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Figure 1. Graphical description of our novel ECMO staffing model.( Created in BioRender. Cain, C.( 2024) BioRender. com / s22z994).
scenarios
, simulations conducted by chief perfusionists, and a multiple-choice quiz based on the Extracorporeal Life Support Organization( ELSO) red book, 6th edition. A score of 80 % or higher is required to pass the course.
To determine the safety and efficacy of our model, we compared the mortality and complication rates of our institution with ELSO rates. The total number of ECMO hours was calculated to quantify the total time cannulated during the study period. Simultaneous ECMO run hours were also calculated to stratify how frequently one perfusionist needed to monitor more than one ECMO patient.
Results
From 2017 to 2023, 289 cannulations were performed, comprising 62,742 cumulative ECMO hours. Simultaneous ECMO runs were evaluated, and the hours were calculated( Figure 2), of which 92 % of the total time was spent with simultaneous ECMO runs. Our mortality and complication rates are compared to the ELSO national rates as shown in Tables 1 and 2. Mortality rate from 2013 to 2017, prior to the institution of the model, was 44.4 %, which is comparable to after the staffing model was implemented.
Discussion
Our model was implemented since 2017. Other centers typically use bedside ECMO specialists or perfusionists for each cannulated patient. We have one pediatric perfusionist who can monitor multiple cannulated patients simultaneously. We always have three perfusionists on-call to cover ECMO activities and operating room needs. One perfusionist is responsible
Figure 2. Hours of simultaneous ECMO runs.
for monitoring ECMO patients. A second perfusionist assists in any additional ECMO initiations, including ECPR, transports, and circuit exchanges, so we have a level of redundancy for patients already on support. The rounding ECMO perfusionist rounds every hour so they can review patients’ labs / notes and take meal breaks in between rounds. Our ECMO staffing model utilizes perfusionists who conduct hourly rounds; however, institutions considering a similar approach should carefully evaluate their workforce capacity and staffing resources to ensure feasibility and sustainability. Protocols and safety measures implemented at our institution make this model effective, including modern technology, ECMO education and simulations, and an ECMO program coordinator. Our coordinator is a nurse practitioner who serves as a liaison between the ECMO team and the ICU teams. We also conduct biweekly ECMO team meetings and debriefing sessions after