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 2016-2020

 

KCH 2016

KCH 2017

KCH 2018

KCH 2019

KCH 2020

Neonatal ECMO Patients (n)

11

6

7

3

3

Care outcomes

 

 

 

 

 

Survival to discharge (%)

82

100

57

100

67

Infection while on ECMO (%)

1

0

0

0

0

Intracranial hemorrhage (%)

18

0

14.3

0

33

Circuit clots (%)

9

33

0

0

33

Circuit air (%)

0

0

14.3

0

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 (%)

100

100

100

100*

100*

Efficiency

 

 

 

 

 

Length of ECMO (hours)

134

95

137

111.5

170.9


ECMO Quality Metrics 2020 and Cumulative ELSO Adjusted Outcomes (KCH vs. ELSO)

 

KCH 2020

KCH
Cumulative
2016-2020

 

ELSO Outcome #

KCH ECMO
Team Goal

Neonatal ECMO patients (n)

3

30

2937

 

Care outcomes

 

 

 

 

Survival to discharge (%)

67

80

68

>68

Infection while on ECMO (%)

0

3

2.8

<2.8

Intracranial hemorrhage (%)

33

13.3

11.1

<11.1

Circuit clots (%)

33

13.3

40.2

<40.2

Circuit air (%)

0

3

3.6

<3.6

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*

100*

 

100%

Efficiency

 

 

 

 

Length of ECMO (hours)

170.9

128.3

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.