Key Considerations in Establishing a Pediatric Rescue Extracorporeal Life Support Program: A Multi Methods Review.

Abstract

Extracorporeal life support (ECLS) is generally limited to centers with cardiac surgery. However, pediatric centers without cardiac surgery can still provide potentially lifesaving ECLS through a Rescue Program, allowing a local team to cannulate and stabilize patients before they are transported to a center with cardiac surgery support for ongoing care. This multimethod study provides an exploration of pediatric ECLS team insights regarding program implementation and offers recommendations for other centers wishing to develop a similar program. We performed surveys and semi-structured interviews to gather perspectives from ECLS team members. Demographics and preliminary perspectives were obtained from surveys. Interviews were transcribed and coded using thematic analysis to identify key considerations, facilitators, and barriers related to rescue program implementation. Our multidisciplinary ECLS team perceived great value in the rescue program and identified elements critical to successful program development and implementation, including barriers that might exist for any center wishing to set up a similar program. Participants emphasized that the initial design and continued maintenance of any Rescue ECLS Program be a comprehensive, multidisciplinary initiative. Clear communication, a mechanism for debriefing and feedback, and a strategy allowing for flexible program evolution are essential.