The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

INITIAL EXPERIENCE WITH A RAPID-RESPONSE ECMO SERVICE

Lynne K. Bower, RRT, Peter Betit, RRT, John E. Thompson, RRT, John H. Arnold, MD, Children's Hospital, Boston, Massachusetts

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been available in our institution since 1984. Beginning 2/96, we modified our ECMO circuit in order to provide a rapid-response ECMO service capable of supporting patients during cardiopulmonary arrest. We report our initial experience with this service from 2/96-5/97. METHOD: A pre-assembled ECMO circuit capable of supporting patients up to 20 kg, is maintained in our PICU. The circuit includes a silicone membrane and roller pump and is CO_{2}/vacuum primed. Upon activation of the rapid-response ECMO service, the circuit is prepared with a crystalloid/albumin prime and is ready within 20 minutes. If time permits, the circuit is further primed with blood products, otherwise initiation of ECMO proceeds with a crystalloid prime. ECMO support is established by a veno-arterial route either transthoracically or via neck vessels. Respiratory therapists, trained in the establishment of ECMO support, provide 24 hour coverage for this rapid-response ECMO service. A new ECMO circuit is assembled every 7 days if the system is unused. Results: The rapid-response ECMO service was activated 24 times, in 6 different hospital locations, and with a response time of < = 20 minutes. Nine patients recovered without needing ECMO. Fifteen patients required ECMO, 8 of which required cardiac compression throughout the cannulation procedure. Diagnoses included cardiac failure, congenital diaphragmatic hernia and sepsis. The median age was 6 weeks (1 day-4 years) and the median weight was 4.0 kg (2.4-15 kg). The overall survival rate was 67% (10/15). Additionally, emergent ECMO was requested for 6 patients weighing > 20 kg. DISCUSSION: Historically in our institution, the decision to initiate ECMO has been elective, and ECMO has been staffed by respiratory therapist with an on-call system. We have found the implementation of a rapid-response ECMO service feasible. The favorable survival rate may be attributed to the availability of the rapid-response ECMO service. Future considerations will center on investigating different technologies to expand our rapid-response ECMO service to include patients > 20kg. Additionally, infection control, cost-effectiveness and long-term patient outcome need to be evaluated.

OF-97-182

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