Setting up a Rescue Extracorporeal Life Support Program

Blackwood, Jaime; Nikitovic, Dejana; Spence, Tara; Khaira, Gurpreet; Brindle, Mary

doi:10.1097/mat.0000000000001752

Cited by 3 publications

(6 citation statements)

References 7 publications

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“…Our team’s experience with developing and implementing a Rescue ECLS Program provides important considerations for other centers looking to develop similar programs. The outcomes data from our center 7 suggest a Rescue ECLS Program can be established at a pediatric noncardiac surgery center with patient outcomes like those achieved by comprehensive ECLS Programs. 14 The development of a formal cannulation program is a core aspect of the Rescue Program and has previously been demonstrated to improve outcomes over ad hoc cannulations.…”

Section: Discussionmentioning

confidence: 90%

Section: Study Design and Methodsmentioning

confidence: 99%

“…Remaining clinicians (RTs, PICU RNs, CAs, and NPs) are part of the bedside team, caring for the patients before cannulation, and continuing with their clinical tasks once the patient is cannulated. 7 Surveys were disseminated in July 2018, through internal distribution lists within each profession. By engaging all stakeholders and gathering perspectives from each group, a robust, frontline-informed inquiry was used to address the aims of the study.…”

Section: Participantsmentioning

confidence: 99%

“…Before our Program was established, roughly 8–10 patients died annually at our center that may have survived if ECLS were available. 7…”

mentioning

confidence: 99%

“…Before our Program was established, roughly 8-10 patients died annually at our center that may have survived if ECLS were available. 7 Our objective is to provide an overview of ECLS team insights regarding implementation and offer recommendations for other centers wishing to develop a Rescue ECLS Program.…”

mentioning

confidence: 99%

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Key Considerations in Establishing a Pediatric Rescue Extracorporeal Life Support Program: A Multi Methods Review

et al. 2022

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Extracorporeal life support (ECLS) is generally limited to centers with cardiac surgery. However, pediatric centers without cardiac surgery can still provide potentially lifesaving ECLS through a Rescue Program, allowing a local team to cannulate and stabilize patients before they are transported to a center with cardiac surgery support for ongoing care. This multimethod study provides an exploration of pediatric ECLS team insights regarding program implementation and offers recommendations for other centers wishing to develop a similar program. We performed surveys and semi-structured interviews to gather perspectives from ECLS team members. Demographics and preliminary perspectives were obtained from surveys. Interviews were transcribed and coded using thematic analysis to identify key considerations, facilitators, and barriers related to rescue program implementation. Our multidisciplinary ECLS team perceived great value in the rescue program and identified elements critical to successful program development and implementation, including barriers that might exist for any center wishing to set up a similar program. Participants emphasized that the initial design and continued maintenance of any Rescue ECLS Program be a comprehensive, multidisciplinary initiative. Clear communication, a mechanism for debriefing and feedback, and a strategy allowing for flexible program evolution are essential.

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Section: Discussionmentioning

confidence: 90%

Section: Study Design and Methodsmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

“…Before our Program was established, roughly 8–10 patients died annually at our center that may have survived if ECLS were available. 7…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Key Considerations in Establishing a Pediatric Rescue Extracorporeal Life Support Program: A Multi Methods Review

et al. 2022

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Designing and maintaining a rescue extracorporeal life support program: A holistic simulation approach

Spence,

Nikitovic,

Duncan

et al. 2023

Perfusion

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Rescue Extracorporeal Life Support Programs based at non-cardiac surgery centers have unique needs to be able to ensure successful outcomes despite low patient volumes. In this paper we describe the important role simulation had in each stage of development, implementation, and maintenance of our pediatric Rescue ECLS Program. Systems-focused simulations were used to develop robust workflows, processes, and bundles. Simulation-based education targeted the acquisition and maintenance of clinical skills for individual team members, bringing together a multidisciplinary team of local clinicians who do not routinely perform pediatric cannulation related tasks. Translational simulation ensured continued improvement by addressing adverse events or latent safety threats observed during system-focused or educational simulations. Realism of all simulations was our priority, and was achieved through in situ simulations, participation of multidisciplinary teams, use of real equipment and medical supplies, and use of a high-fidelity cannulation manikin. This holistic simulation approach allowed us to overcome the barriers to high quality care, and maintain outcomes comparable to high volume centers. A similar approach can help other centers design simulation for their own Rescue ECLS Program, and can be translated to other high-risk and high-acuity critical care programs.

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Successful Extracorporeal Membrane Oxygenation Implementation at a Non-tertiary Medical Center: A Single-Center Experience

Hassani,

Tran,

Hansaliya

et al. 2023

Cureus

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The inexperience and limited resources at non-tertiary medical centers pose unique challenges to the successful development of an extracorporeal membrane oxygenation (ECMO) program. The current literature does not provide a detailed framework that addresses the unique challenges encountered at these facilities.We outline a proactive approach to developing an ECMO program and provide a retrospective analysis of patient demographics, clinical characteristics, ECMO configuration, duration of ECMO support, major adverse events, and survival to hospital discharge. Data are summarized using mean, median, percentages, standard deviation, and interquartile range.Eleven patients were cannulated between December 2021 to March 2023. The age range of the patients who received ECMO varied significantly, with the youngest being 25 years old and the oldest being 69 years old. The mean age was 38 years old, with a standard deviation of 15.9. Hypertension was the most common comorbid condition occurring in 64% (n=7) of patients. Only one patient had a major adverse event, and survival to hospital discharge was 73% (n=8). Of the patients that survived hospital discharge, seven patients were discharged home and one to a rehabilitation facility. These findings suggest that the safe implementation of an ECMO program at a non-tertiary hospital with inexperienced staff and limited resources is feasible. Adherence to established guidelines is essential for new programs, especially with regard to patient selection. Furthermore, a proactive approach that emphasizes high-yield training techniques, patient management protocols, and strategies that mitigate adverse events may be the key to achieving survival rates that exceed those of larger academic hospitals.

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Setting up a Rescue Extracorporeal Life Support Program

Cited by 3 publications

References 7 publications

Key Considerations in Establishing a Pediatric Rescue Extracorporeal Life Support Program: A Multi Methods Review

Key Considerations in Establishing a Pediatric Rescue Extracorporeal Life Support Program: A Multi Methods Review

Designing and maintaining a rescue extracorporeal life support program: A holistic simulation approach

Successful Extracorporeal Membrane Oxygenation Implementation at a Non-tertiary Medical Center: A Single-Center Experience

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