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 neonatal, pediatric 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 2017-2022
|
|
KCH 2017 |
KCH 2018 |
KCH 2019 |
KCH 2020 |
KCH 2021 |
KCH 2022 |
|
Neonatal ECMO Patients (n) |
6 |
7 |
3 |
3 |
7 |
2 |
Care outcomes |
|
|
|
|
|
|
|
Survival to discharge (%) |
100 |
57 |
100 |
67 |
57 |
50 |
|
Infection while on ECMO (%) |
0 |
0 |
0 |
0 |
14.3 |
0 |
|
Intracranial hemorrhage (%) |
0 |
14.3 |
0 |
33 |
0 |
100 |
|
Circuit clots (%) |
33 |
0 |
0 |
33 |
29 |
0 |
|
Circuit air (%) |
0 |
14.3 |
0 |
0 |
0 |
0 |
Resource availability |
|
|
|
|
|
|
|
ECMO equipment availability (%) |
100 |
100 |
100 |
100 |
100 |
100 |
|
Efficient head ultrasound performance (%) |
100 |
100 |
100 |
100 |
100 |
100 |
|
Utilizing order sets (%) |
100 |
100 |
100 |
100 |
100 |
100 |
Patient satisfaction |
|
|
|
|
|
|
|
Documentation of attending speaking with parents on a daily basis (%) |
100 |
100 |
100 |
100 |
100* |
100 |
Efficiency |
|
|
|
|
|
|
|
Length of ECMO (hours) |
95 |
137 |
111.5 |
170.9 |
209.4 |
98.3 |
ECMO Quality Metrics 2020 and Cumulative ELSO Adjusted Outcomes (KCH vs. ELSO)
|
|
KCH 2020 |
KCH |
ELSO Outcome # |
KCH ECMO |
|
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.
