Establishing a New ECMO Referral Center Using an ICU-Based Approach: A Feasibility and Safety Study

Abstract

Background: A high-volume center with a multidisciplinary team is regarded as the optimal place for providing extracorporeal membrane oxygenation (ECMO). We hypothesize that an ECMO center can also be successfully created and subsequently developed entirely by intensivists in a mid-size mixed intensive care unit (ICU). Methods: A model was created for setting up a new ECMO referral center within the structure of an existing mixed ICU in a tertiary hospital. A retrospective analysis was carried out of the first 33 patients treated in the initial period of the center’s activity, from mid 2018 to the end of 2020. Results: An ECMO center was established and developed entirely based on the resources of an existing mixed ICU. Thirty-three patients were treated. They had an overall survival rate at 90 days of 60.6%. In veno-venous (VV) mode ECMO duration, ICU length of stay, and SOFA score were significantly higher than in veno-arterial mode. No significant differences in clinical characteristics were observed between survivors and non-survivors on VV-ECMO. Conclusions: A regional ECMO center can be set up as an integral part of a mixed ICU in a tertiary hospital. Extracorporeal therapy, such as continuous renal replacement therapy and mechanical ventilation can be managed entirely by intensivists. Further studies are needed to show that the ICU-based approach to setting up a new ECMO center is no less effective than the multidisciplinary approach.

The Jena Method: Perfusionist Independent, Standby Wet-Primed Extracorporeal Membrane Oxygenation (ECMO) Circuit for Immediate Catheterization Laboratory and/or Hybrid Operating Room Deployment

“…In Europe, where perfusionists typically take on the technical aspects of the ECMO program, high quality ECMO/ECLS programs have been established. However, it is possible to establish a program without perfusionists, as is currently the case in many ECMO programs for lung support in the ICU [ 13 ]. These programs may also involve committed doctors with a higher understanding of the technical aspects of the ECMO program who act as trainers for the staff.…”

The future of cardiac critical care: an anesthesia perspective

“…In Poland, Gawda et al described the creation of an ECMO center including mobile ECMO established and run entirely by intensivists. They advocate that this allows greater access for patients to ECMO without relying on surgeons or interventional cardiologists who may be otherwise preoccupied with their scheduled procedural obligations ( 19 ). Gutsche et al advocated for the importance of the use of transthoracic or transesophageal echocardiography in the mobile ECMO process, another skill which cardiac anesthesia intensivists offer and add ( 20 ).…”