Fagan Andrew, Grunau Brian, Caddell Andrew, Gould James, Rayner-Hartley Erin, Lamarche Yoan, Singh Gurmeet, Nagpal Dave, Slessarev Marat
Division of Critical Care Medicine, Western University, London, Ontario, Canada.
Department of Emergency Medicine and the Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
CJC Open. 2022 Feb 15;4(6):520-531. doi: 10.1016/j.cjco.2022.02.005. eCollection 2022 Jun.
Extracorporeal life support (ECLS) is associated with high morbidity and mortality. Complications and mortality are higher at lower-volume centres. Most Canadian ECLS institutions are low-volume centres. Protocols offer one way to share best practices among institutions to improve outcomes. Whether Canadian centres have ECLS protocols, and whether these protocols are comprehensive and homogenous across centres, is unknown.
Purposeful sampling with mixed methods was used. A Delphi panel defined key elements relevant to the ECLS process. Documentation used in the delivery of ECLS services was requested from programs. Institutional protocols were assessed using deductive coding to determine the presence of key elements.
A total of 37 key elements spanning 5 domains (referral, initiation, maintenance, termination, and administration) were identified. Documentation from 13 institutions across 10 provinces was obtained. Institutions with heart or lung transplantation programs had more-complete documentation than did non-transplantation programs. Only 5 key elements were present in at least 50% of protocols (anticoagulation strategy, ventilation strategy, defined referral process, selection criteria, weaning process), and variation was seen in how institutions approached each of these elements.
The completeness of ECLS protocols varies across Canada. Programs describe variable approaches to key elements. This variability might represent a lack of evidence or consensus in these areas and creates the opportunity for collaboration among institutions to share protocols and best practice. The key-element framework provides a common language that programs can use to develop ECLS programs, initiate quality-improvement projects, and identify research agendas.
体外生命支持（ECLS）与高发病率和死亡率相关。在低容量中心，并发症和死亡率更高。加拿大大多数ECLS机构都是低容量中心。协议是机构间分享最佳实践以改善结果的一种方式。加拿大各中心是否有ECLS协议，以及这些协议在各中心是否全面且统一，尚不清楚。
采用有目的抽样的混合方法。一个德尔菲小组确定了与ECLS过程相关的关键要素。要求各项目提供ECLS服务提供过程中使用的文件。使用演绎编码对机构协议进行评估，以确定关键要素的存在情况。
共确定了跨越5个领域（转诊、启动、维持、终止和管理）的37个关键要素。获得了来自10个省份13家机构的文件。有心脏或肺移植项目的机构比没有移植项目的机构有更完整的文件。至少50%的协议中仅存在5个关键要素（抗凝策略、通气策略、明确的转诊流程、选择标准、撤机流程），并且各机构在处理这些要素的方式上存在差异。
加拿大各地ECLS协议的完整性各不相同。各项目对关键要素的处理方式各不相同。这种差异可能代表这些领域缺乏证据或共识，并为机构间合作分享协议和最佳实践创造了机会。关键要素框架提供了一种通用语言，各项目可用于制定ECLS项目、启动质量改进项目和确定研究议程。
