Authors (including presenting author) :
Wan HY(1), Fung SH(1), Wong LY(1), Chiu SH(1), Rocha BA(1), Yam N(1), Das SR(2), Cheng CC(3), Lun KS(4), Au WK(1)
Affiliation :
(1)Department of Cardiothoracic Surgery, Queen Mary Hospital, (2)Department of Cardiothoracic Anaesthesia, Queen Mary Hospital, (3)Department of Microbiology, Queen Mary Hospital, (4)Department of Paediatric Cardiology, Queen Mary Hospital
Introduction :
In emergency cases where there is the need for instituting ECMO CPR and ECMO retrieval the time required in setting up the ECMO circuit is a critical factor that determines the outcome of the patient. This is even more challenging in paediatric and neonatal age groups because of the lower cardiopulmonary reserves. A pre-assembled, pre-primed and “ready-to-use” paediatric ECMO circuit has been a widely practiced in many major overseas pediatric cardiac centers and has saved critical minutes in patient management leading to improved survival. We propose to adopt the practice of having a pre-primed ECMO circuit for rapid initiation of ECMO whenever necessary in Queen Mary Hospital (QMH). The Department of Cardiothoracic Surgery, QMH, provides 24-hour adult and pediatric ECMO service, and is the largest single provider of such service in Hong Kong. Prior to making it our regular practice, we sought to establish that such a pre-primed circuit remains sterile and is therefore safe to use in our patients and shortens the ECMO deployment times.
Objectives :
The purpose of this study was to evaluate whether pre-assembled and pre-primed paediatric ECMO circuits could maintain sterility for up to 30 days and thus establish any infectious risk to this common practice in our clinical setting in QMH.
Methodology :
This was a multidisciplinary study involving cardiothoracic surgeons, cardiothoracic anaesthetists, paediatric cardiologists, microbiologists and perfusionists. Five ECMO (Maquet Rotaflow Paediatric ECMO machine and circuit (QUADROX-iD)) were set up in operating room. ECMO assembly and priming were done by the perfusionists. Circuits were primed with 1 liter crystalloid solution. Culture samples of priming fluid obtained from each circuit were transferred to sterile bottles and were collected at the time of assembly and priming ie.0 hr, followed by 24 and 72 hours and then at one-week intervals up to 30 days. A total of 35 sets of culture samples were obtained. The culture was considered as negative if there was no growth after 5 days of incubation.
Result & Outcome :
All the cultures obtained from the priming solution of the ECMO circuits showed no microbial growth for the 30 days study period. Conclusion: This study demonstrated that preassembled and preprimed paediatric ECMO circuits maintain sterility for a period up to 30 days. A pre-primed paediatric ECMO circuit protocol was initiated. Implementation of pre-primed paediatric ECMO protocol in our clinical practice in QMH reduced the emergent ECMO deployment time from 15 min to 3 min thus potentially enhancing the patient safety.
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