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Standardized therapies after ECMO program (STEP); a novel approach to pediatric post-ECMO care
Rebekah K H Shappley1, Christen M Holder2, Constance E Poplos3
1Department of Pediatrics, Division of Critical Care, University of Tennessee Health Science Center, Memphis, TN 38103, USA - Le Bonheur Children's Hospital, Memphis, TN 38103, USA.
Insights
The Standardized Therapy after ECMO Program (STEP) improved follow-up care for pediatric extracorporeal membrane oxygenation (ECMO) survivors. This pathway significantly increased neurodevelopmental testing and specialist referrals, enhancing post-discharge care.
Area of Science:
- Pediatric critical care medicine
- Extracorporeal membrane oxygenation (ECMO) outcomes
- Neurodevelopmental follow-up
Background:
- Pediatric patients requiring extracorporeal membrane oxygenation (ECMO) often face long-term neurodevelopmental challenges.
- Effective post-discharge care pathways are crucial for optimizing outcomes in pediatric ECMO survivors.
- The Standardized Therapy after ECMO Program (STEP) was developed to address these needs.
Purpose of the Study:
- To evaluate the compliance with post-ECMO care guidelines after implementing the STEP discharge pathway.
- To assess the impact of STEP on neurodevelopmental testing and specialist referrals for pediatric ECMO survivors.
Main Methods:
- The study compared compliance rates before and after the implementation of the STEP program.
- Data collection included tracking neurodevelopmental testing, inpatient consultations, and outpatient referrals.
- 77 pediatric ECMO survivors discharged from a US hospital were analyzed.
Main Results:
- STEP implementation significantly increased complete neurodevelopmental testing from 38.8% to 74.2%.
- Time-appropriate neurodevelopmental testing increased from 71.4% to 95.6%.
- Referrals for audiology, physical therapy, occupational therapy, and speech-language pathology significantly increased post-STEP.
Conclusions:
- The STEP program effectively enhances compliance with hospital and Extracorporeal Life Support Organization (ELSO) follow-up guidelines.
- Implementing an intentional discharge pathway like STEP leads to more timely and comprehensive neurodevelopmental evaluations for pediatric ECMO survivors.
Background:
The study objective was to characterize compliance with Standardized Therapy after ECMO Program (STEP), an intentional discharge pathway for extracorporeal membrane oxygenation (ECMO) survivors in a US pediatric hospital.
Methods:
The program identified pediatric ECMO survivors before discharge, appropriate consultations were reviewed and requested, families were educated on ECMO sequelae, and ECMO summaries were sent to pediatricians. Compliance with institutional post-ECMO guidelines was evaluated before and after STEP implementation.
Results:
We identified 77 ECMO survivors to hospital discharge (36 [46.8%] before and 41 [53.2%] after STEP implementation). There was a significant increase in complete (38.8% vs. 74.2%, p < 0.001) and time-appropriate neurodevelopmental testing (71.4% vs. 95.6%, p = 0.03). Significant increase in inpatient evaluations by neurology (52.7% vs. 75.6%, p = 0.03) and audiology (66.7% vs. 87.8%, p = 0.02), and in referrals for outpatient audiology (66.6 vs. 95.1%, p = 0.002), physical therapy (P.T.) (63.8% vs. 95.1%, p = 0.001), occupational therapy (O.T.) (63.8% vs. 95.1%, p = 0.001) and speech-language pathology (S.L.P.) (55.5% vs. 95.1%, p < 0.001) were noted.
Conclusion:
Implementing an intentional discharge pathway for pediatric ECMO survivors (STEP) successfully increases inpatient and outpatient compliance with hospital and Extracorporeal life support organization (ELSO) follow-up guidelines. It leads to timely and complete neurodevelopmental evaluation.
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