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NTUH: World's Top ECMO Center with Highest Survival Rate

2018-08-21

 

50 years ago, National Taiwan University Hospital (NTUH) completed Asia's first kidney transplantation from a family member, paving the way for organ transplants in Taiwan and Asia. NTUH went on to achieve many of Taiwan's "firsts", including the first transplant of hearts, lungs, pancreas, and kidneys. 10 years ago, NTUH was the first in the world to successfully complete heart transplant in a patient after 16 days on extracorporeal membrane oxygenation (ECMO) support without a heart.



ECMO was first brought back to Taiwan by NTUH's Dr. Wen-Je Ko after undergoing training in the US and in 1994, Taiwan completed its first successful use of ECMO.  In 2003, NTUH was the first in the world to publish a large-scale report on extracorporeal CPR. The report established the feasibility of using ECMO with CPR and coined the term ECPR. No discussion of ECPR is complete without the mention of the outstanding achievements of NTUH, a list that includes the most cases and highest survival rate in the world (the survival rate of patients supported on who suffered cardiac arrest before arrival at the hospital on ECMO support is 38.7%) and the ELSO Award of Excellence in 2014 and 2017. Its success with ECMO has become one of the most internationally acclaimed medical achievements of Taiwan.



The NTUH ECMO team works with the emergency and critical care units to rescue cardiac arrest cases with a standardized, reactive protocol that is on-call 24/7. They have proven that they can improve the patient's overall and neurologic prognosis. The key methods of the team include:

  1. Innovation: Precutting lines and oxygenators, simplifying the tubing, and customizing kits which have been certified by the FDA and available for the rest of the world to use.
  2. Excellent efficiency: An ECMO cart is designed with all the equipment and surgical tools ready for excellent mobility. Portable kits are prepared in advance and the protocol has been streamlined to allow ECPR to be ready within 15-minutes.
  3. Teamwork: Demonstrating the chemistry between the team and the surgical intensive care unit and the strength in collaboration.
  4. Expanding scope: Pioneering a new field of application, ECMO is currently utilized for any patient that requires short-term cardiac or pulmonary function support. Even the inventor of ECMO, Prof. Robert H. Bartlett has come to Taiwan to exchange ideas. The team has accumulated experience in a variety of cases and have continued to improve upon the details.
  5. Standardization: Standardizing the protocol and keeping an up-to-date manual for all members to use.
  6. Transparency: Providing clear information about the service and the protocol on the web for improved convenience.

 

The most difficult part of using ECMO is not the set-up, said Dr. Yih-Sharng Chen, the Director of Cardiovascular Surgery at NTUH. The real challenge starts after ECMO has been set up. This is because the patient condition can change drastically in an instant. The medical team must solve the problem that caused cardiac and pulmonary failure in the first place in a short amount of time. Highly professional skills are required to deal with any sudden crisis that may occur. The NTUH ECMO team has proven time and again that they can handle the crisis and have accumulated over 2500 cases, the most in Asia and one of the best records in the world. NTUH has also published extensively and is the Asia Pacific training center for ECMO, with participants from around the world. The team has also continued its research to establish pioneering work in evidence-based medicine.


(Editing by Nicole Yang, Research Center for Biotechnology and Medicine Policy)