oa How to maintain a quality ECMO program?

Quality and patient safety are core elements of a successful extracorporeal membrane oxygenation (ECMO) program. Patient survival, patient safety, and quality of life were the main considerations when establishing an ECMO service in Qatar, with the alternatives being death from refractory hypoxemia or permanent lung fibrosis and reduced quality of life as a result of harmful ventilation. The program strives to achieve these goals through a systematic, evidence-based, and structured program that does not use shortcuts, and integrates and provides high quality of care to improve survival rates among critically ill patients.

There is strong clinical evidence supporting the use of ECMO as a lifesaving procedure in critical patients, as it provides a viable alternative for patients with certain conditions that previously had high mortality rates.¹ This leads us to define one of our objectives as improving our patients' outcome, while avoiding needless harm through the introduction of this service. Our objective was to establish an evidence-based but locally relevant structure for an ECMO center of excellence in the region, learning from other centers' experiences through strategic partnerships.² The development involved an appropriately structured and staged education and training program for our staff to develop the required knowledge and skills and understanding the challenges associated with ECMO. We defined each team members' functions, roles, and responsibilities and established effective communication processes, thus inculcating a change to a collaborative culture of multi-professional teamwork. To ensure the best delivery of the service, we have ongoing support from experienced regional centers with high patient volumes, and focused and trained multidisciplinary teams, helping to positively impact patient outcomes in complex cases.

To ensure the maintenance of quality, our center believes that collecting accurate ECMO data in a timely manner is essential to track the progress, improve the logistics, report the metrics, and link them to international registries for benchmarking, sharing experience, and evaluating our performance. We use debriefing sessions, demonstrated as an effective reflective tool in simulation-based education,³ in our program's different daily activities to enhance the culture of our multidisciplinary teamwork. The success and program outcome is made and measured here, as everyone is accountable and contributes to analyzing the available data of our patients. The team reviews the structure, processes, and outcome using the quality tools of plan–do–study–act, root-cause analysis, process mapping, etc. Clear tasks and assignments are distributed and SMART goals are set.⁴ Crisis Resource Management (CRM) is another valuable component in developing and maintaining a quality service in the ECMO program, and empowerment of the team to ensure expectations are met through effective communication, involvement, skill enhancement, professional development, recredentialing, and setting the standards.⁵ Our center invests in developing and running simulation-based workshops and training sessions that provide additional learning opportunities beyond the traditional quality improvement tools.⁶

In conclusion, it needs a persistent effort to maintain a quality ECMO program, with clear objectives, quality standards, ongoing training, and good communication as important elements for success.