We have incredible bereavement support for our families and have made many memories for them that they will cherish,” said Miller, who started her nursing career at Riley in 1988 and became part of the ECMO team in 1990.
“Families love them. It means a lot to them to have something like that to take home.”
Riley’s ECMO team received a Red Shoe Award recently for outstanding contributions to family-centered care, as well as IU Health’s Living the Values Award for Excellence.
“We have seen so many miracles,” Miller said, adding, “It’s all about the team coming together.”
Photos by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org