Pediatric Critical Hematology Oncology Referral Pathway for Extracorporeal Life Support: Standardized Evaluation and Transfer Can Improve Survival.

Abstract

Over the last decade, extracorporeal life support (ECLS) use for patients with a hematologic or oncologic diagnosis or who have undergone hematopoietic cell transplant has increased, with steadily improving outcomes. To standardize our approach to early evaluation and identification of ECLS candidates, we developed the Critical Hematology Oncology Referral Pathway for Extracorporeal Life Support (CHORPE). We performed a retrospective chart review of patients transferred between two pediatric hospitals for ECLS evaluation. Forty-six patients were transferred for ECLS evaluation: 17 pre-CHORPE, 28 post-CHORPE implementation, and 1 index patient between January 2010 and December 2021. Six were placed on ECLS in the preprocess group; three survived decannulation, but none survived to hospital discharge. In the post-process group, nine were placed on ECLS, with six surviving to decannulation and transfer back to the referring hospital (odds ratios [OR] = 24, p = 0.01) and five surviving to hospital discharge (OR = 15.9, p = 0.03). In the post-process group, there were fewer complications during transfer (p = 0.0228), and clinical improvement was the reason for not going on ECLS (p = 0.0120). A standardized approach to ECLS candidacy evaluation, early identification, and safe transfer with continuity of care is associated with improved survival after ECLS.