Successful Establishment of the First Neonatal Respiratory Extracorporeal Membrane Oxygenation (ECMO) Program in the Middle East, in Collaboration With Pediatric Services
Background: Extracorporeal membrane oxygenation (ECMO) is a complex life-saving support for acute cardio-respiratory failure, unresponsive to medical treatment. Starting a new ECMO program requires synergizing different aspects of organizational infrastructures and appropriate extensive training of...
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Published in | Frontiers in pediatrics Vol. 8; p. 506 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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Frontiers Media S.A
11.09.2020
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Abstract | Background:
Extracorporeal membrane oxygenation (ECMO) is a complex life-saving support for acute cardio-respiratory failure, unresponsive to medical treatment. Starting a new ECMO program requires synergizing different aspects of organizational infrastructures and appropriate extensive training of core team members to deliver the care successfully and safely.
Objectives:
To describe the process of establishing a new neonatal ECMO program and to evaluate the program by benchmarking the ECMO respiratory outcomes and mechanical complications to the well-established Extracorporeal Life Support Organization (ELSO) registry data.
Materials and Methods:
We reviewed the processes and steps involved in planning and setting up the new ECMO program. To assess the success of the ECMO implementation program, we retrospectively reviewed data of clinical outcomes and technical complications for the first 11 patients who have received ECMO therapy for respiratory indications since program activation (July 2018–May 2020). We analyzed mechanical complications as a tool to measure infrastructures and our effective training for the core team of ECMO specialists. We also looked at all clinical complications and benchmarked these numbers with the last 10 years of ELSO registry data (2009–2019) in the corresponding categories for comparison. Chi-square test was used to compare, and outcomes are presented in percentage; a
p
-value of <0.05 is considered significant.
Results:
A total of 27 patients underwent ECMO in the hospital, out of which 11 (six neonatal and five pediatric) patients had acute respiratory failure treated with venovenous (VV) ECMO or veno-arterial (VA) ECMO over a 22-month period. We had a total of 3,360 h of ECMO run with a range from 1 day to 7 weeks on ECMO. Clinical outcomes and mechanical complications are comparable to ELSO registry data (no significant difference); there were no pump failure, oxygenator failure, or pump clots.
Conclusions:
Establishing the ECMO program involved a multisystem approach with particular attention to the training of ECMO team members. The unified protocols, equipment, and multistep ECMO team training increased staff knowledge, technical skills, and teamwork, allowing the successful development of a neonatal respiratory ECMO program with minimal mechanical complications during ECMO runs, showing a comparable patient flow and mechanical complications. |
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AbstractList | Background: Extracorporeal membrane oxygenation (ECMO) is a complex life-saving support for acute cardio-respiratory failure, unresponsive to medical treatment. Starting a new ECMO program requires synergizing different aspects of organizational infrastructures and appropriate extensive training of core team members to deliver the care successfully and safely.Objectives: To describe the process of establishing a new neonatal ECMO program and to evaluate the program by benchmarking the ECMO respiratory outcomes and mechanical complications to the well-established Extracorporeal Life Support Organization (ELSO) registry data.Materials and Methods: We reviewed the processes and steps involved in planning and setting up the new ECMO program. To assess the success of the ECMO implementation program, we retrospectively reviewed data of clinical outcomes and technical complications for the first 11 patients who have received ECMO therapy for respiratory indications since program activation (July 2018–May 2020). We analyzed mechanical complications as a tool to measure infrastructures and our effective training for the core team of ECMO specialists. We also looked at all clinical complications and benchmarked these numbers with the last 10 years of ELSO registry data (2009–2019) in the corresponding categories for comparison. Chi-square test was used to compare, and outcomes are presented in percentage; a p-value of <0.05 is considered significant.Results: A total of 27 patients underwent ECMO in the hospital, out of which 11 (six neonatal and five pediatric) patients had acute respiratory failure treated with venovenous (VV) ECMO or veno-arterial (VA) ECMO over a 22-month period. We had a total of 3,360 h of ECMO run with a range from 1 day to 7 weeks on ECMO. Clinical outcomes and mechanical complications are comparable to ELSO registry data (no significant difference); there were no pump failure, oxygenator failure, or pump clots.Conclusions: Establishing the ECMO program involved a multisystem approach with particular attention to the training of ECMO team members. The unified protocols, equipment, and multistep ECMO team training increased staff knowledge, technical skills, and teamwork, allowing the successful development of a neonatal respiratory ECMO program with minimal mechanical complications during ECMO runs, showing a comparable patient flow and mechanical complications. Background: Extracorporeal membrane oxygenation (ECMO) is a complex life-saving support for acute cardio-respiratory failure, unresponsive to medical treatment. Starting a new ECMO program requires synergizing different aspects of organizational infrastructures and appropriate extensive training of core team members to deliver the care successfully and safely. Objectives: To describe the process of establishing a new neonatal ECMO program and to evaluate the program by benchmarking the ECMO respiratory outcomes and mechanical complications to the well-established Extracorporeal Life Support Organization (ELSO) registry data. Materials and Methods: We reviewed the processes and steps involved in planning and setting up the new ECMO program. To assess the success of the ECMO implementation program, we retrospectively reviewed data of clinical outcomes and technical complications for the first 11 patients who have received ECMO therapy for respiratory indications since program activation (July 2018–May 2020). We analyzed mechanical complications as a tool to measure infrastructures and our effective training for the core team of ECMO specialists. We also looked at all clinical complications and benchmarked these numbers with the last 10 years of ELSO registry data (2009–2019) in the corresponding categories for comparison. Chi-square test was used to compare, and outcomes are presented in percentage; a p -value of <0.05 is considered significant. Results: A total of 27 patients underwent ECMO in the hospital, out of which 11 (six neonatal and five pediatric) patients had acute respiratory failure treated with venovenous (VV) ECMO or veno-arterial (VA) ECMO over a 22-month period. We had a total of 3,360 h of ECMO run with a range from 1 day to 7 weeks on ECMO. Clinical outcomes and mechanical complications are comparable to ELSO registry data (no significant difference); there were no pump failure, oxygenator failure, or pump clots. Conclusions: Establishing the ECMO program involved a multisystem approach with particular attention to the training of ECMO team members. The unified protocols, equipment, and multistep ECMO team training increased staff knowledge, technical skills, and teamwork, allowing the successful development of a neonatal respiratory ECMO program with minimal mechanical complications during ECMO runs, showing a comparable patient flow and mechanical complications. |
Author | Anand, Dhullipala Wong, Duane Sigalet, David More, Kiran S. Elkhwad, Mohammed Al-Maraghi, Samira Crowe, Myles Metcalf, Julianne Yadav, Santosh K. |
AuthorAffiliation | 5 Nurse Education Subunit, Sidra Medicine , Doha , Qatar 6 Functional and Molecular Imaging, Sidra Medicine , Doha , Qatar 1 Division of Neonatology, Sidra Medicine , Doha , Qatar 7 Department of Pediatric Surgery, Sidra Medicine , Doha , Qatar 4 Division of Cardiac Intensive Care Unit, Sidra Medicine , Doha , Qatar 2 Weill Cornell Medicine , Doha , Qatar 3 Department of Respiratory Therapy, Sidra Medicine , Doha , Qatar |
AuthorAffiliation_xml | – name: 7 Department of Pediatric Surgery, Sidra Medicine , Doha , Qatar – name: 1 Division of Neonatology, Sidra Medicine , Doha , Qatar – name: 4 Division of Cardiac Intensive Care Unit, Sidra Medicine , Doha , Qatar – name: 6 Functional and Molecular Imaging, Sidra Medicine , Doha , Qatar – name: 5 Nurse Education Subunit, Sidra Medicine , Doha , Qatar – name: 2 Weill Cornell Medicine , Doha , Qatar – name: 3 Department of Respiratory Therapy, Sidra Medicine , Doha , Qatar |
Author_xml | – sequence: 1 givenname: Mohammed surname: Elkhwad fullname: Elkhwad, Mohammed – sequence: 2 givenname: Kiran S. surname: More fullname: More, Kiran S. – sequence: 3 givenname: Dhullipala surname: Anand fullname: Anand, Dhullipala – sequence: 4 givenname: Samira surname: Al-Maraghi fullname: Al-Maraghi, Samira – sequence: 5 givenname: Myles surname: Crowe fullname: Crowe, Myles – sequence: 6 givenname: Duane surname: Wong fullname: Wong, Duane – sequence: 7 givenname: Julianne surname: Metcalf fullname: Metcalf, Julianne – sequence: 8 givenname: Santosh K. surname: Yadav fullname: Yadav, Santosh K. – sequence: 9 givenname: David surname: Sigalet fullname: Sigalet, David |
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Cites_doi | 10.1177/2150135115589788 10.1097/ANC.0000000000000054 10.1097/MAT.0000000000000495 10.4103/0971-5916.200891 10.1097/PCC.0000000000001304 10.1016/j.micinf.2013.06.003 10.1111/aor.13016 10.1097/MAT.0b013e3182904a52 10.1053/j.semperi.2016.08.002 10.1177/000313481808400436 10.1016/j.anpede.2017.04.003 10.4236/ijcm.2015.63023 10.1136/heartjnl-2015-308591 10.1177/2150135114526760 10.1038/s41372-018-0129-4 10.1186/s12890-016-0299-9 10.1097/MAT.0000000000000603 10.1007/s00134-013-2985-x 10.2147/IJWH.S12426 10.1097/PCC.0b013e318292e528 10.1097/PCC.0000000000001388 10.1136/adc.2002.025635 10.1097/MAT.0000000000000475 10.3390/ijerph14040360 |
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Copyright | Copyright © 2020 Elkhwad, More, Anand, Al-Maraghi, Crowe, Wong, Metcalf, Yadav and Sigalet. 2020 Elkhwad, More, Anand, Al-Maraghi, Crowe, Wong, Metcalf, Yadav and Sigalet |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Edited by: Arjan Te Pas, Leiden University, Netherlands Reviewed by: Peter Paul Roeleveld, Leiden University Medical Center, Netherlands; Warwick Wolf Butt, Royal Children's Hospital, Australia; Heidi J. Dalton, Inova Health System, United States This article was submitted to Neonatology, a section of the journal Frontiers in Pediatrics |
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Snippet | Background:
Extracorporeal membrane oxygenation (ECMO) is a complex life-saving support for acute cardio-respiratory failure, unresponsive to medical... Background: Extracorporeal membrane oxygenation (ECMO) is a complex life-saving support for acute cardio-respiratory failure, unresponsive to medical... |
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StartPage | 506 |
SubjectTerms | ECMO program extracorporeal membrane oxygenation meconium aspiration newborn infant Pediatrics persistent pulmonary hypertension respiratory ECMO |
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Title | Successful Establishment of the First Neonatal Respiratory Extracorporeal Membrane Oxygenation (ECMO) Program in the Middle East, in Collaboration With Pediatric Services |
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