Neonatal extracorporeal life support: will the newest technology reduce morbidity?

The objectives of this review are to describe the Extracorporeal Life Support (ECLS) research at the Penn State Pediatric Cardiovascular Research evaluating new pediatric ECLS components and to discuss a proposed continuous quality improvement model after implementation of new technology. Review of current literature pertaining to studies at the Penn State Hershey Children's Hospital (PSHCH) is presented along with a retrospective chart review of ECLS pediatric patients from January 2000 to June 2010. We describe improvements in the newest hollow-fiber oxygenator demonstrating a lower pressure drop (compared with silicone), and in the newest RotaFlow centrifugal pump which allows higher hemodynamic energy delivered to the patient at higher flow rates with less retrograde flow. The miniaturized pediatric circuit implemented is portable and primes quickly for rapid deployment. Our model of continuous quality improvement includes in-depth evaluation of all circuit component performance through on-site in vivo and in vitro testing at the PSHCH. We utilize the same model to provide comprehensive education and hands-on training of the staff. This cycle can be repeated for evaluation and implementation of any new circuit component. Our comprehensive approach to ECLS may provide the ideal means from which to safely introduce new technology.