Document Type

Presentation

Publication Date

4-2022

Keywords

texas; covenant; covid-19

Abstract

Background: COVID-19 extracorporeal membrane oxygenation (ECMO) specific treatment guidelines were released by the National Institute for Health and the World Health Organization in 2020 for adults with acute respiratory distress syndrome (ARDS). With 42% of COVID‐19 infected patients developing ARDS pneumonia, medical centers increased ECMO treatment capacity to meet pandemic-related demand. The rising treatment demands in adult populations led organizations to implement strategies to increase ECMO treatment availability in adult intensive care units.

Purpose: The purpose of this project was to deploy an evidence-based adult ECMO program in a surgical intensive care unit (SICU) by March 2020.

Methods/Approach: This evidence-based quality improvement project used the 2017 International Extracorporeal Life Support Organization (ELSO) clinical practice guideline to implement an adult ECMO program in an urban hospital in the southwest United States during the pandemic. A logic model guided project design, planning, strategy development, monitoring, and evaluation. SICU was selected for adult ECMO treatments. A multidisciplinary team used ELSO guideline recommendations to develop institutional policies and practices. An ECMO-trained physician-led seventeen experienced PICU and SICU nurses who attended a 35-hour course with didactic and hands-on skills. ECMO therapy initiation and discontinuation criteria were instituted. A pre-ECMO checklist was developed to drive team communication and equipment readiness. Ongoing training was established to maintain caregiver competencies and proficiency based on low volume and high-risk ideology. An adapted Collaboration and Satisfaction About Care Decisions in Teams (CSACD‐T) questionnaire was used to measure perceptions of collaboration and satisfaction with decision-making before and six months after program implementation. Descriptive and inferential statistics were calculated using SPSS Version 27.

Results: Twenty-nine healthcare team members completed the pretest and 24 completed the posttest with the majority of team members being ECMO specialists. A total score for collaboration (min=7 max=49) and satisfaction (min=2 max=14) was calculated. There was a statistically significant, strong positive correlation before intervention between satisfaction and collaboration among the ECMO team members rs (27) = .794, p<.001. After the intervention, there was a statistically significant, strong positive correlation between satisfaction and collaboration among the ECMO team members rs (22) = .897, p<.001. Collaboration scores were not statistically significantly different between pretest (Mdn = 42) and posttest (Mdn = 42), U = 361, p = .816. Satisfaction scores were not statistically significantly different between pretest (Mdn = 12) and posttest (Mdn = 12), U = 372, p = .666.

Conclusion: While survey results were not statistically significant, minimal positive changes were seen on the post-implementation survey. Most of these improvements were seen between “agree” and “mostly agree” answer choices. Notably, only two adult ECMO patients were cared for during the 6-months after implementation. Measuring collaboration and satisfaction in decision-making using the CSACD-T survey at set time intervals may guide continued improvement efforts.

Implications for practice: Establishment of adult ECMO programs allow organizations to keep 100% of adult ECMO patients within the organization versus transferring to another hospital with treatment capabilities. Developing a successful ECMO program based on current evidence and recommendations facilitates reliable care delivery and program sustainability.

Department

Infectious Diseases

Department

Nursing

Comments

References

Aaberg, O. R., Hall-Lord, M. L., Husebø, S. I. E., & Ballangrud, R. (2019). Collaboration and satisfaction about care decisions in team questionnaire-Psychometric testing of the Norwegian version, and hospital healthcare personnel perceptions across hospital units. Nursing Open, 6(2), 642-650. doi:10.1002/nop2.251

Assy, J., Skouri, H., Charafeddine, L., Majdalani, M., Younes, K., Bulbul, Z., Sfeir, R., Bourgi, J., Hallal, A., Rifai, K., Zaatari, R., & El Rassi, I. (2019). Establishing an ECMO program in a developing country: Challenges and lessons learned. Perfusion, 34(6), 508-515. https://doi.org/10.1177/0267659119834489

Baggs, J.G. (1994). Development of an instrument to measure collaboration and satisfaction about care decisions. Journal of Advanced Nursing, 20(1), 176-182. doi: 10.1046/j.1365-2648.1994.20010176.x

Dalia, A. A., Ortoleva, J., Fiedler, A., Villavicencio, M., Shelton, K., & Cudemus, G. D. (2019). Extracorporeal membrane oxygenation is a team sport: Institutional survival benefits of a formalized ECMO team. Journal Cardiothoracic and Vascular Anesthesia, 33(4), 902-907. doi:10.1053/j.jvca.2018.06.003

Extracorporeal Life Support Organization. (2020). Award of excellence. Retrieved from https://www.elso.org/AwardofExcellence/AwardofExcellence.aspx

Extracorporeal Life Support Organization. (2017). ELSO guidelines for ECMO centers. Retrieved from https://www.elso.org/Resources/Guidelines.aspx

Extracorporeal Life Support Organization. (2021). Quality reporting platform. https://www.elso.org/Registry/QualityReportingPlatform.aspx

Guglin, M., Zucker, M. J., Bazan, V. M., Bozkurt, B.,El Banayosy, A., Estep, J. D., Gurley, J., Nelson, K., Malyala, M., Panjrath, G., Zwischenberger, J., & Pinney, S. P. (2019). Venoarterial ECMO for adults: JACC scientific expert panel. Journal of the American College of Cardiology, 73(6), 698-716. https://doi.org/10.1016/j.jacc.2018.11.038

Komindr, A., Abe, R., Tateishi, Y., Takahashi, Y., Goto, J., Wada, K., . . . Oda, S. (2019). Establishing extracorporeal membrane oxygenation team increased number of patients and improved data recording. Journal of Intensive Care, 7, 1-8. doi:10.1186/s40560-019-0366-4

Na, S. J., Chung, C. R., Choi, H. J., Cho, Y. H., Sung, K., Yang, J. H., Suh, G.Y., & Jeon, K. (2018). The effect of multidisciplinary extracorporeal membrane oxygenation team on clinical outcomes in patients with severe acute respiratory failure. Annals of Intensive Care, 8(1). doi:10.1186/s13613-018-0375-9

McCallister, D., Pilon, L., Forrester, J., Alsaleem, S., Kotaru, C., Hanna, J., Hickey, G., Roberts, R., Douglas, E., Libby, M., & Firstenberg, M. (2019). Clinical and administrative steps to the ECMO program development. Advances in Extracorporeal Membrane Oxygenation, 8(3).

Ramanathan, K., Antognini, D., Combes, A., Paden, M., Zakhary, B., Ogino, M., . . . Shekar, K. (2020). Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. The Lancet Respiratory Medicine. https://doi.org/10.1016/S2213-2600(20)30121-1

W.K. Kellogg Foundation. (1998/2004). Logic Model development guide. https://www.wkkf.org/resource-directory/resources/2004/01/logic-model-development-guide

World Health Organization. (2020). Clinical management of severe acute respiratory infection when novel coronavirus (‎‎‎nCoV)‎‎‎ infection is suspected: Interim guidance. Retrieved from Geneva: https://apps.who.int/iris/handle/10665/330854

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