A recent article in The Fresno Bee highlights the success of an expanding ECMO program at Valley Children’s Hospital in Fresno, CA. Valley Children’s has been providing ECMO support for post-op cardiac surgery patients for some time, but have only expanded beyond that population recently.
The article quotes Valley Children’s ECMO Medical director,
“It requires a lot of expertise to do this right,” Kallas said.”
Valley Children’s has been working very diligently over the last several months to methodically plan for the success of an expanding ECMO program to care for pulmonary ECMO patients in addition to the post-op cardiac patients. The planning process involved looking to the ELSO guidelines to establish a solid foundation for the ECMO program structure as well as a solid plan for training new ECMO Specialists. The article says,
“It’s taken a team of people to build the ECMO program at Valley Children’s, said Dr. Harry Kallas, medical director of the ECMO program. The hospital has contracted with an outside company, ECMO Advantage, for consultation to help build the program and train staff, he said.”
Read more here
We are very excited for the success Valley Children’s Hospital is having with their ECMO Program and especially excited for the high quality of care the patients they serve are now able to receive close to home.
ECMO services team structure at hospitals across the United States can be complex. Many institutions starting new programs, growing programs, or needing to adjust their program operations are constantly seeking the best way to structure their ECMO teams to provide the safest, most efficient care to their patients.
ECMO Advantage established a survey in 2014 to evaluate different aspects of ECMO Services Team Structure. We would like to present the same survey again in 2016 to evaluate how ECMO team structure may be changing with the advances in technology and the rapid expansion of ECMO programs across the United States.
If you would be willing to participate in the survey please complete the survey below. If you would like to receive the summary results, please complete the last question of the survey with your contact information. All individual survey results will be kept confidential so that no one will be able to trace an individual result back to an individual person or institution.
ECMO Outcomes Updated Dec 2015
Are ECMO outcomes dependent on the number of ECMO patients supported at your institution? Does it really matter how many ECMO patients your program supports? Do patients suffer by being on ECMO at smaller ECMO programs? There have been a couple of publications recently suggesting that it does matter. A recent abstract I came across a few months ago has an interesting twist to it. The results summary would make it sound like there is significant benefit to a patient on ECMO if they are supported at a high volume center. But if you read the message carefully, you will see that there was NO SIGNIFICANT SURVIVAL BENEFIT for the pediatric age group for the period of study between 1989-2013. When broken down into relative data from the time period of 2008-2013, there was NO SIGNIFICANT SURVIVAL BENEFIT for the neonatal nor pediatric group. Only the Adult group was implicated in improved survival in “larger” ECMO programs (those who supported > 30 ECMO patients per year) compared to the smallest ECMO Programs (those supporting < 6 ECMO patients per year). It’s also interesting to note that they didn’t report on the Adult ECMO Programs supporting between 6 and 30 patients per year.
More recently an article was presented in Pediatric Critical Care Medicine:November 2015 – Volume 16 – Issue 9 – p 868–874 that looks specifically at Cardiac patients <16 years old supported with ECMO either before or after surgery. The conclusion from this group states: “We demonstrated no relationship between extracorporeal membrane oxygenation center volume and mortality. Further analyses are needed to evaluate this relationship.”
So what really makes the difference in the care that ECMO patients receive that allow them to survive to home?
The primary purpose of ECMO Advantage is to help raise the level of ECMO support to the absolute highest quality no matter how small or large your ECMO program is. Our primary objective is to help Hospitals develop ECMO Programs that have the proper structure, training, education, expertise and quality to safely and effectively support patients on ECMO and return them home to their families.
If your outcomes are not as good as they should be, contact us. We have a proven track record assisting both new and experienced ECMO programs develop into high quality programs with better then ELSO average survival to home.
Randy Bartilson, President of ECMO Advantage – Serving the ExtraCorporeal Community
Prophylactic antibiotic use on ECMO has historically been a very common practice. Many institutions are still practicing prophylactic antibiotic use on ECMO but is it justified?
A review of the ELSO database published in PEDIATRIC CRITICAL CARE MEDICINE in May of 2011 highlighted an overall rate of 11.7% incidence of acquired infections on ECMO from 1998 to 2008. It’s clear that infections acquired on ECMO are associated with longer ECMO runs, increased ICU stays, and decreased survival rates. But how do we mitigate the risks of ECMO related to infections?
A recent abstract in ASAIO looked at the use of prophylactic antibiotic use on ECMO and found no evidence of benefit over treating on a case by case basis. It was suggested that one reason there was no benefit may be because the causative organisms were so diverse that it would be difficult to determine a clear prophylactic strategy.
So as ECMOlogists, what do we do to mitigate the risk of infections acquired on ECMO? ELSO set out to answer this very complex question in 2008. The ELSO Task Force on Infectious Disease on ECMO: Diagnosis, Treatment and Prevention, submitted a SUMMARY report on their findings. In that report they also state lack of evidence for routine prophylactic antibiotic use on ECMO. The summary report provides 8 pages of recommendations related to infection control on ECMO and is well worth a few minutes to review.
The recommendation of prone positioning on ECMO may put fear into the heart of the caregiver. Thoughts of inadvertent decannulation, extubation, excessive bleeding, kinked ECMO tubing…
A recent article in RESPIRATORY CARE provided a review of 7 prospective studies or case reports that revealed very few complications related to prone positioning on ECMO. There were no reports of decannulation, inadvertent extubation, or chest tube dislodgment. They also reported minimal bleeding from cannula site and no evidence of chest tube site bleeding were reported.
Hemodynamic instability was reported by two of the studies. But the episodes were reported as being short and reversible.
So next time someone suggests prone positioning on ECMO, take the time to carefully plan, gather adequate staff support, and approach the process with confidence that it can be done safely!
A recent article in the Annals of Thoracic Surgery highlights successful support of Adult Myocarditis using VA ECMO. Use of Adult ECMO has significantly increased over the last few years. The benefits of using ECMO in various adult populations are still being proven.
This article provides a nice overview of successful use for this special diagnostic group.