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Yan K, Tang LK, Xiao FF, Zhang P, Cheng GQ, Wang LS, Lu CM, Ge MM, Hu LY, Zhou YF, Xiao TT, Xu Y, Yin ZQ, Yan GF, Lu GP, Li Q, Zhou WH. Brain development in newborns and infants after ECMO. World J Pediatr 2024; 20:556-568. [PMID: 38238638 PMCID: PMC11239726 DOI: 10.1007/s12519-023-00768-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/28/2023] [Indexed: 07/12/2024]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) not only significantly improves survival rates in severely ill neonates but also is associated with long-term neurodevelopmental issues. To systematically review the available literature on the neurodevelopmental outcomes of neonates and infants who have undergone ECMO treatment, with a focus on motor deficits, cognitive impairments, sensory impairments, and developmental delays. This review aims to understand the incidence, prevalence, and risk factors for these problems and to explore current nursing care and management strategies. DATA SOURCES A comprehensive literature search was performed across PubMed, EMBASE, and Web of Science using a wide array of keywords and phrases pertaining to ECMO, neonates, infants, and various facets of neurodevelopment. The initial screening involved reviewing titles and abstracts to exclude irrelevant articles, followed by a full-text assessment of potentially relevant literature. The quality of each study was evaluated based on its research methodology and statistical analysis. Moreover, citation searches were conducted to identify potentially overlooked studies. Although the focus was primarily on neonatal ECMO, studies involving children and adults were also included due to the limited availability of neonate-specific literature. RESULTS About 50% of neonates post-ECMO treatment exhibit varying degrees of brain injury, particularly in the frontal and temporoparietal white matter regions, often accompanied by neurological complications. Seizures occur in 18%-23% of neonates within the first 24 hours, and bleeding events occur in 27%-60% of ECMO procedures, with up to 33% potentially experiencing ischemic strokes. Although some studies suggest that ECMO may negatively impact hearing and visual development, other studies have found no significant differences; hence, the influence of ECMO remains unclear. In terms of cognitive, language, and intellectual development, ECMO treatment may be associated with potential developmental delays, including lower composite scores in cognitive and motor functions, as well as potential language and learning difficulties. These studies emphasize the importance of early detection and intervention of potential developmental issues in ECMO survivors, possibly necessitating the implementation of a multidisciplinary follow-up plan that includes regular neuromotor and psychological evaluations. Overall, further multicenter, large-sample, long-term follow-up studies are needed to determine the impact of ECMO on these developmental aspects. CONCLUSIONS The impact of ECMO on an infant's nervous system still requires further investigation with larger sample sizes for validation. Fine-tuned management, comprehensive nursing care, appropriate patient selection, proactive monitoring, nutritional support, and early rehabilitation may potentially contribute to improving the long-term outcomes for these infants.
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Affiliation(s)
- Kai Yan
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Lu-Kun Tang
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
- Kunming Medical University Affiliated Dehong Hospital, Dehong, Yunnan, China
- Graduate School, Kunming Medical University, Kunming, Yunnan, China
| | - Fei-Fan Xiao
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Peng Zhang
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Guo-Qiang Cheng
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Lai-Shuan Wang
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Chun-Mei Lu
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Meng-Meng Ge
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Li-Yuan Hu
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Yuan-Feng Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Tian-Tian Xiao
- School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yan Xu
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhao-Qing Yin
- Kunming Medical University Affiliated Dehong Hospital, Dehong, Yunnan, China
- Graduate School, Kunming Medical University, Kunming, Yunnan, China
| | - Gang-Feng Yan
- Department of Intensive Care Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Guo-Ping Lu
- Department of Intensive Care Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Qi Li
- Department of Intensive Care Medicine, The Sixth Medical Center of PLA General Hospital, Beijing, China.
| | - Wen-Hao Zhou
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China.
- Key Laboratory of Neonatology, National Health Care Commission, Shanghai, China.
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Ross P, Watterson J, Fulcher BJ, Linke NJ, Nicholson AJ, Ilic D, Hodgson CL. Nursing workforce, education, and training challenges to implementing extracorporeal membrane oxygenation services in Australian intensive care units: A qualitative substudy. Aust Crit Care 2023; 36:114-118. [PMID: 35016842 DOI: 10.1016/j.aucc.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The use of extracorporeal membrane oxygenation (ECMO) is increasing in the management of critical care patients. ECMO service delivery requires an organisation-supported approach to ensure appropriate resources to deliver training, equipment, capacity, staffing, and the required model of care for quality care delivery. The aim of this nested substudy was to explore challenges specific to nursing staff in ECMO services in Australian intensive care units. METHODS This was a nested substudy within a qualitative study using semistructured focus group discussions conducted with 83 health professionals, which included 40 nurses. There were 14 focus groups across 14 ECMO centres participating in the binational ECMO (EXCEL) registry of Australia and New Zealand. An inductive thematic analysis focused on the nurse's experiences of the barriers and facilitators for nursing in providing an ECMO service. RESULTS Four themes emerged relating to the nurse's experience of implementing ECMO services: workforce requirements, workload demands, models of care, and level of experience. The complexity and intensity of caring for ECMO patients may need to be considered an additional factor in the burnout in critical care nurses. Current nursing ratios and responsibilities in critical care need to be considered, with the opportunity for the development of specialist advanced practitioner nursing roles. CONCLUSION This study highlights the challenges for nursing in providing ECMO services in the intensive care setting. The complexity and intensity of ECMO is challenging and leads to concerns regarding burnout and workforce preparedness. New models of care need to be considered to mitigate the barriers for nursing identified across ECMO centres.
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Affiliation(s)
- Paul Ross
- Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Jason Watterson
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia; Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia.
| | - Bentley J Fulcher
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Natalie J Linke
- Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | | | - Dragan Ilic
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Carol L Hodgson
- Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
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A Scoping Review and Appraisal of Extracorporeal Membrane Oxygenation Education Literature. ATS Sch 2022; 3:468-484. [PMID: 36312813 PMCID: PMC9585707 DOI: 10.34197/ats-scholar.2022-0058re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Despite a recent rise in publications describing extracorporeal membrane oxygenation (ECMO) education, the scope and quality of ECMO educational research and curricular assessments have not previously been evaluated. Objective The purposes of this study are 1) to categorize published ECMO educational scholarship according to Bloom’s educational domains, learner groups, and content delivery methods; 2) to assess ECMO educational scholarship quality; and 3) to identify areas of focus for future curricular development and educational research. Methods A multidisciplinary research team conducted a scoping review of ECMO literature published between January 2009 and October 2021 using established frameworks. The Medical Education Research Study Quality Instrument (MERSQI) was applied to assess quality. Results A total of 1,028 references were retrieved; 36 were selected for review. ECMO education studies frequently targeted the cognitive domain (78%), with 17% of studies targeting the psychomotor domain alone and 33% of studies targeting combinations of the cognitive, psychomotor, and affective domains. Thirty-three studies qualified for MERSQI scoring, with a median score of 11 (interquartile range, 4; possible range, 5–18). Simulation-based training was used in 97%, with 50% of studies targeting physicians and one other discipline. Conclusion ECMO education frequently incorporates simulation and spans all domains of Bloom’s taxonomy. Overall, MERSQI scores for ECMO education studies are similar to those for other simulation-based medical education studies. However, developing assessment tools with multisource validity evidence and conducting multienvironment studies would strengthen future work. The creation of a collaborative ECMO educational network would increase standardization and reproducibility in ECMO training, ultimately improving patient outcomes.
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