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ECMO (Extracorporeal Membrane Oxygenation)

Heart-lung bypass for respiratory failure

UK Albert B. Chandler Hospital and Kentucky Children’s Hospital have been designated an ECMO Center of Excellence by the Extracorporeal Life Support Organization (ELSO). (The designation is renewed every three years.) There are fewer than 100 centers of excellence in the world, most of which are in the U.S.

ECMO, or extracorporeal membrane oxygenation, is a highly specialized treatment that uses a catheter to remove blood from the body, transport the blood to a pump to circulate blood through an artificial lung back into the bloodstream of a critically ill person. This system provides heart-lung bypass support outside of the person's body.

With the designation of excellence in neonatalpediatric and adult ECMO care, UK HealthCare is one of a few centers offering a comprehensive program in extracorporeal life support (ECLS) committed to the needs of patients of all ages in respiratory failure.

The ELSO Award recognizes programs that reach the highest level of performance, innovation, satisfaction and quality. It signifies to patients and families a commitment to exceptional patient care. It also demonstrates to the health care community an assurance of high quality standards, specialized equipment and supplies, defined patient protocols, and advanced education of all staff members.

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  • KCH Neonatal ECMO Outcomes and Quality Assurance Metrics

    ECMO Quality Metrics 2015-2019

     

    KCH 2015

    KCH 2016

    KCH 2017

    KCH 2018

    KCH 2019

    Neonatal ECMO Patients (n)

    16

    11

    6

    7

    3

    Care outcomes

     

     

     

     

     

    Survival to discharge (%)

    94

    82

    100

    57

    100

    Infection while on ECMO (%)

    0

    1

    0

    0

    0

    Intracranial hemorrhage (%)

    12.5

    18

    0

    14.3

    0

    Circuit clots (%)

    56

    9

    33

    0

    0

    Circuit air (%)

    6.3

    0

    0

    14.3

    0

    Resource availability

     

     

     

     

     

    ECMO equipment availability (%)

    100

    100

    100

    100

    100

    Efficient head ultrasound performance (%)

    100

    100

    100

    100

    100

    Utilizing order sets (%)

    100

    100

    100

    100

    100

    Patient satisfaction

     

     

     

     

     

    Documentation of attending speaking with parents on a daily basis (%)

    98.3

    100

    100

    100

    100*

    Efficiency

     

     

     

     

     

    Length of ECMO (hours)

    172

    134

    95

    137

    111.5


    ECMO Quality Metrics 2019 and Cumulative (KCH vs. ELSO)

     

    KCH 2019

    KCH
    Cumulative
    2015-2019

     

    ELSO
    Cumulative #

    KCH ECMO
    Team Goal

    Neonatal ECMO patients (n)

    3

    43

    2,891

     

    Care outcomes

     

     

     

     

    Survival to discharge (%)

    100

    86

    67

    >67

    Infection while on ECMO (%)

    0

    2.3

    3.9

    <3.9

    Intracranial hemorrhage (%)

    0

    11.6

    11.5

    <11.5

    Circuit clots (%)

    0

    27.9

    40.7

    <40.7

    Circuit air (%)

    0

    4.7

    4.3

    <4.3

    Resource availability

     

     

     

     

    ECMO equipment availability (%)

    100

    100

     

    100%

    Efficient head ultrasound performance (%)

    100

    100

     

    100%

    Utilization of order sets (%)

    100

    100

     

    100%

    Patient satisfaction

     

     

     

     

    Documentation of attending speaking with parents on a daily basis while on ECMO (%)

    100*

    99

     

    100%

    Efficiency

     

     

     

     

    Length of ECMO (hours)

    111.5

    132

    225

    <225

    Note: The U.S. ELSO data is updated semi-annually in January and July at  www.elso.org.

    Definitions

    Circuit air: any air bubble that is detected in the ECMO circuit.

    Circuit clots: clots that develop anywhere in the ECMO circuit (tubing, pump, bladder, oxygenator, bridge). This is not unusual since blood is running through tubing.

    Key

    Survival to discharge (%): The higher the percentage, the better the survival.

    Infection while on ECMO (%): Lower percentage is better (lower number of infections occurred).

    Intracranial hemorrhage (%): Lower percentage is better (lower number of head bleeds).

    Circuit clots (%): Lower percentage is better (fewer clots in circuit).

    Circuit air (%): Lower percentage is better (fewer episodes of air in the circuit).

    Length of ECMO (hours): Lower number of hours is better. The less time a patient spends on the ECMO circuit, the less risk of complication and the shorter time required to recover.