An intensivist-led ECMO accreditation pathway and safety data over the first 4 years

Stuart C Duffin; Judith H Askew; Timothy J Southwood; Paul Forrest; Brian Plunkett; Richard J Totaro

doi:10.1016/j.ccrj.2023.11.006

An intensivist-led ECMO accreditation pathway and safety data over the first 4 years

Crit Care Resusc. 2023 Dec 14;26(1):41-46. doi: 10.1016/j.ccrj.2023.11.006. eCollection 2024 Mar.

Authors

Stuart C Duffin¹, Judith H Askew¹, Timothy J Southwood¹, Paul Forrest², Brian Plunkett¹, Richard J Totaro¹

Affiliations

¹ Royal Prince Alfred Hospital, Sydney, Australia.
² Royal Prince Alfred Hospital, Sydney Medical School, Sydney, Australia.

Abstract

Objective: To describe the training and accreditation process behind an intensivist-led extracorporeal membrane oxygenation (ECMO) cannulation program, and identify the rate of complications associated with the ECMO cannulation procedure.

Design: A narrative review of the accreditation process, and a retrospective review of complications related to cannulation during the first four years of the intensivist program.

Setting: Royal Prince Alfred Hospital, a quaternary referral hospital in Sydney.

Participants: All patients initiated onto ECMO during the first four years of the intensivist cannulation program (August 2018 to August 2022).Main outcome measures: All cases were reviewed for identification of 14 pre-defined adverse events which were classified as low, medium or high clinical significance complications.

Results: A total of 402 cannulations were attempted by the intensivist group in 194 separate cannulation episodes involving 179 patients. This included 93 V-V initiations, 69 V-A initiations (36 of these ECMO-CPR), 3 V-AV (veno-arteriovenous) initiations, 25 ECMO reconfigurations and four patients cannulated for peripheral cardiopulmonary bypass in cardiothoracic theatre. One of the 402 cannulations was halted as resuscitation was ceased, and one was halted and the patient transferred to theatre for central arterial cannulation. 394 out of the remaining 400 cannulations were successful (98.5%). Of 402 total cannulations, 32 complication events occurred (7.96% event rate), of which 15 (3.7% event rate) were low significance complications, 10 medium significance (2.5% event rate), and seven high clinical significance (1.7% event rate).

Conclusions: Our experience of the first four years of an intensivist-led ECMO service demonstrates that our training process and cannulation technique result in the provision of a complex therapy with low levels of complications, on par with those in the published literature.

Keywords: Cannulation; Extracorporeal life support; Intensive care; Resuscitation - training.