UC Davis Medical Center's Extracorporeal Life Support (ECLS) program, encompassing neonatal, pediatric, and adult care, transitioned from the Jostra Rotaflow/Quadrox combination the Cardiohelp system in 2019 for adults and in 2020 for neonatal and pediatric patients. As part of this shift, we recognized the necessity to modify our previously uniform circuit design to better serve our smaller patients. The primary objectives of the disposable circuit redesign were to reduce complications related to cannula clotting, mitigate the risk of cranial hemorrhages linked to swift CO2 decreases at the start of the procedure, lower the usage of Continuous Renal Replacement Therapy (CRRT) in patients with non-renal disease experiencing fluid overload, and minimize platelet consumption. To evaluate the effectiveness of these changes, we performed a comparison of our patients weighing less than 15kg from 2018 and 2019 (23 ECLS Runs), who were treated with the old system, against those treated from 2020 onwards (53 ECLS) with the custom Cardiohelp circuits. Results reflect a 23% decrease in circuit changes between the old system and the new system despite the increased number of runs. With the switch to the new system, we noted an increase in clotted cannulas to 8 incidences. This prompted a redesign of the shunt, change in practice of moving flow probes, and a tiered heparin bolus system. With that implementation there has been 1 clotted cannula.

Extracorporeal Life Support (ECLS) patients have traditionally been excluded from early mobility interventions due to sedation requirements and safety concerns. However, recent evidence suggests that implementing early mobility interventions in ECLS patients is safe and can lead to improved patient outcomes and reduced length of stay. An interprofessional UC Davis Medical Center team investigated early mobility interventions in ECLS patients. One innovative intervention was the VitalGo Total Lift Bed (VGTLB), capable of an 82o upright tilt angle. With scant literature evidence supporting its use, a 5-patient trial was authorized to assess safety and outcomes. We developed a progressive tilt bed protocol for passive mobility in accordance with the Society of Critical Care Medicine's comprehensive four-phase mobility guidance. Nursing and rehabilitation staff received training on the VGTLB's operation. Five patients participated in the passive early mobility intervention using the VGTLB. Four patients progressed to Level II (Tilt >45o), and three patients to Level III (Full 82o tilt) of the mobility protocol. No patients reached Level IV (ambulation). Compared to a retrospective cohort, the early mobility group experienced a 22.5% reduction in median ECLS run hours (502 to 402 hours), improved ECLS survival (63% to 75%), and decreased hospital mortality (50% to 25%). Median ICU and hospital stays were shortened by approximately seven days. No adverse safety events occurred with VGTLB use. Our early passive mobility trial in ECLS patients using the VGTLB yielded positive outcomes, suggesting that further investigation into progressive tilting as an early mobility intervention is warranted.

BACKGROUND:Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs).PURPOSE:To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions.METHODS:Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients.RESULTS:Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3-6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8-32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions.CONCLUSIONS:The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.

Introduction: Pediatric patients are immobilized for certain procedures such as extracorporeal membrane oxygenation (ECMO). These procedures place the patient at high risk for developing hospital acquired pressure injuries (HAPI). The purpose of this quality improvement initiative was to implement HAPI prevention interventions and provider education and to evaluate the rate of HAPI occurrence in ECMO patients before and after implementation. We hypothesized that the number of ECMO patients who developed a HAPI would decrease. Methods: All …

Intracranial hemorrhage (ICH) can be a devastating complication of extracorporeal life support (ECLS); however, studies on the timing of ICH detection by head ultrasound (HUS) are from 2 decades ago, suggesting ICH is diagnosed by day 5 of ECLS. Given advancements in imaging and critical care, our aim was to evaluate if the timing of ICH diagnosis in infants on ECLS support has changed. Patients <6 months old undergoing ECLS 2011-2020 at a tertiary care children's hospital were included. Primary outcome was timing of ICH diagnosis on HUS. Seventy-four infants underwent ECLS for cardiac (54%) or pulmonary (46%) indications. Venoarterial ECLS was most common (88%). Median ECLS duration was 6 days (range 1-26). Sixteen patients were diagnosed with ICH (21.6%), at a median of 2 days postcannulation (range 1-4). Nearly all were <4 weeks old at cannulation (93.8%). In conclusion, one-fifth of infants developed ICH diagnosed by HUS while on ECLS, all within the first 4 days of ECLS, consistent with previous literature. Despite advances in critical care and imaging technology, the temporality of ICH diagnosis in infants on ECLS is unchanged.