Pediatric and neonatal extracorporeal life support technology component utilization: are US clinicians implementing new technology?

The objective of this investigation is to describe recent changes made in extracorporeal life support (ECLS) technology in the US Postal survey to directors and coordinators of all 125 US ECLS centers identified by Extracorporeal Life Support Organization as of November 2010, with follow-up of nonrespondents. Spearman coefficients were used to correlate the method of updating knowledge of ECLS technology with the likelihood of changing technology, and to correlate decision-making hierarchy with the likelihood of changing equipment. The response rate was 75% representing 34 states, and the majority of respondents were ECLS coordinators (56.6%). Respiratory diagnosis is the predominant indication for ECLS at any age. Over 40% of centers are using a hollow-fiber oxygenator for neonates and 80% of pediatric patients. Roller pumps are used in 70% of neonatal and pediatric ECLS. Forty-two percent of centers changed the oxygenator type within the past 3 years, while 30% changed both the oxygenator and pump. Less than 10% of centers reported problems with either oxygenator or pump in both neonates and pediatric ECLS. Forty-six percent of respondents that changed oxygenators cited that the primary reason for changing was "clinical preference/experience," while the other half was split between "FDA approval" and "Research results." In 40% of centers, a multidisciplinary group made decisions on changing technology. This survey indicates that over one-half of ECLS centers implemented new technology within the past 3 years. Knowledge of ECLS technology and safe operation of ECLS circuit components is essential in preventing some of the mechanical complications.

Neonatal extracorporeal life support: will the newest technology reduce morbidity?

The objectives of this review are to describe the Extracorporeal Life Support (ECLS) research at the Penn State Pediatric Cardiovascular Research evaluating new pediatric ECLS components and to discuss a proposed continuous quality improvement model after implementation of new technology. Review of current literature pertaining to studies at the Penn State Hershey Children's Hospital (PSHCH) is presented along with a retrospective chart review of ECLS pediatric patients from January 2000 to June 2010. We describe improvements in the newest hollow-fiber oxygenator demonstrating a lower pressure drop (compared with silicone), and in the newest RotaFlow centrifugal pump which allows higher hemodynamic energy delivered to the patient at higher flow rates with less retrograde flow. The miniaturized pediatric circuit implemented is portable and primes quickly for rapid deployment. Our model of continuous quality improvement includes in-depth evaluation of all circuit component performance through on-site in vivo and in vitro testing at the PSHCH. We utilize the same model to provide comprehensive education and hands-on training of the staff. This cycle can be repeated for evaluation and implementation of any new circuit component. Our comprehensive approach to ECLS may provide the ideal means from which to safely introduce new technology.

Pediatric extracorporeal life support systems: education and training at Penn State Hershey Children's Hospital.

The following is a description of the training offered to extracorporeal life support (ECLS)-trained staff at the Penn State Hershey Children's Hospital. Changes with the ECLS circuit prompted the need for an initiative to train staff in the care of patients requiring ECLS support. In addition to didactic material, we incorporated a "hands-on" approach in designing the education. During the didactic portion, the circuit was demonstrated as a wet lab. The final step offered a voluntary visit to the animal research facility utilizing clinical case scenarios which allowed participants to articulate and demonstrate proper circuit management.The effort throughout this process was to build a competent ECLS team which will ultimately provide our patients with the greatest chance for a full recovery.