Advanced nurse specialist-managed pediatric extracorporeal membrane oxygenation: A 35-year single center experience

Abstract

Aim: To investigate the feasibility, safety, and clinical outcomes of a solely registered nurse (RN)-managed extracorporeal membrane oxygenation (ECMO) program in a community hospital over a 35-year period. Material and Methods: A retrospective single-center review was conducted on all patients who received at least 24 hours of ECMO support in our pediatric intensive care unit (PICU) between August 1987 and August 2021. An integrated study of ECMO support type, ECMO duration, and patient survival to discharge was systematically performed. Results: 321 ECMO runs were initiated on 319 patients. 273 (85.0%) runs were for elective pulmonary support, 34 (10.6%) were for elective cardiac support, and 14 (4.36%) were for emergent cardiac support in extracorporeal cardiopulmonary resuscitation (ECPR). Of the 321 ECMO runs, 279 (86.9%) were performed on neonatal patients, 37 (11.5%) on pediatric patients, and 5 (1.56%) on adult patients (excluded from analysis). The median duration of ECMO was 120 hours for neonatal patients and 134 hours for pediatric patients. 69.5% of all patients on ECMO survived to discharge. ECPR was an independent predictor of poor outcomes, in which 28.6% of the 14 patients survived to discharge. Conclusion: A pediatric ECMO program fully managed by advanced nurse specialists was successfully implemented, maintained, and expanded. This model produced safe and efficacious outcomes that were comparable to data from the Extracorporeal Life Support Organization (ELSO) registry. Such an ECMO model is feasible even in a resource-limited setting like a community hospital. Nevertheless, for the most critical patients, the support of neonatologists, intensivists, and surgeons is imperative for enhancing favorable outcomes.