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Extracorporeal Membrane Oxygenation Appropriateness: An Interdisciplinary Consensus-Based Approach

Nurok, Michael, MBChB, PhD*; Warsh, Jonathan, PhD; Griner, Todd, RN, MSN, NEA-BC; Kharabi, Mayumi, RN, MSN, CNL§; Castongia, Joseph, MHA§; Overbeck, Cali, MHA§; Krueger, Lisa, LCSW, ACM-SW; Coleman, Bernice, PhD, ACNP-BC, FAAN; Ramzy, Danny, MD, PhD*; Chung, Joshua, MD*; Chan, Alice, RN, MSN, CNS, CCRN; Ley, Eric, MD*; Kubendran, Sindhu, MPH; Parrish, Neil, MBA; Yu, Zhe, MD, MPH; Langberg, Michael, MD#; Finder, Stuart, PhD**; Rosen, Bradley, T., MD, MBA, FACP, SFHM††; Kaplan, Robert, S., PhD; Sax, Harry, MD*; Arabia, Francisco, MD, MBA*

doi: 10.1213/ANE.0000000000002723
Research Report: PDF Only

We describe a quality improvement initiative aimed at achieving interdisciplinary consensus about the appropriate delivery of extracorporeal membrane oxygenation (ECMO). Interdisciplinary rounds were implemented for all patients on ECMO and addressed whether care was consistent with a patient’s minimally acceptable outcome, maximally acceptable burden, and relative likelihood of achieving either. The rounding process was associated with decreased days on venoarterial ECMO, from a median of 6 days in 2014 (first quartile [Q1]–third quartile [Q3], 3–10) to 5 days in 2015 (Q1–Q3, 2.5–8) and in 2016 (Q1–Q3, 1–8). Our statistical methods do not allow us to conclude that this change was due to our intervention, and it is possible that the observed decreases would have occurred whether or not the rounding process was implemented.

From the *Department of Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Harvard Business School, Boston, Massachusetts; Critical Care Nursing, Cedars-Sinai Medical Center, Los Angeles, California; §Human Centered Design, Cedars-Sinai Medical Center, Los Angeles, California; Department of Social Work, Cedars-Sinai Medical, Los Angeles, California; Department of Clinical Transformation, Cedars-Sinai, Los Angeles, California; #Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, California; **Center for Healthcare Ethics, Cedars-Sinai Medical Center, Los Angeles, California; ††Supportive Care Medicine and Physician Alignment & Care Transitions, Cedars-Sinai Medical Center, Los Angeles, California.

Accepted for publication October 26, 2017.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Michael Nurok, MBChB, PhD, Division of Cardiac Surgery, Department of Surgery and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 San Vicente Blvd, Suite 3100, Los Angeles, CA 90048. Address e-mail to michael.nurok@cshs.org.

© 2018 International Anesthesia Research Society
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