Successful Establishment of the First Neonatal Respiratory Extracorporeal Membrane Oxygenation (ECMO) Program in the Middle East, in Collaboration With Pediatric Services

Elkhwad, Mohammed; More, Kiran; Anand, Dhullipala; Al-Maraghi, Samira; Crowe, Myles; Wong, Duane; Metcalf, Julianne; Yadav, Santosh Kumar; Sigalet, David L.

doi:10.3389/fped.2020.00506

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…ECMO centers may be set up as a result of national healthcare strategies that involve creating network centers [ 17 ]. Having the support of local authorities is key for new ECMO center creation, particularly in its early stages [ 11 ]. Setting up our ECMO center was a totally bottom-up initiative, with financial support limited only to purchasing the ECMO machines required.…”

Section: Discussionmentioning

confidence: 99%

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Establishing a New ECMO Referral Center Using an ICU-Based Approach: A Feasibility and Safety Study

et al. 2022

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Background: A high-volume center with a multidisciplinary team is regarded as the optimal place for providing extracorporeal membrane oxygenation (ECMO). We hypothesize that an ECMO center can also be successfully created and subsequently developed entirely by intensivists in a mid-size mixed intensive care unit (ICU). Methods: A model was created for setting up a new ECMO referral center within the structure of an existing mixed ICU in a tertiary hospital. A retrospective analysis was carried out of the first 33 patients treated in the initial period of the center’s activity, from mid 2018 to the end of 2020. Results: An ECMO center was established and developed entirely based on the resources of an existing mixed ICU. Thirty-three patients were treated. They had an overall survival rate at 90 days of 60.6%. In veno-venous (VV) mode ECMO duration, ICU length of stay, and SOFA score were significantly higher than in veno-arterial mode. No significant differences in clinical characteristics were observed between survivors and non-survivors on VV-ECMO. Conclusions: A regional ECMO center can be set up as an integral part of a mixed ICU in a tertiary hospital. Extracorporeal therapy, such as continuous renal replacement therapy and mechanical ventilation can be managed entirely by intensivists. Further studies are needed to show that the ICU-based approach to setting up a new ECMO center is no less effective than the multidisciplinary approach.

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Section: Discussionmentioning

confidence: 99%

“…Reports on practical methods for setting up new ECMO centers are limited [ 11 , 12 ]. To date, there have been no reports describing the establishment of ECMO centers solely from the perspective of an individual mixed intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

Establishing a New ECMO Referral Center Using an ICU-Based Approach: A Feasibility and Safety Study

et al. 2022

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“…Aligned with published literature on the development of standard ECLS programs, we identify the importance of strong leadership, multi-disciplinary steering committee representation, effective communication, and well-established education processes. [2][3][4][5]18 Furthermore, we describe considerations specific to rescue programs, including policies, procedures, indications, consent, and equipment with partner programs, and establishing a well-developed transport process.…”

Section: Discussionmentioning

confidence: 99%

Key Considerations in Establishing a Pediatric Rescue Extracorporeal Life Support Program: A Multi Methods Review

et al. 2022

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Extracorporeal life support (ECLS) is generally limited to centers with cardiac surgery. However, pediatric centers without cardiac surgery can still provide potentially lifesaving ECLS through a Rescue Program, allowing a local team to cannulate and stabilize patients before they are transported to a center with cardiac surgery support for ongoing care. This multimethod study provides an exploration of pediatric ECLS team insights regarding program implementation and offers recommendations for other centers wishing to develop a similar program. We performed surveys and semi-structured interviews to gather perspectives from ECLS team members. Demographics and preliminary perspectives were obtained from surveys. Interviews were transcribed and coded using thematic analysis to identify key considerations, facilitators, and barriers related to rescue program implementation. Our multidisciplinary ECLS team perceived great value in the rescue program and identified elements critical to successful program development and implementation, including barriers that might exist for any center wishing to set up a similar program. Participants emphasized that the initial design and continued maintenance of any Rescue ECLS Program be a comprehensive, multidisciplinary initiative. Clear communication, a mechanism for debriefing and feedback, and a strategy allowing for flexible program evolution are essential.

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“…As DeMeo et al further explore, neonatal endotracheal intubation for example remains a critical skill for paediatric residents and neonatal-perinatal fellows in the NICU, but they don't usually get a lot of chances to learn this vital skill ( 6 ). Simulation hence remains one of the ways to enhance this vital competency ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Neonatal Simulation Program: A 5 Years Educational Journey From Qatar

et al. 2022

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We describe the process of implementation, adaptation, expansion and some related clinical intuitional impacts of the neonatal simulation program since its launch in 2016 in a non-simulation neonatal unit. The team has developed 6 types of curricula: 1 full-day course and 5 half-day workshops. A total of 35 free of charge simulation courses/workshops were conducted, 32 in Qatar and 3 abroad with a total of 799 diverse participants. There was a steady increase in the overall success rate of PICC insertion from 81.7% (309/378) to 97.6% (439/450) across 3 years (P < 0.0001). The first attempt PICC insertion success rate has been also increased from 57.7% (218/378) to 66.9% (301/450) across 3 years. The mean duration of PICC insertion has been improved from 39.7 ± 25 to 34.9 ± 12.4 min after implementing the program (P = 0.33). The mean duration of the LISA catheter insertion at the beginning of the workshop was 23.5 ± 15.9 compared to 12.1 ± 8.5 s at the end of the workshop (P = 0.001). When it came to clinical practise in real patients by the same participants, the overall LISA catheter insertion success rate was 100% and the first attempt success rate was 80.4%. The mean duration of LISA catheter insertion in real patients was 26.9 ± 13.9 s compared to the end of the workshop (P = 0.001). The mean duration of the endotracheal intubation at the beginning of the workshop was 12.5 ± 9.2 compared to 4.2 ± 3.8 s at the end of the workshop (P = 0.001). In real patients, the first-attempt intubation success rate has been improved from 37/139 (26.6%) in the first year to 141/187 (75.5%) in the second year after the program implementation (P = 0.001). The mean duration of successful endotracheal intubation attempts has been improved from 39.1 ± 52.4 to 20.1 ± 9.9 s (P = 0.78). As per the participants, the skills learned in the program sessions help in protecting neonates from potential harm and improve the overall neonatal outcome. Implementing a neonatal simulation program is a promising and feasible idea. Our experience can be generalised and replicated in other neonatal care institutions.

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Successful Establishment of the First Neonatal Respiratory Extracorporeal Membrane Oxygenation (ECMO) Program in the Middle East, in Collaboration With Pediatric Services

Cited by 5 publications

References 25 publications

Establishing a New ECMO Referral Center Using an ICU-Based Approach: A Feasibility and Safety Study

Establishing a New ECMO Referral Center Using an ICU-Based Approach: A Feasibility and Safety Study

Key Considerations in Establishing a Pediatric Rescue Extracorporeal Life Support Program: A Multi Methods Review

Neonatal Simulation Program: A 5 Years Educational Journey From Qatar

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