An Intensivist-Led Extracorporeal Membrane Oxygenation Program: Design, Implementation, and Outcomes of the First Five Years

Abstract

We describe the development, implementation, and outcomes of an intensivist-led adult extracorporeal life support (ECLS) program using intensivists both to perform venovenous (V-V), venoarterial (V-A), and extracorporeal cardiopulmonary resuscitation (ECPR) cannulations, and to manage patients on ECLS throughout their ICU course. All adults supported with ECLS at the University of New Mexico Hospital (UNMH) from February 1, 2017 to December 31, 2021 were retrospectively analyzed. A total of 203 ECLS cannulations were performed in 198 patients, including 116 V-A cannulations (including 65 during ECPR) and 87 V-V cannulations (including 38 in patients with COVID-19). UNMH intensivists performed 195 cannulations, with 9 cannulation complications. Cardiothoracic surgeons performed 8 cannulations. Overall survival to hospital discharge or transfer was 46.5%. Survival was 32.3% in the ECPR group and 56% in the non-ECPR V-A group. In the V-V cohort, survival was 66.7% in the COVID-19-negative patients and 34.2% in the COVID-19-positive patients. This large series of intensivist-performed ECLS cannulations—including V-A, V-V, and ECPR modalities—demonstrates the successful implementation of a comprehensive intensivist-led ECLS program. With outcomes comparable to those in the literature, our program serves as a model for the initiation and development of ECLS programs in settings with limited access to local subspecialty cardiothoracic surgical services.

An intensivist-led ECMO accreditation pathway and safety data over the first 4 years

“…Our experience adds to the increasing body of evidence demonstrating that a cannulation program performed primarily by intensivists is achievable and safe with a low level of clinically significant complications. 13 , 16 , 17 …”

“…Our data demonstrated a 98.5% cannulation success rate with a low rate (4.2%) of medium and high clinical significance complications per cannula inserted, or 8.8% per cannulation episode, in keeping with data described in other reports of intensivist-led ECLS programs. 12 , 13 , 16 A paper describing an intensivist-led VV ECMO program quoted a major complication rate of 6.9% per patient, or 3.5% per cannulation attempt. 13 Their definition of major complications were similar to those we have included in ‘high clinical significance’ events.…”

“…describe the development of their intensivist-led ECLS program and mention a complication rate of 4.6% – again the complications they describe would be in keeping with our ‘high clinical significance’ events. 16 …”

Extracorporeal cardiopulmonary resuscitation

“…The composition of CCPR and ECPR teams varies widely at centers worldwide and differs depending on whether IHCA or OHCA is targetted 17,18 . High-performing resuscitation teams have clearly defined roles for the delivery of CCPR 19 .…”

“…The composition of CCPR and ECPR teams varies widely at centers worldwide and differs depending on whether IHCA or OHCA is targetted. 17,18 High-performing resuscitation teams have clearly defined roles for the delivery of CCPR. 19 At our institution, we have developed a roles-based CPR system that includes the use of a separate Resuscitation Leader and ACLS Captain to facilitate high-quality CCPR (Fig.…”