Negative pressure therapy for ECMO cannula stabilization.

Cannula stabilization for extracorporeal membrane oxygenation (ECMO) is important for patient mobilization and rehabilitation. Limitations to mobilization on ECMO include staff discomfort and cannula instability. We utilized the technique of negative pressure therapy for ECMO cannula stabilization to improve mobilization. Negative pressure therapy for ECMO cannula stabilization can be utilized safely for a variety of cannulation sites in any patient age from newborns to adults. This wound management strategy may facilitate patient mobilization and rehabilitation therapies in addition to extending cannula site duration.

Reduced Intracranial Hemorrhage with Anticoagulation Guideline Implementation.

Hemorrhagic and thrombotic complications, including intracranial hemorrhage, embolic stroke, surgical bleeding, and circuit thrombosis, are common during extracorporeal membrane oxygenation (ECMO), occurring in up to 50% of patients. These complications have a significant impact on morbidity and mortality. Our objective was to implement standardized ECMO anticoagulation guidelines for the pediatric cardiothoracic intensive care unit (CTICU) to reduce the incidence of intracranial hemorrhage while on ECMO. All CTICU patients who received ECMO from January 2016 to December 2020 were retrospectively reviewed. Standardized ECMO anticoagulation guidelines were implemented in the fourth quarter of 2017. Variables and clinical outcomes before and after guideline implementation were compared. From January 2016 to December 2017, there were 22 separate ECMO runs. Eight of 22 (36%) suffered intracranial hemorrhage while on ECMO. Seven of 8 (88%) were withdrawn from ECMO secondary to bleed and expired prior to hospital discharge. From January 2018 to December 2020, there were 22 separate ECMO runs in the CTICU. Three of 22 (14%) suffered intracranial hemorrhage while on ECMO. One of 3 (33%) expired prior to hospital discharge. Implementation of standardized ECMO anticoagulation guidelines in the CTICU was successful in improving clinical outcomes as evidenced by reduction in the incidence of intracranial hemorrhage in this high-risk patient population.

Paving a Road Home: Developing Education for a Pediatric Home-Going VAD Program.

The objective was to create a multidisciplinary education plan for discharge home following implantation of a ventricular assist device (VAD) in pediatrics. Educational program was developed for the local community: emergency department, emergency medical services, medical transport team, as well as, the pediatric patient and their caregivers. Education geared to the individual learner included both lecture and hands-on training. A direct line for family and local providers to speak directly with a VAD-trained physician 24/7 was also created. Patient and caregivers required to 1) perform 10 supervised power exchanges; 2) qualify written quizzes on the controller, battery charger, alarms, and troubleshooting; 3) perform 10 supervised dressing changes; 4) pass simulation session responding correctly to alarm scenarios; and 5) take both an on-campus and off-campus field trip unaccompanied by support staff. Once the education plan is complete and the patient is medically stable, they are considered ready for discharge. From a mechanical support perspective, discharge home of a medically complex pediatric patient on a durable VAD can be accomplished safely, even in a low volume center, with attention to detail, creation of a robust education plan, and close partnership between the VAD team, the family, and the community.