1542: CONSIDERATION OF ECMO CANNULATION FOR NEONATAL HYDROPS AND VENTRICULAR TACHYCARDIA

Abstract

Learning Objectives: The use of Extracorporeal Membrane Oxygenation (ECMO) in pediatric centers has drastically evolved over the past 2 decades due to variability in institutional regulations and guidelines in cannulating and maintaining a patient on ECMO. Accordingly, this project evaluates the current infrastructure and practice characteristics of pediatric ECMO programs across North America. Methods: A 43-question survey of center-specific demographics and clinical setting, practice structure, program experience, and the support network that is utilized to cannulate and maintain a pediatric patient on ECMO was designed via a web based survey tool (Qualtrics, Provo, UT). The survey was distributed to the ECMO program directors of 101 centers across North America. Results: Of the 101 centers that were invited to participate, 42 centers completed the survey (41.6%). Out of the responding centers, 73% are university based and operate in a PICU that has between 15-25 beds (58%). Only 53% responding centers have an independent CVICU. Of the centers with an independent CVICU, 54% have a15-25 bed capacity. 85% of the responding centers have offered ECMO for > 10 years. The median number of total cannulations per center in 2017 was 5 (IQR = 3 10.5) in the PICU; 11 (IQR = 324.5) in the CVICU and 3 (IQR = 0 7) in the NICU. Only 25 of the 42 centers offered ECPR with a median number of 4 cases/year (IQR = 2 7). Only 18/42 (43%) of centers have a formal ECMO transport program. The majority of the cannulations are done by surgical subspecialties with only 3 centers having cannulations done by interventional cardiology, intensivist or anesthesiologist. The majority of the cannulations occur in the OR / ICU with the exception of 11 centers that cannulate in the pediatric ED. 67% of the centers have standardized protocols for post cannulation management of ECMO. On further analysis anticoagulation (24/24), sedation (18/24) and ventilator management (17/24) were the most standardized while LV decompression (8/24) as well as reperfusion cannula placement (6/24) were the least standardized procedures. 27 out of the 42 centers had a designated time for ECMO rounds and 19 of the centers had a designated ECMO consult service. Conclusions: While majority of the ECMO centers have adopted the infrastructure guidelines recommended by Extracorporeal Life Support Organization, there remains a broad variability of practice characteristics and organizational infrastructure for pediatric ECMO centers across the US and Canada.