title: Outcomes before and after implementation of a pediatric rapid-response extracorporeal membrane oxygenation program.
abstract: BACKGROUND
  Rapid-response extracorporeal membrane oxygenation (RR-ECMO) has been implemented at select centers to expedite cannulation for patients placed on ECMO during extracorporeal cardiopulmonary resuscitation (ECPR). In 2008, we established such a program and used it for all pediatric venoarterial ECMO initiations. This study was designed to compare outcomes before and after program implementation.
  
  
  METHODS
  Between 2003 and 2011, 144 pediatric patients were placed on venoarterial ECMO. Records of patients placed on ECMO before (17 ECPR and 62 non-ECPR) or after (14 ECPR and 51 non-ECPR) RR-ECMO program implementation were retrospectively compared.
  
  
  RESULTS
  The peak performance of the ECMO team was assessed by measuring ECMO initiation times for the ECPR patient subgroup (n = 31). There was a shift toward more ECPR initiations achieved in less than 40 minutes (24% pre-RR-ECMO versus 43% RR-ECMO; p = 0.25) and fewer requiring more than 60 minutes (47% pre-RR-ECMO versus 21% RR-ECMO; p = 0.14) after program implementation, although these changes did not reach statistical significance. After multivariable risk adjustment, RR-ECMO was associated with a 52% reduction in neurologic complications for all patients (adjusted odds ratio, 0.48; 95% confidence interval, 0.23 to 0.98; p = 0.04), but the risk of in-hospital death remained unchanged (adjusted odds ratio, 0.99; 95% confidence interval, 0.50 to 1.99; p = 0.99).
  
  
  CONCLUSIONS
  Implementation of a pediatric RR-ECMO program for venoarterial ECMO initiation was associated with reduced neurologic complications but not improved survival during the first 3 years of program implementation. These data suggest that development of a coordinated system for rapid ECMO deployment may benefit both ECPR and non-ECPR patients, but further efforts are required to improve survival.
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, University of Iowa Children's Hospital, Iowa City, Iowa, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Turek
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Andersen
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lawson
authors.forename: Desiree
authors.initials: D
authors.lastname: Bonadonna
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Peters
authors.forename: James
authors.initials: J
authors.lastname: Jaggers
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lodge
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006284:Health Plan Implementation / Q000458:organization & administration; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends*; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States