Fun Fact: I have a "black cloud" when it comes to being on call. I always have. And I don’t just mean that when I’m on call, we’re busy. It seems that whenever I’m on call, not only are we working, but something disastrous is happening. (For the record, I do have good patient outcomes, even if they take a few weeks to fully recover!)
During my first few months on call in the CVOR, things were so hectic that I was gifted the scrub hat in this picture, along with a Christmas card from our anesthesia providers that read: “While we really enjoy working with you, we really don’t like being on call with you!”
(Go ahead and laugh—I found it hilarious!)
My black cloud call days typically involve one of two cardiac emergencies in the middle of the night: aortic dissections or the need to put a patient on ECMO.
What is ECMO? Extracorporeal Membrane Oxygenation (ECMO) is a device used to support patients in cardiogenic shock or respiratory distress. It’s considered a cardiac surgical procedure, which means the on-call cardiac team is responsible for coming in to perform it, even during off-hours. Sometimes, we initiate ECMO during cardiac surgery if the patient’s heart isn’t recovering as expected. Other times, it’s an emergency and happens outside the OR.
Here are the last three times I was called in for off-OR ECMO:
May 3, 9:00 PM
October 28, 8:45 PM
November 5, 4:20 AM
I was on call for all three of these. Thankfully, as you can see, off-hours ECMO procedures aren’t very common—but when they happen, they can occur at any time.
What Happens During an ECMO Call? Lives are on the line, and time is of the essence. For these last three cases, I arrived at the hospital in whatever I was wearing at home — scrubs and flip-flops, for example — and went straight to the unit. I’d threw on a bouffant, a face mask, and a gown over my clothes. And yes, I’ve even performed surgical procedures involving blood while wearing flip-flops! (And for those wondering, I’ve never once gotten blood on my flip-flops.)
One time, at 2:15 AM, I was so disoriented that I ran out of the house in my pajamas and tennis shoes. I don't even remember if I brushed my teeth... And I'm a "professional! But, when you’re on call and performing ECMO outside the OR, scrubs aren’t a priority. Even the surgeons and anesthesiologists often show up in street clothes, but maybe not their pj's...
The only thing on my mind is getting to the hospital and setting up the table. Most off-OR ECMOs happen in the ER or ICUs (medical or surgical), which are large enough to accommodate the code team and the ECMO call team. But sometimes, space is tight. For example, my May call happened in a stepdown unit—those rooms are tiny compared to the OR.
Organized Chaos: Once we arrive, the first task is to set up the table with the ECMO tray, wires, needles, and cannulas. It’s chaotic: the code team is shouting updates, the surgeon is yelling for instruments, and if I’m scrubbed in, I’m shouting for supplies. Inevitably, unnecessary items end up on the field, adding to the disarray.
If I’m circulating, there’s no time to chart in the moment. I throw supply packages into a trash bag, jot down critical times and names, and leave detailed charting for later. The process itself is straightforward but intense:
Obtain venous and arterial access.
Insert the cannulas.
Connect the cannulas to the ECMO machine with the perfusionist’s help.
Within 15–20 minutes, the patient is on ECMO, allowing their heart and lungs to rest and recover. Afterward, the patient is transferred to the surgical ICU. Occasionally, we’ll head to the OR to insert an additional heart pump device, which is a more controlled procedure.
The Aftermath: Once the chaos subsides, we return to the OR to change into scrubs, document the case, and restock the ECMO cart for the next emergency. We also check on the patient to ensure no further surgical interventions are needed.
On a good call, the entire process takes about two hours. But as every on-call team knows, you’re never truly done until you leave the hospital without getting paged again.
Why Time Matters: “Time is muscle” is a phrase used to stress the importance of immediate cardiac care during a heart attack. “Time is brain” underscores the urgency of treating strokes. For ECMO, time is critical for both. Everything else — scrubs, documentation, appearances — can wait.
Being on call, especially for emergencies like ECMO, is never predictable. It’s a blend of urgency, chaos, and teamwork, with every second focused on saving lives. While these moments can be stressful and physically demanding, we all know that we're making a difference in the lives of the patients who need us. And when it comes to patient care, the only thing that truly matters is showing up, ready to give it everything we’ve got, even in flip-flops. 😊
Keep up the great work out there,
Lindsey
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