Joining us today is Kurt Strudwick, a clinical educator for ECMO services at Specialty Care. In today’s episode we talked to Kurt about how a family tragedy in his youth led him to have a passion for working in healthcare, how we started working in extra corporeal membrane oxygenation which is what ECMO stands for, and how he has taken his vast experience at ECMO to help hospitals across America start their own ECMO programs. Enjoy the conversation.
Todd Schlosser: Hello and welcome to Checking the Vitals, a podcast powered by Specialty Care. I’m Todd Schlosser and joining us today is Kurt Strudwick, a clinical educator for ECMO services at Specialty Care. In today’s episode we talked to Kurt about how a family tragedy in his youth led him to have a passion for working in healthcare, how we started working in extra corporeal membrane oxygenation which is what ECMO stands for, and how he has taken his vast experience at ECMO to help hospitals across America start their own ECMO programs. Enjoy the conversation.
Joining me today is Kurt Strudwick, who is the national clinical educator for ECMO services at Specialty Care, and this is the first time we’ve had… well, I will say an ECMO specialist on, someone who focuses on ECMO, so I’m going to be picking your brain a lot about that specifically later in the episode. But what I’d like to do right now is talk to you about why you wanted to work in healthcare in general. So what was it that brought you to that field?
Kurt Strudwick: So I think was born into that family of health professionals.
Todd Schlosser: Okey.
Kurt Strudwick: But my main inspiration came from my mother. She was a pediatrician.
Todd Schlosser: Oh, okey.
Kurt Strudwick: I think the triggering point for me was when she got diagnosed with cancer and she six months later lost her battle to cancer.
Todd Schlosser: Sorry to hear that.
Kurt Strudwick: I typically tell people that like a personal experience, like this can be one or two things. It can either consume you and make you make nothing out of it. Or you can go on and continue to live their legacy and inspire people and make a difference in their lives and I obviously chose the latter.
Todd Schlosser: Yeah, absolutely.
Kurt Strudwick: So she passed when I was going into high school.
Todd Schlosser: Okey.
Kurt Strudwick: I kind of knew I wanted to go into the medical profession, but didn’t know exactly what.
Todd Schlosser: Sure.
Kurt Strudwick: To focus heavily on the sciences. Of course, and college provided me that exposure to different avenues in medicine being affected by asthma as a child. That was kind of what drew me to focus on the loans [crosstalk] .
Todd Schlosser: Like Respiratory issues right?
Kurt Strudwick: Yep.
Todd Schlosser: Yeah, absolutely
Kurt Strudwick: I remember sophomore year of college, I was going through Midlife college crisis. Like a lot of people do.
Todd Schlosser: Yeah.
Kurt Strudwick: And it kind of Dawned on me, I was like it says respiratory therapy. And I was like, this must be a sign. So from there, you know, just kind of like phoned more [inaudible] the profession. And I was given the opportunity to work in pediatrics and unitards Johns Hopkins in Baltimore. And I invested most of my time in the pediatric cardiac intensive care unit, which is where we did predominantly the direct moon.
Todd Schlosser: Yeah.
Kurt Strudwick: And it was just like so fascinating and that’s where I became trained as a micro specialist. It just took off from there.
Todd Schlosser: And you just sort of made a career out of that specifically. It sounds like.
Kurt Strudwick: Yep. [crosstalk] just like jumped ship off the respiratory cherry.
Todd Schlosser: Well, I would still say that they’re somewhat related, although normally when ECMO comes up on checking, the vitals is because we’re talking to a perfusionist who also assists in ECMO. So can, can we talk briefly about how it’s different? So can you give me a basic, I guess, explanation of what ECMO specifically does?
Kurt Strudwick: Oh yeah. So ECMO is a form of extra corporate life support and it’s able to kind of augment oxygenation and ventilation as well as cardiac output by a cannula that is inserted into the patient’s neck or from our vein or artery. And it removes the blood from the patient’s body, pumps it through our circuit and when it passes through the circuit, it passes through an oxygen ator and this oxygen ator plays the role of the heart and lungs and it oxygenates the blood and remove CO2 and then returns to the oxygenated blood to the patient’s body. This allows the patients sick heart or lungs or both to rest while the medical team tries to figure out what the underlying problem is and treat the underlying issue.
Todd Schlosser: I would assume that it’s used a lot to give the body a chance to rest and recover because it might take a while for whatever’s going on. It could be a virus or it could be anything I’m sure, you know, a lot more about it than I do, but it could take a while for that to dissipate to a point where the heart and lungs can take back over. I’m assuming, is that it all correct?
Kurt Strudwick: A hundred percent correct.
Todd Schlosser: Okey.
Kurt Strudwick: Sometimes you see, it depends on the underlying cause obviously.
Todd Schlosser: Sure Yeah.
Kurt Strudwick: So a baby that is on a McCone aspiration who probably only needs that most four, three, four days maybe.
Todd Schlosser: Right.
Kurt Strudwick: You could see somebody with COVID and they ended up being on ECMO for four weeks so it kind of varies.
Todd Schlosser: And that’s actually an interesting distinction between like perfusion, like running a heart and lung machine during surgery, which can last hours. But
Kurt Strudwick: Yeah.
Todd Schlosser: which is a long time, but ECMO it’s usually days, sometimes weeks, as you just mentioned for a lot of COVID patients.
Kurt Strudwick: Right.
Todd Schlosser: So does someone to the technician or a specialist as you were, do they need to be in the room where the patient is receiving ECMO 24 hours a day with that ECMO patients?
Kurt Strudwick: Yes. So the ECMO specialists. They are at the bedside 24/7. And in my experience as a specialist, because you can’t leave the bedside at all. If you needed to take a break, you’d be bricked up another ECMO specialist or a perfusionist for somebody who is trained in asthma.
Todd Schlosser: You’d be sort of relieved and then you can come back and take my call for sure. Yeah,
Kurt Strudwick: Absolutely. And obviously that’s because in the blink of an eye, anything can go wrong. So you obviously have to respond quickly and appropriately in the event that something like that should occur.
Todd Schlosser: I mean, the ECMO machine is essentially acting as the heart and lungs, which are two of the most important organs.
Kurt Strudwick: That is exactly what is keeping the patient alive [crosstalk] happens to that machine. Chances are, if it’s not corrected almost immediately that the patient could die.
Todd Schlosser: Yeah. And we obviously, the patient outcomes are the most important thing in this line of business. So that’s paramount, no matter what’s going on. So while you’re there, and I just wonder while you were at Johns Hopkins doing this and sitting by the bedside, you were in pediatrics too. Right? So it’s just like children, you’re sitting there with.
Kurt Strudwick: Yep.
Todd Schlosser: Are you able to talk to them or are they intubated and sort of lack of a better term of sleep during this
Kurt Strudwick: In pediatrics, they’re intubated. And [inaudible] because there’s no way that you can rationalize with a three year old that you have these cameras coming out your neck and you need to stay still.
Todd Schlosser: That was my question I have, I have a niece and nephew, and there’s no way they would allow that to happen at that age.
Kurt Strudwick: Yeah. Yeah. Typically, you know, like our pediatric population or babies, they’re typically intubated and on drips to keep them comfortable and keep them sedated.
Todd Schlosser: Yeah.
Kurt Strudwick: What are the later advancements? And ECMO is if it’s being used as the bridge for like a lung transplant, those patients wants to go on ECMO. They can, you know, be extubated. They can get up, they can walk, they can work with PT. So that’s one of the things that you see with a lot of the bigger centers they’re doing is getting just like early mobility. So there’s no point to keep an adult or, you know, like even a teenager who you can rationalize with. There’s no reason to keep them heavily sedated and intubated.
Todd Schlosser: Sure.
Kurt Strudwick: So you can get them up and walking and moving until the time comes for them to have a lung transplant.
Todd Schlosser: Oh so they can get up and walk around when they’re on ECMO.
Kurt Strudwick: Yeah. Obviously not the more severe where it’s total part and along support. But if they’re on the ECMO support purely for their lungs and their heart’s fine, they can get up, they can work with PT, they can walk around and it takes a lot, but,
Todd Schlosser: Well, I’d imagine you’re sort of wheeling a machine around with them. You’re sort of following them.
Kurt Strudwick: You have the tubing coming out? It’s a production, but
Todd Schlosser: So you worked at Johns Hopkins for, it seems like it was six, seven years. Is that about right.
Kurt Strudwick: Yeah, almost 7 years.
Todd Schlosser: And you did that as an ECMO coordinator in the ECMO capacity for that long.
Kurt Strudwick: So our therapists played both roles.
Todd Schlosser: Oh,okey.
Kurt Strudwick: So you kind of function as both a respiratory therapist and an ECMO specialist.
Todd Schlosser: So can I ask and I realize this is deviating from the ECMO area, but what exactly does a respiratory therapist do day to day with patients?
Kurt Strudwick: It could be as simple as giving a breathing treatment for an asthma attack, or it could be doing chest compressions and incubating a patient and putting them on a mechanical ventilator
Todd Schlosser: Okey, [crosstalk] so a pretty Wide [crosstalk] the other. Yeah.
Kurt Strudwick: It kind of varies. Obviously, if you work in an intensive care unit, especially now during COVID, I can only imagine.
Todd Schlosser: Yeah.
Kurt Strudwick: It’s crazy because COVID is attacking the respiratory system mainly. So I’m sure all the rest of their therapists are just slammed right now.
Todd Schlosser: Oh, I’m sure that’s true. And then it sounds like at least the places like Johns Hopkins where they sort of pulled double duty as far as respiratory therapy and ECMO duty, they’re even more so. [crosstalk] Yeah. Just because they are that. And maybe we can focus on that a little bit, but it seems to me, and obviously correct me if I’m wrong because you’re the expert, but it seems to me like ECMO or going on ECMO is sort of the last line of defense against COVID for a lot of patients. And I don’t know exactly why that is, but I think it is because it attacks the lungs and you’re just trying to buy them more time.
Kurt Strudwick: Yeah. So the outcomes vary, obviously.
Todd Schlosser: Yeah.
Kurt Strudwick: And it depends on like institutional practices, but typically what I tell people is that you shouldn’t wait until the last possible moment to put a patient on ECMO. You should have thresholds once the patient meets that threshold, then you just put them on that way. Because what you’re finding, especially with the patients whose lungs are severely compromised, is that you’re taking a lot of pressure from the mechanical ventilator to, essentially keep their body’s pH normal.
Todd Schlosser: Yeah.
Kurt Strudwick: So obviously as you increase that pressure, you increase the settings, this just poses more and more problems in regards to lung protective mechanism.
Todd Schlosser: Sure.
Kurt Strudwick: So that’s something that could be considered is if you put them on ECMO sooner, or the outcome is better.
Todd Schlosser: Is there any data to suggest that?
Kurt Strudwick: It’s way too soon to, especially this just happened in the past nine months. So I think people are still just kind of like making educational, like a team effort, making the best educated guess that’s possible.
Todd Schlosser: And that’s really all you can do at this point. It’s, it’s interesting. And it’s been interesting to see this from a, I call myself a bystander just because I sort of work in the healthcare field, but I don’t actually practice any medicine. Right. I just sort of help people [crosstalk] tell the stories. Yeah, but I wouldn’t say it, if you asked me what you should do, I would be like you call Kurt. Cause I have no idea, but I think that a lot of people look at the medical community as well, they’re the experts, they know what they’re doing 100% of the time, but when things like this happen that are sort of maybe not brand new, because we’ve dealt with Corona viruses before, but not specifically this one and it’s always a little bit different. So, it’s really just seems to be that the medical community is taking educated guesses and then capturing the data. So that later once we have enough of a sample size or data set, if you will, we can make better educated guesses.
Kurt Strudwick: Right.
Todd Schlosser: At [crosstalk]
Kurt Strudwick: In the future. It won’t be educated guesses anymore.
Todd Schlosser: Oh, yeah.
Kurt Strudwick: Because that research information so even at the end of the day. looking at the data that started in March when the COVID pandemic started taking off.
Todd Schlosser: Yeah.
Kurt Strudwick: In comparison to the data now it’s exponentially improved.
Todd Schlosser: Yes.
Kurt Strudwick: So, and obviously that’s sitting down and reviewing the information that’s provided and kind of like making better practices or better education, better clinical decisions. I should say. I shouldn’t say guesses.
Todd Schlosser: Yeah.
Kurt Strudwick: Better clinical decisions going forward.
Todd Schlosser: So is that something that as a national clinical educator, you have a hand in as far as what is the best standard of practice for specialty care where you work?
Kurt Strudwick: Yeah. So I, for me, as the clinical educator, I work with our clients all over the entire United States, wherever we have an account, it’s kind of my responsibility to. It’s a new account, getting them up and going and, getting them on their feet or if it’s an account that we’ve had for awhile, I have to stay up to date with the information and the data and that kind of stuff.
Todd Schlosser: Sure.
Kurt Strudwick: To send that information and be a resource to these people. Cause I’m supposed to be clinical expert of the the division.
Todd Schlosser: Yeah. So do you mind if I ask how you stay up to date with what is the latest and greatest in ECMO or [crosstalk] is that a trade secret
Kurt Strudwick: It’s not a secret.
Todd Schlosser: Okey.
Kurt Strudwick: I get a lot of my information from Elsa, which is the governing body for asthma.
Todd Schlosser: Okey.
Kurt Strudwick: For corporate life support organization.
Todd Schlosser: Sure.
Kurt Strudwick: For every ECMO case that is done. You pretty much like input all this information into the system and they kind of maintain that data, and I’m able to like access the data, look at it and see what the best practices that other big institutions are doing and how they’re improving their outcomes.
Todd Schlosser: And I’d imagine that once you get that data, you are then sort of in charge of disseminating it across all the specialty cares accounts, wherever that hospital is.
Kurt Strudwick: Yeah.
Todd Schlosser: You’re sort of on the phone, I’d imagine calling them or maybe even doing zoom, sort of. [crosstalk]
Kurt Strudwick: It can be on a phone, it can be Zoom. It can be in-person training, which is a little bit difficult now, of course with the pandemic.
Todd Schlosser: Yeah.
Kurt Strudwick: But yeah, the position itself is relatively newer. So it’s kind of like getting the information out to the accounts and letting them know that there is an educational resource that they can reach out to. So of course the more that happens. My emails just keep coming in.
Todd Schlosser: So how long has ECMO as a service line or specialty been around?
Kurt Strudwick: So ECMO Started in the 1970s, seventies.
Todd Schlosser: So shortly sort of after the heart and lung machine and profusion started. Cause that was maybe fifties, sixties and ECMO came online,
Kurt Strudwick: Which just kind of just like, on the cardiac bypass outside of the operating room.
Todd Schlosser: Yes, yeah.
Kurt Strudwick: And for a longer period of time, obviously.
Todd Schlosser: Yeah. Because it’s not hours it’s days and weeks.
Kurt Strudwick: Right.
Todd Schlosser: So have you seen a much wider adoption of ECMO as a service post COVID or was it pretty well regarded in the industry as a option for a lot of patients, it just wasn’t done as much
Kurt Strudwick: In the 1980s.
Todd Schlosser: Sure.
Kurt Strudwick: It was kind of like a treatment for neonates. It didn’t really have much of a take in the adult world.
Todd Schlosser: Sure.
Kurt Strudwick: Probably until the H1N1 pandemic of 2008, 2009.
Todd Schlosser: Yeah, okey.
Kurt Strudwick: That’s when you started to see more of these adult intensivists gravitate towards ECMO because in previous years it was more so for the pediatric and neonatal.
Todd Schlosser: And then I’d imagine once COVID came around, it started to open up and a lot more people are using it. So do you think post COVID that ECMO has sort of established itself as a standard of practice or at least a good option for a lot more medical issues than before COVID
Kurt Strudwick: Yeah, I think so, especially because COVID kind of what happens to the body is that it, it kind of falls onto this umbrella title of acute respiratory distress.
Todd Schlosser: Yeah. Or ARDS
Kurt Strudwick: Yes.
Todd Schlosser: Ye.
Kurt Strudwick: Exactly. So with that happening, other things can fall under, under that umbrella as well. So if a patient is diagnosed with severe ARDS and they meet that criteria that we talked about previously that the institution comes up with because like the threshold it’s kind of like recommendations.
Todd Schlosser: Sure.
Kurt Strudwick: So the governing body, they can recommend that, you have a PF ratio less than this, that you should go ahead and put the patient on ECMO.
Todd Schlosser: Right.
Kurt Strudwick: But it’s still up to the physician and the institution, how they want to run their program.
Todd Schlosser: Sure.
Kurt Strudwick: Some people are a bit more, conservative, some people are more liberal and they’re like, okay, let’s try and put this position off.
Todd Schlosser: Yeah.
Kurt Strudwick: So I think when people have started to see the value that it truly brings to the table, especially despite the fact that it’s more recent, they’re definitely seeing it as a positive option. And that’s kind of. When we talked earlier, I kind of focused on not waiting until the last possible thing that you can do because probably it’s too far gone then.
Todd Schlosser: Right.
Kurt Strudwick: With the patient etiology, whatever it is. But if you kind of like pulled that trigger sooner or sooner, the outcomes could potentially be better.
Todd Schlosser: Right. And that’s sort of the data we’re collecting now, I’d imagine throughout, you know, all of these extra cases we’re seeing because of COVID is going to be sort of a data boon for ECMO. And then we can look at that data and say, might be a too soon for ECMO, but there probably is. I’m sure there’s also a too late for ECMO.
Kurt Strudwick: Ye.
Todd Schlosser: And we got to find that sweet spot.
Kurt Strudwick: Yeah, perfect.
Todd Schlosser: So [crosstalk] is that something that you have a hand in as the national educator for ECMO, or is that more of a data scientist and you sort of disseminate the information?
Kurt Strudwick: I think it comes Honestly, it comes down to physician practices.
Todd Schlosser: Oh, Okey.
Kurt Strudwick: So they can reach to me as the resource or as the expert. And I can give them my input or my take on what they should do and how they should modify it. And it’s up to them at the end of the day, because even in certain institutions, you have physicians within the department that are sometimes a little bit more conservative or they want to wait a little bit more to put the patient on ECMP.
Todd Schlosser: Yeah.
Kurt Strudwick: So that’s, my role is kind of just like to let you know that specialty care is here for you. We want to let you know that you have the resource available, that, and the information is as up-to-date as possible and you guys can use it, however you want to.
Todd Schlosser: And if you do choose to use it, you are there to support them in doing so.
Kurt Strudwick: Absolutely. A hundred percent. I think the get back to your question about using respiratory therapists and nurses with ECMO.
Todd Schlosser: Yeah.
Kurt Strudwick: So one of the things that we find is that perfusionist are limited.
Todd Schlosser: Yes.
Kurt Strudwick: Especially with like the limited schools. So smaller programs are that kind of stuff.
Todd Schlosser: Well, and there’s their staffing shortages for profusion.
Kurt Strudwick: Exactly.
Todd Schlosser: That’s probably the best medical field to get into right now because everybody needs them. Yeah.
Kurt Strudwick: And I toyed with the idea of going back before getting into a leadership role, but what you’re finding is that these perfusionists, you expect them to be in the or cardiac cases.
Todd Schlosser: Yeah.
Kurt Strudwick: They’re there from 6:00 AM sometimes earlier, depending on the institution that they work for. And then after the day is complete, you want them to take care of an ECMO patient.
Todd Schlosser: Yeah when do they go home and sleep.
Kurt Strudwick: Exactly.
Todd Schlosser: Yeah.
Kurt Strudwick: There’s no way that you can have somebody at the bedside a hundred percent of the time to support this patient from a ton of ECMO, [inaudible] standpoint, by just having the profusion team, especially with them being in a national shortage. So you’re finding that a lot of these programs they’re gravitating towards this like RT or respiratory therapy and our registered nurse model.
And that seems to be working really well because that allows, 24 hour coverage, you have nurses that are coming in, you can hand pick the best of the best from your team who you think would make a good ECMO specialist.
Todd Schlosser: Sure.
Kurt Strudwick: Especially you get to see what positive clinical impact they’ve had in their entire career. And you can tell based on that impact, will they be a good ECMO specialist or not? Because, centers, the medical team they’re a lot more involved, but for a lot of centers, it’s protocol driven. So they’re putting the trust in the bedside ECMO specialists that you kind of know what you’re doing and doing what you’re expected to do, competently and appropriately.
Todd Schlosser: Sure.
Kurt Strudwick: I think this new or newer RTR and model is working really well, and it’s kind of like getting away from that burnout that a lot of perfusionists are experienced in.
Todd Schlosser: Yeah. They’re sort of stretched then. So with the RT or RN sort of support model, do you, as you’re training them. I’d imagine that you are reaching out and saying, Hey, do you have new respiratory therapist or RNs that need to be trained for ECMO specialists? And you sort of walk them through how to correct me if I’m wrong, use the machine, what the puzzles are supposed to look like. [crosstalk].
Kurt Strudwick: That’s a part of my responsibility.
Todd Schlosser: Okey.
Kurt Strudwick: As an educator. So I work with the VP of perfusion and the VP of ECMO, and to kind of devise a strategy for how we’re going to go about implementing an ECMO program at these facilities.
Todd Schlosser: Sure.
Kurt Strudwick: But they reach out to us or business development, people reach out to them and present the pitch for what, what benefit an ECMO program will bring to their institution. And from there, we kind of device from a clinical standpoint, how to best global, building the program, establishing the program and getting them on their feet.
Todd Schlosser: Okay. It sounds like you are sort of the first person they talk to. Once they sign on to start an ECMO program with specialty care.
Kurt Strudwick: From a clinical Point.
Todd Schlosser: Yeah, You’re the person that like, you’re the person that says, here’s what you need to do to get it up and running.
Kurt Strudwick: And I think that’s what cause obviously getting a program up and running isn’t solely just from a clinical perspective, you have to think about the management perspective.
Todd Schlosser: Oh, yeah, its staffing, its budget, its all of that.
Kurt Strudwick: You got it. The staffing, the budget, for me, it’s beneficial having the ECMO coordinator experience because that role, you get to see the behind the scenes.
Todd Schlosser: Yep.
Kurt Strudwick: Of how things work and it definitely was eye opening. I will say it and stressful because you’re the point person, the person that when a kid comes in or cause I worked in pediatrics.
Todd Schlosser: Yeah.
Kurt Strudwick: When a patient comes in, in cardiac arrest and they’re actively doing CPR and they’re calling you at home.
Todd Schlosser: Yeah.
Kurt Strudwick: In and then be able to get the pump prime then, or get the pump on. It kind of is just like stressful than the burnout. The burnout definitely is real. But I think that coordinator experience definitely would of been beneficial in being able to like take a step back now and be able to offer that advice for hospitals that are trying to build a program.
Todd Schlosser: I would be more comfortable if I was a specialty care account or hospital, or however that is phrased, knowing that the person who is showing me how to do it, how to run an ECMO program has done it themselves and has a lot of experience in doing that specifically. So it sounds like that’s sort of what you’re drawing on. When you know, you’re talking to these people, like you were the go-to person, they would call you at home and you drive in and you’d work with these kids.
Kurt Strudwick: Yeah, It is definitely is a team effort.
Todd Schlosser: Oh Yeah [crosstalk].
Kurt Strudwick: And of course we have the backup, we have our perfusionists on backup, but of course you don’t want them to have to come in to, to help put a patient on ECMO at 3:00 AM if they have to pump public case at seven.
Todd Schlosser: Yeah.
Kurt Strudwick: So you kind like reserve them for when you actually do need them and give them an opportunity to rest and recoup. And because of the last thing that you want to do is burn them up.
Todd Schlosser: Well, Kurt, I think I’m going to leave it there for this episode of checking the vitals, but I really, really appreciate you taking the time today to talk to us about sort of your career path, but also ECMO in general because you’re the first person we’ve talked to about it.
Kurt Strudwick: Thank you, Todd. Anytime.