Department of Pediatrics, Division of Critical Care, University of Tennessee Health Science Center, Memphis, TN 38103, USA - Le Bonheur Children's Hospital, Memphis, TN 38103, USA.
Department of Pediatrics, Division of Neurology, University of Tennessee Health Science Center, Memphis, TN 38103, USA - Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103, USA.
J Extra Corpor Technol. 2024 Sep;56(3):94-100. doi: 10.1051/ject/2024009. Epub 2024 Sep 20.
The study objective was to characterize compliance with Standardized Therapy after ECMO Program (STEP), an intentional discharge pathway for extracorporeal membrane oxygenation (ECMO) survivors in a US pediatric hospital.
The program identified pediatric ECMO survivors before discharge, appropriate consultations were reviewed and requested, families were educated on ECMO sequelae, and ECMO summaries were sent to pediatricians. Compliance with institutional post-ECMO guidelines was evaluated before and after STEP implementation.
We identified 77 ECMO survivors to hospital discharge (36 [46.8%] before and 41 [53.2%] after STEP implementation). There was a significant increase in complete (38.8% vs. 74.2%, p < 0.001) and time-appropriate neurodevelopmental testing (71.4% vs. 95.6%, p = 0.03). 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), and in referrals for outpatient audiology (66.6 vs. 95.1%, p = 0.002), physical therapy (P.T.) (63.8% vs. 95.1%, p = 0.001), occupational therapy (O.T.) (63.8% vs. 95.1%, p = 0.001) and speech-language pathology (S.L.P.) (55.5% vs. 95.1%, p < 0.001) were noted.
Implementing an intentional discharge pathway for pediatric ECMO survivors (STEP) successfully increases inpatient and outpatient compliance with hospital and Extracorporeal life support organization (ELSO) follow-up guidelines. It leads to timely and complete neurodevelopmental evaluation.
本研究旨在描述美国一家儿科医院体外膜肺氧合（ECMO）幸存者出院计划（STEP）的标准化治疗依从性，该计划是 ECMO 幸存者的一种有意出院途径。
该计划在患者出院前确定儿科 ECMO 幸存者，审查并要求适当的会诊，对患者家属进行 ECMO 后遗症教育，并将 ECMO 总结发送给儿科医生。在 STEP 实施前后，评估机构 ECMO 后指南的依从性。
我们确定了 77 名 ECMO 幸存者出院（STEP 实施前 36 名，实施后 41 名）。完全（38.8% vs. 74.2%，p<0.001）和适时神经发育测试（71.4% vs. 95.6%，p=0.03）的依从性显著增加。神经病学（52.7% vs. 75.6%，p=0.03）和听力学（66.7% vs. 87.8%，p=0.02）的住院评估以及听力学（66.6% vs. 95.1%，p=0.002）、物理治疗（P.T.）（63.8% vs. 95.1%，p=0.001）、职业治疗（O.T.）（63.8% vs. 95.1%，p=0.001）和言语治疗（S.L.P.）（55.5% vs. 95.1%，p<0.001）的转介显著增加。
为儿科 ECMO 幸存者实施有意出院途径（STEP）可成功提高住院和门诊依从性，符合医院和体外生命支持组织（ELSO）的随访指南。它可以及时和全面的进行神经发育评估。
