Pediatric and Neonatal Extracorporeal Life Support Technology Component Utilization: Are US Clinicians Implementing New Technology?

The objective of this investigation is to describe recent changes made
in extracorporeal life support (ECLS) technology in the US Postal survey
to directors and coordinators of all 125 US ECLS centers identified by
Extracorporeal Life Support Organization as of November 2010, with
follow-up of nonrespondents. Spearman coefficients were used to
correlate the method of updating knowledge of ECLS technology with the
likelihood of changing technology, and to correlate decision-making
hierarchy with the likelihood of changing equipment. The response rate
was 75% representing 34 states, and the majority of respondents were
ECLS coordinators (56.6%). Respiratory diagnosis is the predominant
indication for ECLS at any age. Over 40% of centers are using a
hollow-fiber oxygenator for neonates and 80% of pediatric patients.
Roller pumps are used in 70% of neonatal and pediatric ECLS. Forty-two
percent of centers changed the oxygenator type within the past 3 years,
while 30% changed both the oxygenator and pump. Less than 10% of centers
reported problems with either oxygenator or pump in both neonates and
pediatric ECLS. Forty-six percent of respondents that changed
oxygenators cited that the primary reason for changing was “clinical
preference/experience,” while the other half was split between “FDA
approval” and “Research results.” In 40% of centers, a multidisciplinary
group made decisions on changing technology. This survey indicates that
over one-half of ECLS centers implemented new technology within the
past 3 years. Knowledge of ECLS technology and safe operation of ECLS
circuit components is essential in preventing some of the mechanical
complications.