ECLS Program in the Hub and Spoke Model Julia Akhtarekhavari, BSN, - - PowerPoint PPT Presentation

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Sep 25, 2022 294 likes •488 views

ECLS Program in the Hub and Spoke Model Julia Akhtarekhavari, BSN, RN Mechanical Circulatory Support Manager William Dillon, MD, FACC Medical Director, Outpatient Cardiology Research, Baptist Health Louisville Faculty Disclosure I have no

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ECLS Program in the Hub and Spoke Model

Julia Akhtarekhavari, BSN, RN Mechanical Circulatory Support Manager William Dillon, MD, FACC Medical Director, Outpatient Cardiology Research, Baptist Health Louisville

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Faculty Disclosure

I have no financial disclosures.

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Gap = Development and rapid expansion of ECLS programs in

low volume centers

Need = Decreased costs and improved mortality exist in high

volume centers. Outcomes of transported ECLS patients are equivalent to non-transported ECLS patients.

Educational Need/Practice Gap

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Upon completion of this educational activity, you will be able to:

1. Discuss the benefits of an ECLS Hub and Spoke Model.
2. Review process of becoming an ECLS Spoke Center.

Objectives

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Expected Outcome

Consider use of hub and spoke model for initiation of ECLS

program in low volume centers.

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500 1000 1500 2000 2500 3000 3500 4000 4500 5000 1-5 6-14 15-30 30+

Number of Cases Annual Hospital Volume

ECLS Volume Distribution (1989-2013)

Barbaro, et al. Am J Respir Crit Care Med (2015)

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Does Volume Matter in ECLS

Volume = Outcomes ?

Probably…to an extent

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Considerations:
Severity of illness
Conservative vs. aggressive

deployment

Cost
Staff vs. center expertise

ECLS Center Volume

10 20 30 40 50 60 1 2 3 4 5 ECLS Cases Year

Huesch. ASAIO (2018)

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Hub and Spoke

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Learn from our experience

and our mistakes

Didactic, wet lab, simulations
Initial/annual training
Consult peer to review

candidates

Debrief cases

Training & Expertise

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Ability to offer life saving

technology

Little to no duplicate staff
Fewer high cost cases at

spoke

Resources & Cost

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Patient selection criteria
Protocol alignment
Best possible outcomes

Care Coordination & Outcomes

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The Final Link - ECLS Transport

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Multidisciplinary Collaboration Efforts

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Didactic classwork, protocol education and high fidelity simulation to transport ECMO patients Core team of 4:

Cardio-Thoracic Vascular critical care nurse
Perfusionist
Paramedic
EMT/Paramedic Driver

Protocol Development & Training

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UKHC Adult ECLS Transport

ECLS Survival 52%

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VA ECLS - 39 % VV ECLS - 55%

ECLS Transport Survival

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ECMO transport is safe, effective, and efficient for patients 26 Adult ECMO Runs No Adverse Events

UK Experience

Broman, et al. Critical Care (2015) Bryner, et al. Ann Thorac Surg (2014) Javidfar, et al. ASAIO (2011)

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