Allocation of resources and development of guidelines for extracorporeal membrane oxygenation (ECMO): Experience from a pediatric center in the epicenter of the COVID-19 pandemic

Gerall, Claire; Cheung, Eva W.; Klein-Cloud, Rafael; Kreines, Erica; Brewer, Michael; Middlesworth, William

doi:10.1016/j.jpedsurg.2020.08.015

Cited by 15 publications

(10 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adult and pediatric ECMO centers within a region 28 should consider pooling resources, whenever feasible, such as pumps, disposables, or staff, to optimize ECMO capacity from existing resources.…”

Section: Ecmo Program Organizationmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization

et al. 2021

View full text Add to dashboard Cite

Disclaimer: This is an updated guideline from the Extracorporeal Life Support Organization (ELSO) for the role of extracorporeal membrane oxygenation (ECMO) for patients with severe cardiopulmonary failure due to coronavirus disease 2019 (COVID-19). The great majority of COVID-19 patients (>90%) requiring ECMO have been supported using venovenous (V-V) ECMO for acute respiratory distress syndrome (ARDS). While COVID-19 ECMO run duration may be longer than in non-COVID-19 ECMO patients, published mortality appears to be similar between the two groups. However, data collection is ongoing, and there is a signal that overall mortality may be increasing. Conventional selection criteria for COVID-19–related ECMO should be used; however, when resources become more constrained during a pandemic, more stringent contraindications should be implemented. Formation of regional ECMO referral networks may facilitate communication, resource sharing, expedited patient referral, and mobile ECMO retrieval. There are no data to suggest deviation from conventional ECMO device or patient management when applying ECMO for COVID-19 patients. Rarely, children may require ECMO support for COVID-19–related ARDS, myocarditis, or multisystem inflammatory syndrome in children (MIS-C); conventional selection criteria and management practices should be the standard. We strongly encourage participation in data submission to investigate the optimal use of ECMO for COVID-19.

show abstract

Section: Ecmo Program Organizationmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Establishing networks at a regional level may improve the delivery of emergent interventions such as ECLS to the whole population. 56,[64][65][66][67] Abrams et al suggested seamless patient transport and clearly defined pathways for transition to centers of the most complex care with advanced cardiac capabilities. 42 The trends in volume-outcome relationships were described as controversial.…”

Section: Discussionmentioning

confidence: 99%

GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe (GENERATE)

et al. 2023

View full text Add to dashboard Cite

Introduction A cross-sectional survey GENERATE (GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe) initiated on behalf of the European chapter of the Extracorporeal Life Support Organization (EuroELSO), aims to provide a systematic, detailed description of contemporary Extracorporeal Life Support (ECLS) provision in Europe, map the spatial distribution of ECLS centers, and the accessibility of ECLS. Methods Structured data collection forms were used to create a narrative description of ECLS provision in EuroELSO affiliated countries. This consisted of both center-specific data and relevant national infrastructure. Data was provided by a network of local and national representatives. Spatial accessibility analysis was conducted where appropriate geographical data were available. Results 281 centers from 37 countries affiliated to EuroELSO were included in the geospatial analysis and demonstrate heterogeneous patterns of ECLS provision. Accessibility of ECLS services within 1 hour of drive-time is available for 50% of the adult population in 8 of 37 countries (21.6%). This proportion is reached within 2 hours in 21 of 37 countries (56.8%) and within 3 hours in 24 of 37 countries (64.9%). For pediatric centers, accessibility is similar with 9 of 37 countries (24.3%) reached the covering of 50% of the population aged 0–14 within 1 hour and 23 of 37 countries (62.2%) within 2 hours and 3 hours. Conclusions ECLS services are accessible in most of the European countries, but their provision differs across the continent. There is still no solid evidence given regarding the optimal ECLS provision model. The spatial disparity in ECLS provision demonstrated in our analysis requires governments, healthcare professionals and policy makers to consider how to develop existing provision to accommodate the anticipated increase in need for time critical access to this advanced support modality.

show abstract

“… 66 , 67 , 68 Access to ECMO for children with non-COVID-19 critical illness, congenital anomalies and emergent peri-operative indications, in addition to the infrequent pediatric patients who were critically ill with COVID-19, was preserved in many regions and recommended in guidelines. 22 , 69 , 70 , 71 , 72 , 73 In addition, many established pediatric ECMO centers expanded their admission criteria to facilitate the care of adult COVID patients who required ECMO and offload regional centers at capacity. 69 , 70 , 74 While there are many examples of successful shared resource allocation protocols, particular care was required to address the unique challenges of assessing mortality risk in the neonatal and pediatric populations.…”

Section: Evaluating Effectiveness Of Ecmo In An Ongoing Pandemicmentioning

confidence: 99%

“… 22 , 69 , 70 , 71 , 72 , 73 In addition, many established pediatric ECMO centers expanded their admission criteria to facilitate the care of adult COVID patients who required ECMO and offload regional centers at capacity. 69 , 70 , 74 While there are many examples of successful shared resource allocation protocols, particular care was required to address the unique challenges of assessing mortality risk in the neonatal and pediatric populations. The COVID-19 pandemic highlighted that at times of critical care shortages, protocols which ensure equity across the life span should be employed.…”

Section: Evaluating Effectiveness Of Ecmo In An Ongoing Pandemicmentioning

confidence: 99%