Abstract
According to the Extracorporeal Life Support Organization (ELSO) guidelines, pre-assembled and already primed extracorporeal membrane oxygenation (ECMO) systems can be safely stored for up to 30 days under specific conditions. This study gives a detailed overview of existing pre-assembly practices. An anonymous online survey was conducted among chief perfusionists at German ECMO centers. Forty-four of a total of 83 ECMO centers (53%) completed the survey. Thirty-three percent do not preassemble ECMO systems. Seventy-seven percent (n = 34) reported having preassembled ECMO systems readily available (30% dry preassembly/20% wet preassembly/27% wet preassembly with circulation). Half of the participating centers (50%) reported having a standard operating procedure (SOP) and the majority (57%) of chief perfusionists expressed a need for an evidence-based SOP. A maximum storage time for wet preassembled ECMO systems is established in 88% of departments. On average, wet preassembled systems are discarded after 20 days, which is below the ELSO’s safe limit of 30 days. Overall, this survey reveals a heterogeneous approach regarding the practice of provisioning preassembled ECMO systems. The demand for an evidence-based SOP for the preassembly and storing of ECMO systems becomes evident, necessitating the determination of hygienic standards, regular training, and a reliable maximum storage period.
Key Findings
- Preassembly Practices: 77% of centers maintain preassembled systems, divided into dry preassembly (30%), wet preassembly without circulation (20%), and wet preassembly with circulation (27%). 23% of centers do not preassemble systems due to concerns over cost, storage limitations, or potential disposal of unused setups.
- Storage Durations: Wet systems are typically discarded after an average of 20 days, though ELSO permits storage up to 30 days. Centers with higher case loads tend to use systems within 9.5 days, while those with lower caseloads store systems longer, sometimes surpassing safe limits.
- Standard Operating Procedures (SOPs): Only 50% of centers have SOPs for preassembly and storage, and 57% of perfusionists expressed a need for evidence-based, universally applicable guidelines.
- Training and Efficiency: Regular training was more prevalent in centers that did not preassemble systems (80%) compared to those that did (53%). Training improved assembly times and system handling.
Recommendations
The study highlights a critical need for:
- Evidence-Based SOPs: To standardize practices across ECMO centers, ensuring hygienic standards, defined storage periods, and effective assembly protocols.
- Enhanced Training: Regularly supervised training can improve system preparation efficiency and ensure compliance with hygiene protocols.
- Hygienic Standards: Uniform practices like hand disinfection and mask use during assembly should be mandatory to mitigate contamination risks.
- Optimized Storage Policies: Centers should align with ELSO’s 30-day limit and minimize unnecessary disposal of unused systems to reduce waste and costs.
Conclusion
The heterogeneity in ECMO system preassembly practices underscores the importance of adopting standardized guidelines. By addressing the gaps in training, hygiene, and storage practices, ECMO centers can improve readiness for emergencies, enhance patient safety, and optimize resource utilization.
