ecmo coordination- 10 years in 10 minutes · 10 years in 10 minutes holt murray, md department of...
TRANSCRIPT
Regional ECMO
Coordination- 10 years in 10
minutes HoltMurray,MD
DepartmentofCriticalCareMedicine
FEMA Principles of Emergency Management
Comprehensive
Progressive
Risk-Driven
Integration
Collaborative
Flexible
Professional
Lessons learned from H1N1
• ECMOoutreachto“Spoke”hospitals• Earlyidentificationandreferral• Capacityof“Hub”hospital• EffectofincreasedECMOvolumeondailyoperations
• Adaptivestaffingmodels
Outreach and Early
Identification
Critical Components
• Physicianstaffing• Nursingstaffing• Perfusionstaffing• ECMODevices• Disposablesupplies• ICUCapacity
Inventory Assessment
RESP Score
Challenges of ECMO Response Planning
• Highresourceutilization• Lagtime• Unabletoassessbenefitearly
Dynamic Criteria <50%Capacity
• StandardselectioncriteriaandStandardexclusioncriteria• Age<65y/o• Mechanicalventilation<10days
• Approximatesurvival>57%
50-80%Capacity• Enhancedselectioncriteriaandenhancedexclusioncriteria
• Age<60y/o• MechanicalVentilation<7days• Nopre-ECMOcardiacarrest• Pplat<40cmH2O
• Approximatesurvival>76%survival
>80%Capacity• Stringentselectioncriteriaandenhancedexclusioncriteria
• Age<50y/o• Mechanicalventilation<5day• Nopre-ECMOcardiacarrest• Pplat<40cmH2O
• Approximatesurvival>92%survival
PA Hospitals
Shared goals
• Savethemostlives• Ensurecapacitytocareforthosethataremostlikelytobenefit
• Solidarityandsupportfordifficultdecisions• Providesimplicityandclarityfor“spoke”hospitals
Benefits of a Regional Approach
Fairness Transparency
MaximizeBenefit
Coordinationofresources
PA Regional Coalitions
Public Health Emergency Management
Ethics and Challenges
• Selectioncriteria• Age• ICUadmissionv.Transplant
• Stoppingrules• Overcapacitysystems• VentilatorandICUbedshortages
Timeline
15Mar.
Italy,FranceandSpainhealthsystemsclearlystressed
16Mar.
UPMCECMOcriteriacapacityandinventoryreviewed
20Mar.
UPMCSystemWideresponseplanandagreement
25Mar.
WesternPennsylvaniacollaborationbegins
30Mar.
FirstdiscussionswithUniversityofPennsylvania
2Apr.
RegionalCMOgroupandHealthDepartmentannouncecoordinatedcriteriaandplan
7Apr.
WeeklyStatewidediscussionsbegin
17Apr.
Consensusagreementacrossthestate
ELSO Phases of Response
State
Region
System
Hospital