Amelia Griffiths1, Dr Nhi Nguyen2, Dr Kath Carmo3, Frank Kastrounis3, Dr Ian Nicholson4, Maree Standaloft5, Mark Greaves4, Dr Andrew Berry3, Dr Marino Festa1
1NSW Kids ECMO Referral Service, Sydney, Australia, 2Intensive Care NSW Network, ACI, , Australia, 3Newborn and paediatric Emergency Transport Service, , Australia, 4Kids Heart Centre, Sydney Children’s Hospitals Network, , Australia, 5Children’s Hospital at Westmead, , Australia
Abstract:
Background
NSW has a centralised model of intensive care with neonatal and paediatric ECMO available in 2 tertiary centres. Increasing numbers of ad-hoc ECMO retrievals in NSW between 2013-18 raised concerns regarding equity of access, safety, and reliability of ECMO in retrieval.
Methods
A proposal to develop state-wide ECMO retrieval capability was submitted to NSW Health in 2018. Rapid evidence review and survey of ECMO specialists by the Agency for Clinical Innovation, followed by stakeholder engagement workshops led to development of a draft model of care in 2020.
Results
KERS commenced in December 2022 as a state-wide service that works to increase equity of access to ECMO for neonates and children in NSW.
A key element of the service is the KERS specialist roster, available 24/7, contacted via Newborn and pediatric Emergency Transport Service (NETS) to lead collaborative decision-making for key questions: Is ECMO appropriate? When and where should ECMO be commenced?
KERS referral criteria used by NETS trigger early discussion of ECMO candidacy in cases not yet meeting criteria to initiate ECMO and prior to any decision to mobilise ECMO.
A KERS specialist, cardiothoracic surgeon, perfusionist and theatre nurse are mobilised in addition to a NETS retrieval team in cases requiring ECMO in retrieval. Specifically designed and CASA certified equipment fitted to a NETS stretcher secures and powers standardised ECMO equipment in all vehicle types.
The KERS referrals database informs service and quality improvement oversighted by a KERS Operational Committee which has broad stakeholder representation and reports through the KERS Steering Committee to NSW Health.
Conclusion
NSW Health funding allowed a gap in existing services to be addressed through widespread multiagency stakeholder engagement. KERS is a state-wide service designed to work collaboratively to improve equity of access, safety and reliability of ECMO for neonates and children across NSW.
Biographies:
Dr Marino Festa trained and has worked as a paediatric intensivist in the UK and Australia. He has recognized expertise in the fields of deteriorating children, paediatric critical care research, and simulation training. He is the medical director for Kids Critical Care Research at Children’s Hospital at Westmead and a past chair of the ANZICS Paediatric Study Group. He is the medical director for a new state-wide neonatal and paediatric ECMO referral service in NSW – NSW Kids ECMO Referral Service (KERS)