An Intensivist-Led Extracorporeal Membrane Oxygenation Program: Design, Implementation, and Outcomes of the First Five Years. Issue 5 (15th December 2022)

• Record Type: Journal Article
• Authors: Kraai, Erik; Teixeira, J. Pedro; Patel, Ishan A.; Wray, Trenton C.; Mitchell, Jessica A.; George, Naomi; Kamm, Ashley; Henson, Justin; Mirrhakimov, Aibek; Guliani, Sundeep; Tawil, Isaac; Dettmer, Todd; Marinaro, Jonathan
• Is Part Of: ASAIO journal. Volume 69:Issue 5(2023)
• Page Start: 451
• Page End: 459
• Publication Date: 2022-12-15
• Subjects: intensivist -- critical care -- extracorporeal membrane oxygenation -- extracorporeal life support -- cannulation -- extracorporeal cardiopulmonary resuscitation -- ECMO -- ECPR -- ECLS; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001870
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : We describe the development, implementation, and outcomes of an intensivist-led adult extracorporeal life support (ECLS) program using intensivists both to perform venovenous (V-V), venoarterial (V-A), and extracorporeal cardiopulmonary resuscitation (ECPR) cannulations, and to manage patients on ECLS throughout their ICU course. All adults supported with ECLS at the University of New Mexico Hospital (UNMH) from February 1, 2017 to December 31, 2021 were retrospectively analyzed. A total of 203 ECLS cannulations were performed in 198 patients, including 116 V-A cannulations (including 65 during ECPR) and 87 V-V cannulations (including 38 in patients with COVID-19). UNMH intensivists performed 195 cannulations, with 9 cannulation complications. Cardiothoracic surgeons performed 8 cannulations. Overall survival to hospital discharge or transfer was 46.5%. Survival was 32.3% in the ECPR group and 56% in the non-ECPR V-A group. In the V-V cohort, survival was 66.7% in the COVID-19-negative patients and 34.2% in the COVID-19-positive patients. This large series of intensivist-performed ECLS cannulations—including V-A, V-V, and ECPR modalities—demonstrates the successful implementation of a comprehensive intensivist-led ECLS program. With outcomes comparable to those in the literature, our program serves as a model for the initiation and development of ECLS programs in settings with limited access to local subspecialty cardiothoracic surgical services.