Family Perceptions of Virtual Family-Centered Rounds in a Quaternary Cardiac Intensive Care Unit.

Background: Family-centered rounds (FCR) reduce the risk of psychological comorbidities of family members and improve the quality of communication between providers and families. Materials and methods: We conducted a pilot quality improvement study analyzing family perceptions of virtual FCR. Family members of previously admitted cardiac ICU patients who participated in at least one session of virtual FCR between April 2020 and June 2021 at Massachusetts General Hospital were surveyed post-ICU discharge. Results: During the study, 82 family members enrolled and participated in virtual FCR with 29 completing the post-admission telephone survey. Many cardiac ICU patients were male (n = 53), and a majority were discharged home (43%) with the patient's wives being the most common respondents to the questionnaire (n = 18). Across all questions in the survey, more than 75% of the respondents perceived the highest level of care in trust, communication, relationship, and compassion with their provider. Participants perceived the highest level of care in trust (96%), explanation (88%), as well as care and understanding (89%). Conclusions: Family members of cardiac ICU patients positively rated the quality of communication and perceived a high level of trust and communication between their providers on the virtual format.

Extracorporeal Cardiopulmonary Resuscitation: Outcomes and Complications at a Quaternary Referral Center.

OBJECTIVE: At a quaternary care center that regularly performs and cares for patients undergoing extracorporeal cardiopulmonary resuscitation (eCPR), a database of all adult patients who underwent eCPR with venoarterial extracorporeal membrane oxygenation (ECMO) over a 10-year period was reviewed. Seventy-one eCPR patients were analyzed to compare outcomes and complication rates. The authors hypothesized that evidence of end-organ injury, such as the need for continuous renal replacement therapy, in their institution's eCPR population would be associated with increased in-hospital mortality. DESIGN: Retrospective chart review of prospectively collected data at a quaternary care center. SETTING: Single quaternary academic referral center for ECMO. PARTICIPANTS: The study comprised adult patients who underwent venoarterial ECMO for eCPR from 2009-2019 and for whom demographic data, survival data, and complication rates were available. INTERVENTIONS: None-this was a retrospective chart review. MEASUREMENTS AND MAIN RESULTS: eCPR survival was 53.5% (38 of 71), and hospital survival was 33.8% (24 of 71). The most common complications were hemorrhage (26 of 67), renal failure (19 of 67), and neurologic injury (14 of 67). Of 19 patients requiring renal replacement therapy, only 1 survived to hospital discharge (5.3%) versus 23 of 48 patients without renal failure (47.9%) surviving to discharge (p = 0.001). CONCLUSIONS: In this cohort of 71 patients who underwent eCPR, outcomes were promising; however, complication rates were high, and renal failure in particular demonstrated an extremely high mortality. These are single-institution results that should be followed up with larger multicenter cohorts of eCPR patients.

Outcomes of Venoarterial Extracorporeal Membrane Oxygenation Patients Requiring Multiple Episodes of Support.

OBJECTIVES: This study describes the largest North American single-institution experience with adult patients requiring multiple extracorporeal membrane oxygenation (ECMO) runs in the same admission and aims to describe outcomes of survival and complication rates in this patient population. DESIGN: A retrospective chart review-based study in a single quaternary care center of venoarterial (VA) ECMO patients cannulated multiple times on ECMO support to assess for outcomes and survival (both of ECMO therapy and survival to discharge). SETTING: Single quaternary academic center for ECMO. PARTICIPANTS: All patients undergoing VA ECMO who were at least 18 years of age from 2011 to 2019, composed of a total of 14 patients requiring multiple cannulations. INTERVENTIONS: None, this was a retrospective chart review. MEASUREMENTS AND MAIN RESULTS: Of the 326 patients reviewed, 14 patients (4.3% of all patients in the database) had multiple ECMO therapies. The average patient age was 55.2 ± 10.99 years of age, and 57% were female; 4 of the 14 (28.6%) patients survived to hospital discharge. The top 2 indications for initial VA ECMO therapy were cardiogenic shock after myocardial infarction (35.7%) and after cardiotomy shock (35.7%). For repeated cannulation, the most common cause was hypoxia (64%, 9 patients), with 6 of these patients requiring a right ventricular assist device plus oxygenator. Other causes for repeated cannulation included post-cardiotomy shock (14%), recurrent ventricular tachycardia (14%), and cardiogenic shock (7%). All patients who required continuous venovenous hemofiltration during their first run of ECMO did not survive to discharge. CONCLUSIONS: Fourteen of 326 patients in the authors' VA ECMO database required additional ECMO therapy after decannulation; this represents at least 1 to 2 cases per year at higher-volume centers. Despite the small number of patients in this retrospective review, it seems that certain patients are reasonable candidates for additional ECMO therapy should their cardiopulmonary function again decline. The findings of renal replacement therapy and infection being more common during a second ECMO run are logical, but larger cohorts (ideally multicenter or from within the Extracorporeal Life Support Organization registry) are required to validate these preliminary findings.

A 266 Patient Experience of a Quaternary Care Referral Center for Extracorporeal Membrane Oxygenation with Assessment of Outcomes for Transferred Versus In-House Patients.

OBJECTIVE: Patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) require highly trained specialists and resources to be cared for safely. Interestingly, comparisons of outcomes for patients cannulated for VA-ECMO by outside institutions and transferred to referral centers for further care versus those cannulated and taken care of in house at the referral center have not been reported on a large scale. This study aimed to perform the first comparison of these 2 populations based on the experience of a single quaternary referral center. DESIGN: A retrospective chart review-based study in a single quaternary care center of patients cannulated by referring institutions for VA-ECMO then transferred versus patients who were cannulated in house was performed to assess for a difference in survival (both of ECMO therapy and survival to discharge). SETTING: Single quaternary academic referral center for ECMO. PARTICIPANTS: All patients undergoing VA-ECMO who were at least 18 years old from 2011-2018 (266 patients). INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The study comprised 215 patients cannulated for VA-ECMO in house and 51 patients cannulated by 17 different outside institutions then transferred. Survival of the ECMO run for in-house patients (122/215) was 56.7% (95% confidence interval [CI] 50.1-63.3), and survival of transferred patients (31/51) for the ECMO run was 60.8% (95% CI 47.4-74.2; p = 0.58). Survival to discharge in patients cannulated in house (82/215) was 38.1% (95% CI 31.6-44.6) and for outside hospital transfers (24/51 patients) was 47.1% (95% CI 33.4-60.8; p = 0.23). CONCLUSIONS: This retrospective chart review of 266 patients found no difference in survival of the ECMO therapy or survival to discharge in patients cannulated by other institutions and transferred versus those who were cannulated in house. Even though analysis on the feasibility of transfer centers has been performed extensively in patients with respiratory failure requiring venovenous ECMO, minimal investigation has been performed in patients requiring VA-ECMO. These results should be considered hypothesis-generating because larger sample sizes are necessary to guide care of these patients more definitively.

Extracorporeal Membrane Oxygenation Is a Team Sport: Institutional Survival Benefits of a Formalized ECMO Team.

OBJECTIVES: At the authors' institution, prior to 2014, patients requiring care in the peri-extracorporeal membrane oxygenation (ECMO) period were treated by intensivists with specific training in ECMO but worked independently. This isolated form of care was addressed in late 2013 with the formal initiation of an ECMO team. The authors wanted to assess the difference in overall mortality for ECMO patients cared for prior to the initiation of a multidisciplinary team compared to after its establishment. DESIGN: This was a retrospective chart review-based study. SETTING: This was a single-center university-based hospital setting. PARTICIPANTS: The study included all adult patients at the authors' institution who required ECMO support between the years 2009 and 2017. INTERVENTIONS: The new multidisciplinary ECMO team established a set of protocols and guidelines to care for ECMO patients. The formal ECMO team consisted of cardiac surgery, cardiac anesthesia, intensivists, cardiology heart failure specialist, intensive care unit nursing (NP/RN), perfusion services, respiratory therapy, nutrition, physical and occupational therapy, and an ethics committee member. MEASUREMENTS AND MAIN RESULTS: Manual chart review was conducted and survival to discharge was collected and separated into 2 groups, 2009 to 2013 (pre-ECMO team) and 2014 to 2017 (post-ECMO team). In a total of 279 charts reviewed, patients required ECMO support. Survival to discharge for patients between 2009 and 2013 was 37.7% compared to a survival to discharge of 52.3% between 2014 and 2017 (p value = 0.02). CONCLUSIONS: Patients cared for after the initiation of an ECMO team showed improved survival compared to patients cared for prior to the creation of the ECMO team.