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CEPP: Canadian Extracorporeal Life Support (ECLS) Protocol Project.

Andrew Fagan1, Brian Grunau2, Andrew Caddell1

  • 1Division of Critical Care Medicine, Western University, London, Ontario, Canada.

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|June 23, 2022
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Summary
This summary is machine-generated.

Extracorporeal life support (ECLS) protocols vary significantly across Canadian centers, with few common elements. This highlights an opportunity for collaboration to standardize best practices and improve patient outcomes in ECLS care.

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Area of Science:

  • Critical Care Medicine
  • Health Services Research
  • Medical Protocol Development

Background:

  • Extracorporeal life support (ECLS) is linked to high morbidity and mortality, particularly in low-volume centers.
  • Most Canadian ECLS institutions are considered low-volume, suggesting a need for standardized practices.
  • The existence and uniformity of ECLS protocols across Canadian centers remain unexamined.

Purpose of the Study:

  • To investigate the presence and comprehensiveness of Extracorporeal Life Support (ECLS) protocols in Canadian institutions.
  • To assess the homogeneity of ECLS protocols across different Canadian centers.
  • To identify key elements within ECLS protocols and evaluate their implementation.

Main Methods:

  • A mixed-methods approach utilizing purposeful sampling was employed.
  • A Delphi panel identified essential elements for ECLS delivery.
  • Institutional ECLS documentation was collected and analyzed using deductive coding to assess protocol completeness.

Main Results:

  • A framework of 37 key elements across 5 domains (referral, initiation, maintenance, termination, administration) was established.
  • Documentation from 13 institutions across 10 Canadian provinces was analyzed.
  • Only 5 key elements were consistently present in over 50% of protocols, with significant variation in their application.

Conclusions:

  • There is considerable variability in the completeness and content of ECLS protocols across Canada.
  • Inconsistent approaches to critical ECLS elements suggest a potential lack of consensus or evidence.
  • Developing a common framework for ECLS protocols can foster collaboration, quality improvement, and research initiatives.