Original Article

Standardized therapies after ECMO program (STEP); a novel approach to pediatric post-ECMO care

¹ Department of Pediatrics, Division of Critical Care, University of Tennessee Health Science Center, Memphis, TN 38103, USA
² Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
³ Department of Pediatrics, Division of Neurology, University of Tennessee Health Science Center, Memphis, TN 38103, USA
⁴ Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA
⁵ University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38103, USA
⁶ Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
⁷ Department of Pediatrics, Division of Development Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA
⁸ Baylor College of Medicine, Houston, TX 77030, USA

^* Corresponding author: hsandhu@uthsc.edu

Received: 5 March 2024
Accepted: 13 May 2024

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.