A bedside staffing model with perfusionists for pediatric extracorporeal membrane oxygenation (ECMO) at a high-volume center

TL;DR

A new model for pediatric ECMO care uses perfusionists and technology to monitor patients, achieving safety results similar to other centers.

Contribution

A novel bedside staffing model for pediatric ECMO using perfusionists and remote monitoring technology is proposed and evaluated.

Findings

From 2017 to 2023, 289 cannulations were performed with 62,742 cumulative ECMO hours.

The model achieved institutional mortality and complication rates comparable to ELSO rates.

92% of ECMO time involved simultaneous patients, indicating high-volume operation.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) in pediatric patients requires monitoring by specialists to optimize outcomes. Practice variability exists among pediatric ECMO centers across the country. We present a bedside pediatric ECMO staffing model with perfusionists that combines personnel expertise and technology. Methods: At our institution, ECMO care is provided in three intensive care units across one floor. Our primary bedside ECMO provider consists of pediatric perfusionists who provide 24/7 coverage of ECMO patients via remote monitoring and hourly bedside rounding. Neonatal and pediatric ECMO patients are supported using the Cardiohelp SystemTM, which uses Spectrum Medical Quantum Elite Workstation and Variable Input Patient Electronic Records (VIPER) software that remotely delivers ECMO circuit parameters and alarms digitally to a monitor in a workroom and mobile devices. ECMO education and skills are reinforced via dedicated didactic and simulation sessions by an ECMO program coordinator. We compared institutional complication rates to other centers tracked by ELSO. Results: From 2017 to 2023, 289 cannulations were performed, consisting of a total of 62,742 cumulative ECMO hours, of which 92% of that time there were simultaneous ECMO patients. This rounding model has institutional mortality and complication rates that are comparable to ELSO rates. Conclusion: We describe a bedside ECMO staffing model with perfusionists, in contrast to ECMO specialists seen at other institutions. The complication and mortality rates are comparable to ELSO rates, suggesting the safety of this model. Further exploration regarding resource utilization and costs is warranted.

Figures