The Journal of ExtraCorporeal Technology No 56-3 | Page 22

R . K . H . Shappley et al .: J Extra Corpor Technol 2024 , 56 , 94 – 100 97
Table 2 . Demographic characteristics .
Total cohort ( n = 77 ) 2011 – 2020
Before STEP ( n = 36 ) 2011 – 2016
After STEP ( n = 41 ) 2017 – 2020
Age ( months )
1 ( IQR , 0.1 – 21.5 )
0.25 ( IQR , 0.06 – 8.75 )
2 ( IQR , 0.11 – 26 )
0.11
Age group
0.01
Neonates (< 30 days )
38 ( 49.4 %)
23 ( 63.9 %)
15 ( 36.6 %)
— Pediatric ( 30 days )
39 ( 50.6 %)
13 ( 36.1 %)
26 ( 63.4 %)
Race
0.6
— Caucasian
22 ( 28.6 %)
12 ( 33.3 %)
10 ( 24.4 %)
— African American
45 ( 58.4 %)
19 ( 52.7 %)
26 ( 63.4 %)
— Other
10 ( 13 %)
5 ( 14 %)
5 ( 12.2 %)
Gender
0.2
— Male
38 ( 49.4 %)
15 ( 41.7 %)
23 ( 56 %)
— Female
39 ( 50.6 %)
21 ( 58.3 %)
18 ( 44 %)
ECMO type
0.002
— VA
48 ( 62.3 %)
16 ( 44.4 %)
32 ( 78 %)
— VV
29 ( 37.7 %)
20 ( 55.6 %)
9 ( 22 %)
Type of support
0.34
— Pulmonary
58 ( 75.3 %)
25 ( 69.4 %)
33 ( 80.5 %)
— Cardiac
14 ( 18.2 %)
9 ( 25 %)
5 ( 12.2 %)
— ECPR
5 ( 6.5 %)
2 ( 5.6 %)
3 ( 7.3 %)
ECMO duration ( days )
7 ( IQR , 3 – 10 )
6 ( IQR , 3 – 10 )
7 ( IQR , 3.5 – 11 )
0.36
LOS since decannulation ( days )
34.5 ( IQR , 23.7 – 71.5 )
30 ( IQR , 21.5 – 60.75 )
42 ( IQR , 27.2 – 82.7 )
0.13
p-value
* ECMO : extracorporeal membrane oxygenation , ECPR : extracardiac pulmonary resuscitation , IQR : interquartile range , LOS : length of stay , STEP : Standardizing Therapies after ECMO Program , VA : veno-arterial , VV : veno-venous .
Table 3 . Evaluations and referrals at discharge .
Total cohort ( n = 77 ) 2011 – 2020
Before STEP ( n = 36 ) 2011 – 2016
After STEP ( n = 41 ) 2017 – 2020 p-value
Inpatient evaluations Neurology
41 ( 53.2 %)
19 ( 52.7 %)
31 ( 75.6 %)
0.03
Neuro Imaging
63 ( 81.8 %)
31 ( 86.1 %)
32 ( 78 %)
0.36
Audiology
60 ( 77.9 %)
24 ( 66.7 %)
36 ( 87.8 %)
0.02
Physical therapy
69 ( 89.6 %)
30 ( 83.3 %)
39 ( 95.1 %)
0.13
Occupational therapy
66 ( 85.7 %)
30 ( 83.3 %)
36 ( 87.8 %)
0.74
Speech therapy
66 ( 85.7 %)
29 ( 80.5 %)
37 ( 90 %)
0.32
Referrals placed at discharge Audiology
63 ( 81.8 %)
24 ( 66.6 %)
39 ( 95.1 %)
0.002
Physical therapy
62 ( 80.5 %)
23 ( 63.8 %)
39 ( 95.1 %)
0.001
Occupational therapy
62 ( 80.5 %)
23 ( 63.8 %)
39 ( 95.1 %)
0.001
Speech therapy
59 ( 76.6 %)
20 ( 55.5 %)
39 ( 95.1 %)
< 0.001
( IQR , 23.7 – 71.5 ). No significant differences were observed in baseline characteristics between patients before and after STEP implementation , except for more non-neonatal pediatric patients ( 36.1 % vs . 63.4 %, p = 0.01 ) and more frequent veno-arterial cannulation ( 44.4 % vs . 78 %, p = 0.002 ) after STEP implementation ( Table 2 ).
We found a significant increase in inpatient evaluations by neurology ( 52.7 % vs . 75.6 %, p = 0.03 ) and audiology ( 66.7 % vs . 87.8 %, p = 0.02 ). Patients discharged after STEP implementation had significantly more referrals for audiology ( 66.6 vs . 95.1 %, p = 0.002 ), P . T . ( 63.8 % vs . 95.1 %, p = 0.001 ), O . T . ( 63.8 % vs . 95.1 %, p = 0.001 ) and S . L . P . ( 55.5 % vs . 95.1 %, p < 0.001 )( Table 3 ).
There was a significant increase in the completion of neurodevelopmental testing ( 38.8 % vs . 74.2 %, p < 0.001 ) and in time-appropriate completion ( 71.4 % vs . 95.6 %, p = 0.03 ) after
STEP implementation . Neuropsychological referrals included neurodevelopmental clinics , state early intervention programs , and neonatal infant follow-up programs . We identified deficits in 24 of 37 patients ( 64.8 %) who completed neurodevelopmental testing , with no difference before vs . after STEP implementation ( 64.2 % vs . 65.2 %) ( Table 4 ). Deficits were grouped as global developmental delay ( 70.8 %), attention-deficit / hyperactivity disorder ( ADHD ) ( 12.5 %), language disorder ( 8.3 %), mild intellectual disability ( 4.2 %), and learning difficulty ( 4.2 %).
Discussion
Our study is the first to describe the feasibility and effectiveness of an intentional discharge pathway for ECMO survivors