The Jefferson Surgical Cardiac Care Unit (SCCU), reorganized in July 2010, delivers the best survival rates in Pennsylvania for patients plagued by serious lung and/or heart dysfunction. Nicholas Cavarocchi, MD, FACS, FCCP, the SCCU Director and Associate Professor of Surgery, leads a highly trained team that uses extracorporeal membrane oxygenation (an ECMO machine) to provide respiratory and cardiac support to patients whose lungs and/or hearts cannot function on their own. Because of the excellent outcomes – 70 to 80 percent survival rates for patients with life-threatening situations, up from a previous zero-based survival rate – Dr. Cavarocchi believes the Jefferson SCCU model will ultimately be adopted by all hospitals.
“Our SCCU model brings together the ECMO technology and a team of cardiac physicians, nurses and mid-level providers all trained in complex critical care,” Dr. Cavarocchi says. “We have implemented standardized management of patient care using established protocols built with evidence-based medicine.” Jefferson’s SCCU is currently the only service in the nation led by cardiothoracic surgeons, rather than anesthesiologists or other medical doctors. The team physicians, who are all board-certified in thoracic surgery, also include Harrison Pitcher, MD, Hitoshi Hirose, MD, PhD, FACS, and Michel Haddad, MD. The rest of the team is comprised of physicians assistants Angela Kelley, PA, Tamara Boucher, PA and Sarah Langan, PA-C, and nurse practitioner Megan McCullough, CRNP.
Based on the principles of a machine that was invented in the 1950s and first used successfully in humans at Jefferson Hospital by John Gibbon, Jr., MD, ECMO takes a patient’s blood, gives it oxygen, warms it and returns it to the patient. Today’s ECMO machine, with its innovative circuitry, newer membrane oxygenator and centrifugal pump is a completely different machine but the concept is the same. Complemented by the SCCU team’s comprehensive approach, ECMO treatment helps avoid serious complications such as bleeding and hemolysis (the breakdown of red blood cells) and allows the heart and/or lungs to recover. At Jefferson, patients are placed on ECMO earlier than usual, ideally before the patient has organ failure. This improves their chances of either being successfully weaned from ECMO or having surgery with fewer complications, and that reduces costs for both the hospital and the patient.
The SCCU currently treats about 30 patients annually but that number is expected to increase by 50% this year with referrals from within and out-of-state. “Our team has been trained to deliver a level of complex critical care that is sophisticated and consistent,” notes Dr. Cavarocchi, “Our patients are benefiting and our colleagues are noticing.”
"Surgeon-led ECMO Treatment Improves Survival Rates in Surgical Cardiac Care Unit,"
Jefferson Surgical Solutions:
2, Article 6.
Available at: http://jdc.jefferson.edu/jss/vol6/iss2/6