96 R . K . H . Shappley et al .: J Extra Corpor Technol 2024 , 56 , 94 – 100
Figure 1 . Summary of STEP follow-up .
inconsistent translation services for obtaining consent and program explanation . Patients with delayed follow-up ( n = 10 ) during the COVID-19 pandemic due to hospital logistics and restrictions were excluded from the outpatient analysis . The database included patient demographics , basic ECMO characteristics , information about inpatient neuroimaging and neurology evaluation ; audiology , speech and language pathology ( S . L . P .), physical therapy ( P . T .), and occupational therapy ( O . T .) inpatient and outpatient referrals ; and neurodevelopmental testing and referrals .
Patients were referred to a single pediatric intensivist ( R . S .) upon cannulation via automatic ECMO alert . The STEP intensivist reviewed the chart , educated the family on the long-term impacts of ECMO , and coordinated care with consulting specialists and therapists as the patient neared discharge . STEP established an outpatient neurodevelopmental follow-up schedule for age groups and defined time-appropriate testing ( Table 1 ). After family education , the STEP intensivist placed a consultation note in the electronic medical record , and the primary care physician received a letter with long-term care recommendations . Caregivers received an abbreviated version of these recommendations and / or a STEP brochure .
We estimated follow-up compliance of 55 % before and an expected 90 % compliance after STEP implementation . Considering an alpha of 0.05 and a power of 80 %, the calculated sample size for each group of ECMO survivors pre and postintervention was 24 patients . Demographic data and information regarding evaluations and referrals before and after STEP implementation were described using medians and interquartile ranges ( IQR ) for continuous variables and frequencies and percentages for categorical variables . To ascertain differences
before and after STEP implementation , chi-square and Fisher exact tests were used for binomial data , and the Mann-Whitney test was used for continuous data . p-values were 2-sided , and p < 0.05 was considered statistically significant . Statistical analyses were performed using S . A . S . ( version 9.4 , S . A . S . Institute Inc ., NC , U . S . A .).
Results
A total of 186 neonates and children needed ECMO between January 2011 and April 2020 , with 90 ( 48.3 %) surviving ECMO decannulation . Of those , seven patients were excluded due to death between ECMO decannulation and hospital discharge ( n = 3 ), due to transfer to another facility after ECMO support ( n = 2 ), and non-English speaking families ( n = 2 ). Of the remaining 83 ECMO survivors , 36 ( 43.4 %) were before and 47 ( 56.6 %) after the implementation of STEP . Six of these 47 ECMO survivors were excluded after STEP implementation due to a lack of in-hospital STEP consultation . Thus , the study included 77 ECMO survivors ( 36 before and 41 after STEP implementation ) to hospital discharge ( Fig . 1 ). The median age at ECMO cannulation was one month ( IQR , 0.1 – 21.5 ), with 49.4 % of patients being neonates and 49.4 % male . Most patients were African American ( 58.4 %), reflecting the city ’ s demographics [ 18 ].
Respiratory support as an indication for ECMO and venoarterial ( V . A .) ECMO cannulation modes were the most prevalent in the cohort ( 75.3 % and 62.3 %, respectively ). The median ECMO duration was seven days ( IQR , 3 – 10 ), and the median length of hospital stay after decannulation was 34.5 days