54 C. Nemeh et al.: J Extra Corpor Technol 2026, 58, 51--56
Table 1. NewYork-Presbyterian Morgan Stanley Children’ s Hospital vs. ELSO mortality data.
Patient Cohort( 9 / 2017--12 / 2023) |
Adjusted mortality rate |
ELSO adjusted mortality rate |
Neonatal Patients |
46.70 % |
39.50 % |
Pediatric Patients |
47.40 % |
39.80 % |
Table 2. NewYork-Presbyterian Morgan Stanley Children’ s Hospital vs. ELSO neonatal and pediatric complication data. Complication detail
Unadjusted rate neonatal
ELSO unadjusted rate neonatal
Unadjusted rate pediatric
ELSO unadjusted rate pediatric
Any mechanical complication |
33.80 % |
31.50 % |
28.10 % |
26.40 % |
Oxygenator failure |
3.08 % |
5.26 % |
9.18 % |
5.13 % |
Raceway rupture |
0.00 % |
0.05 % |
0.00 % |
0.06 % |
Other tubing rupture |
0.00 % |
0.09 % |
0.00 % |
0.22 % |
Pump malfunction |
1.54 % |
0.70 % |
0.51 % |
0.67 % |
Heat exchanger malfunction |
0.00 % |
0.22 % |
0.00 % |
0.18 % |
Clots: hemofilter |
0.00 % |
2.68 % |
0.00 % |
2.05 % |
Clots: circuit component clots |
6.15 % |
12.00 % |
7.65 % |
8.00 % |
Air in circuit |
6.15 % |
2.74 % |
2.04 % |
2.97 % |
Cracks in pigtail connectors |
0.00 % |
0.08 % |
0.00 % |
0.13 % |
Cannula problems |
9.59 % |
10.20 % |
3.9 % |
8.59 % |
Circuit change |
6.15 % |
12.60 % |
8.16 % |
9.31 % |
Clots and air emboli |
1.54 % |
1.02 % |
0.51 % |
0.45 % |
Thrombosis / Clots: circuit component |
4.62 % |
11.10 % |
7.14 % |
8.09 % |
Any hemorrhagic complication |
26.20 % |
19.50 % |
25.50 % |
21.20 % |
Cannulation site bleeding |
10.80 % |
12.60 % |
11.70 % |
12.80 % |
Surgical site bleeding |
12.30 % |
7.32 % |
13.80 % |
8.08 % |
Hemolysis( PFH > 50 mg / dl) |
21.50 % |
15.30 % |
9.69 % |
11.00 % |
PFH = plasma free hemoglobin.
cannulations. Although our model uses perfusionists, a similar model could potentially be carried out with ECMO specialists.
Our mortality and complication rates are comparable to the ELSO rates. Our mortality rates are not adjusted for; however, a literature review of pediatric ECMO has mortality rates ranging from around 30 to 50 % which is comparable to our mortality rate [ 7, 8 ]. The mortality rates from 2013 to 2017 are 44.4 %, which is comparable to the mortality rates after implementation of the rounding model. The complications described in our institution and ELSO are not uniquely related to ECMO staffing models. The duration of ECMO with multiple patients cannulated significantly exceeds the duration of solo runs. This suggests our model is safe and effective for ECMO staffing and monitoring even with simultaneous ECMO runs. Monitoring by nurses is effective at other institutions; however, it is frequent that these ECMO specialists will require consultation with perfusionists when initiating cannulations and troubleshooting ECMO circuitry [ 4 ]. A perfusionist model provides experienced caregivers for ECMO monitoring; however, this must be leveraged with cost and availability [ 9 ]. The cost burden of a perfusion-led system may be more substantial than that of an ECMO specialist-led model with equivocal outcomes [ 4, 10 ]. Other centers have used ICU-run models in adults due to provider availability and cost reduction, with equivocal outcomes [ 11 ]. Institutions across the country utilize various ECMO staffing models, and the choice of one system over the other should be individualized at each institution [ 9 ]. While resource utilization and cost are important, optimizing patient care and outcomes is the top priority regardless of the staffing model [ 9 ].
ECMO education and simulations
Due to the complexity of ECMO, it requires frequent training and simulations for providers to remain proficient and quickly troubleshoot issues. Our ECMO program coordinator organizes simulation and didactic education days for ICU nurses. All nurses working on ECMO units must take the course and pass a multiple-choice exam to ensure that they understand and escalate high-risk scenarios when they occur. These didactics allow the nurses to be formally trained with an ECMO curriculum. In addition, we have multidisciplinary ECMO simulations to enhance teamwork and evaluate all cannulation processes for improvement. Several studies stress the importance of continuing education and ECMO simulations to improve patient safety and outcomes [ 2, 12, 13 ]. Simulations assemble all involved participants during cannulations, whether controlled or during ECPR. During simulations, a mock code is performed where the medical team begins CPR and activates the ECMO team. This allows the team to practice transitioning from CPR to ECPR. A CPR manikin is used with a plastic neck that can be cut down on in order to simulate a live cannulation. Debriefing after these sessions is crucial to assessing for improvements and system flaws that may not be readily apparent [ 14 ]. Even within our institution, debriefs following the ECPR simulations enhance collaboration and allocation of