Extra-Corporeal Membrane Oxygenation for Neonatal Respiratory Support

Corno, Antonio F.; Faulkner, Gail; Harvey, Chris J.

doi:10.1053/j.semtcvs.2020.02.021

Cited by 7 publications

(3 citation statements)

References 62 publications

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“…Furthermore, significant advances in perioperative support to critically ill infants and children with congenital heart defects have been achieved with readily available and improved extracorporeal membrane oxygenation techniques. Expanded knowledge of extracorporeal membrane oxygenation indications and timing, cannulations strategies, anticoagulation management, extracorporeal membrane oxygenation circuit assessment and optimal flow rates have allowed clinicians to provide improved cardio-circulatory support and mitigate patient complications (33)(34)(35).…”

Section: Review Methodsmentioning

confidence: 99%

A narrative review of modern approach and outcomes evaluation in congenital heart defects

Corno¹,

LaPar²,

Wen³

et al. 2021

Transl Pediatr

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Objective: The purpose of this review is to highlight critical advances and innovative approaches to the most challenging clinical situations in congenital heart surgery, to establish a new perspective from which to evaluate current clinical practice patterns and contemporary United States program ranking systems. Background:The past decades have witnessed substantial advances in the treatment of congenital heart defects. New strategies are deeply rooted in calculated risk-taking innovations. Pioneer surgeons developed, improved and refined critical operative skills and techniques to optimize cardiovascular physiology, decrease operative mortality and improve clinical outcomes.Methods: Unfortunately, in the modern surgical era, supportive environments to allow surgeons to make similar gains and innovative contributions remain scarce. In the current practice, overall procedure volume is prioritized to safeguard quality metrics, including hospital survival and length of stay, surgical complications, and neurocognitive outcomes. As a result, exceptional surgical results have become translated and defined by public ranking systems such as the US News and World Report Best Children's Hospital National Ranking (USNWR) and the Congenital Heart Surgery Database of the Society for Thoracic Surgeons (CHSD-STS), primary based upon early post-operative mortality. This reality places surgeons in a vulnerable position where pressure to achieve a high clinical ranking contrasts with a surgeon definition of "acceptable" surgical risk. Currently, the most frequently used risk stratification tools do not factor in important differences in strategies, such as staged palliation versus complete repair, or bi-ventricular versus uni-ventricular physiology. This favors hospitals pursuing multistage surgical approaches, even if the result is worse long-term morbidity, mortality and increased resource utilization. This economy of ranking-based decision-making causes surgeons either avoid operating altogether or accept less advantageous multi-staged treatment strategies for patients with elevated expected mortality. Such an environment also might present much farther-reaching negative impacts on the growth and development of junior surgeons and trainees, as well as on the pursuit of new surgical innovations to aid future generations of patients.Conclusions: Risk aversive surgical behavior is creating an environment not favorable for the children born with truly complex congenital heart defects.

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Section: Review Methodsmentioning

confidence: 99%

A narrative review of modern approach and outcomes evaluation in congenital heart defects

Corno¹,

LaPar²,

Wen³

et al. 2021

Transl Pediatr

Self Cite

View full text Add to dashboard Cite

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“…One needs to understand the target population because there may exist a relationship between volume of cases and outcomes for ECMO programs. 8,9 Existing Resources Key clinical personnel need to define and clarify the local scope of the ECMO program. Although ECMO can offer sustained life support for both cardiac and respiratory failure in neonates, children and adults, it is not a requirement that a new ECMO center support all patient groups.…”

Section: Anticipated Patient Volumementioning

confidence: 99%

“…One needs to understand the target population because there may exist a relationship between volume of cases and outcomes for ECMO programs. 8,9…”

Section: Identification Of Needmentioning

confidence: 99%

Starting and Sustaining an Extracorporeal Membrane Oxygenation Program

et al. 2022

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The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly in all patient populations, especially adults for both acute lung or heart failure. ECMO is a complex, high risk, resource-intense, expensive modality that requires appropriate planning, training, and management for successful outcomes. This article provides an optimal approach and the basic framework for initiating a new ECMO program, which can be tailored to meet local needs. Setting up a new ECMO program and sustaining it requires institutional commitment, physician champions, multidisciplinary team involvement, ongoing training, and education of the ECMO team personnel and a robust quality assurance program to minimize complications and improve outcomes.

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