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Characteristics of Pediatric Extracorporeal Membrane Oxygenation Programs in the United States and Canada
Lindsey Troy1, Felice Su2, Todd Kilbaugh3
1From the Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Insights
Pediatric extracorporeal membrane oxygenation (ECMO) programs show varied infrastructure and practices across North America. While most centers follow guidelines, significant differences exist in organizational setup and patient care protocols.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Extracorporeal Life Support
Background:
- Pediatric extracorporeal membrane oxygenation (ECMO) is a vital life support therapy.
- Standardization of ECMO programs is crucial for optimal patient outcomes.
- Understanding current program structures is essential for identifying areas for improvement.
Purpose of the Study:
- To assess the current infrastructure and practice characteristics of pediatric ECMO programs in the US and Canada.
- To identify variations in program experience, support networks, and cannulation practices.
- To evaluate the adoption of Extracorporeal Life Support Organization (ELSO) recommendations.
Main Methods:
- A 40-question web-based survey was distributed to pediatric ECMO centers.
- The survey collected data on center demographics, practice structure, program experience, and support systems.
- Data from 41 out of 101 identified centers in the US and Canada were analyzed.
Main Results:
- Most responding centers are university-affiliated and have large ICUs, offering ECMO for over 10 years.
- Median cannulations in 2017 were 15, with most occurring in cardiovascular ICUs.
- While many centers have post-cannulation protocols, standardization varies, especially for complex procedures like left ventricle decompression.
Conclusions:
- Pediatric ECMO centers largely adopt ELSO infrastructure recommendations.
- Significant variability persists in practice characteristics and organizational infrastructure.
- Further efforts are needed to standardize pediatric ECMO practices for improved patient care.
Abstract:
The aim of this study was to evaluate the current infrastructure and practice characteristics of pediatric extracorporeal membrane oxygenation (ECMO) programs. A 40-question survey of center-specific demographics, practice structure, program experience, and support network utilized to cannulate and maintain a pediatric patient on ECMO was designed via a web-based survey tool. The survey was distributed to pediatric ECMO programs in the United States and Canada. Of the 101 centers that were identified to participate, 41 completed the survey. The majority of responding centers are university affiliated (73%) and have an intensive care unit (ICU) with 15-25 beds (58%). Extracorporeal membrane oxygenation has been offered for >10 years in 85% of the centers. The median number of total cannulations per center in 2017 was 15 (interquartile range [IQR] = 5-30), with the majority occurring in the cardiovascular intensive care unit (median = 13, IQR = 5-25). Fifty-seven percent of responding centers offer ECPR, with a median number of four cases per year (IQR = 2-7). Most centers cannulate in an operating room or ICU; 11 centers can cannulate in the pediatric ED. Sixty-three percent of centers have standardized protocols for postcannulation management. The majority of protocols guide anticoagulation, sedation, or ventilator management; left ventricle decompression and reperfusion catheter placement are the least standardized procedures. The majority of pediatric ECMO centers have adopted the infrastructure recommendations from the Extracorporeal Life Support Organization. However, there remains broad variability of practice characteristics and organizational infrastructure for pediatric ECMO centers across the United States and Canada.