Best Practice Guidelines for Initiation of ECMO
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Background: The number of pediatric and neonatal patients that are utilizing Extracorporeal Membrane Oxygenation (ECMO) has increased over the past few decades. ECMO can be used for patients that have cardiac or non-cardiac illness. It is crucial to avoid extracorporeal cardiac pulmonary resuscitation (ECPR) if possible. Furthermore, it is important that there is appropriate candidate selection that identifies a patient prior to cardiac arrest, as well as identify patients that will have positive neurologic outcomes.|Purpose: The purpose of this project was to determine the best time to consider ECMO in the neonatal or pediatric population.|Methods: A retrospective analysis was conducted among all patients that were placed on ECMO at a Midwestern Hospital in 2020. Biomarkers that were analyzed included pH, lactate, base deficit or excess, VIS and OI scores. The specific variables were analyzed in four-hour increments, starting 72 hours prior to the initiation of ECMO.|Results: The data found that certain biomarkers such as pH, lactate, base deficit or excess may be helpful in identifying ECMO candidates. Implications for Practice: This quality improvement project found that there are certain biomarkers that may useful in developing a tool that may help identify ECMO candidates. This tool would utilize a specific numeric criterion that could be built into the EMR and alert a provider.
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