The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

CREATING AN IN-HOUSE ECPR PROGRAM

Susan A. Roark1,2, Joel Davis2, April Tanner2, Micheal Heard2, Teresa Young2, Scott Wagoner2, Esther Taylor1,2



Introduction: Extracorporeal Cardiopulmonary Resuscitation (ECPR) is recognized as a means of improving survival after sudden, witnessed cardiac arrest. At Children's Healthcare of Atlanta the neonatal, pediatric, and cardiac ECMO programs have been in place since 1991 utilizing nurses and respiratory therapists in the ECMO specialist role. In 2002 our average cardiac ECMO cases increased from 2/yr to 14/yr demonstrating the need for a dedicated in-house 24hr ECPR team. Appropriate candidates are patients that are undergoing continuing CPR and are deemed to have a reversible cause of the cardiopulmonary collapse. We describe the development of a successful ECPR program at our institution.

Results: Creation of an in-house ECPR program required selection and training of personnel, physician/staff education, and the development of a rapid priming procedure. To provide 24hr coverage 11 experienced ECMO specialists were selected by the ECMO priming team to be trained to perform the ECPR prime. Training included an initial 2hr didactic review of ECPR with demonstration of the priming procedure followed by 4 one-on-one mock ECPR primes and initiations. These drills are repeated bi-annually with the expectation that the time to initiation will be less than 30 minutes. A standard ECPR circuit was developed consisting of 1/4 inch tubing, a 3/8 inch raceway and a 1.5 m2 membrane (Medtronic, Inc. Minneapolis, MN) which would support patients up to 15kgs. With the assistance of the perfusion team, a rapid prime kit that allows for blood and medications to be rapidly infused into the circuit was developed. Physician and surgeon education focused on defining ECPR, appropriate candidates, when and how to initiate ECPR, and the expectations of the ECPR primer. Staff education included activation of the team and assistance of the ECPR primer in the areas of gathering supplies, drawing up medications and checking blood products. Children's Healthcare of Atlanta's ECPR program was implemented on 12/1/2003. Through May 2007 a total of 35 ECPR cases have been performed with 26 of these being in the Cardiac Intensive Care Unit and an overall survival rate of 51% compared to the international average of 37% as reported by the Extracorporeal Life Support Organization.

Conclusion: The development of an in-house ECPR program can be accomplished with an experienced and dedicated ECMO team.