2004 survey of ECMO in the neonate after open heart surgery: circuitry and team roles

Abstract

Over the past 20 years, the bulk of the literature and texts published about extracorporeal membrane oxygenation (ECMO) has been written by physicians and nurses. The consensus of this body of printed information would suggest, among other things, that (1) despite significant advancements in extracorporeal technology, the standard ECMO circuit has remained fundamentally unchanged since originally described in 1982, and (2) perfusionists are nearly absent from the staffing algorithm at most centers. While these conclusions may be representative of the extracorporeal life support (ELSO) reporting centers, they may not be representative of the field as a whole. We hypothesized that the use of modern extracorporeal equipment and the involvement of perfusionists in ECMO patient care is largely underreported in previous studies. To study this hypothesis, we developed a standard survey instrument and queried perfusion teams from the hospitals listed on the American Society of Extra-Corporeal Technology Pediatric Registry. All centers were contacted by phone and were asked questions regarding their caseload, circuitry, and staffing algorithms. Data are reported as a percentage of respondents. ECMO is used as a method of mechanical support after neonatal open heart surgery in 94% of centers surveyed. For 60% of the centers, a silicone membrane oxygenator is used exclusively, whereas 40% of the centers have used a hollow fiber oxygenator (HFO), and of that group, 19% use a HFO routinely for neonatal post-cardiopulmonary bypass ECMO. Roller pumps are used exclusively at 65% of the centers, whereas centrifugal pumps are used routinely in 12%, and 23% have used both. Perfusionists are responsible for set-up/initiation (79%) and daily rounding/troubleshooting (71%), and provide around-the-clock bedside care (46%) at the surveyed centers. These data suggest that previously published ELSO-centric ECMO studies may significantly underestimate the contemporary application of modern technologies and the involvement of perfusionists.

Figure 1.

The standard ECMO circuit (reprinted by permission from the Extracorporeal Life Support Organization).

Figure 2.

Geographic profile of the survey.

Figure 3.

Program type.

Figure 4.

In the case of failure to wean from neonatal CPB, what mode of mechanical assistance is considered at your institution?

Figure 5.

If ECMO is used for post-CPB support of the neonate, do you use a “standard” ECMO circuit?

Figure 6.

Oxygenator type used in neonates for post-CPB ECMO.

Figure 7.

HFO brand used (n = 26 centers).

Figure 8.

Pump type used in neonatal post-CPB ECMO.