G. Dantes1, H. Jessup1, L. Lima1, M. Paden1, A. Linden1 1Emory University School Of Medicine, Atlanta, GA, USA
Introduction: As extracorporeal life support (ECLS) use has exponentially increased, it needs to be met with a supply of specialty-trained intensivists and surgeons. Formal training programs certified by the Extracorporeal Life Support Organization (ELSO) are available for adult providers, but none exist for pediatric ECLS providers. The goal of this study was to determine the ECLS training experience of U.S. pediatric ECLS fellowships (EF) and how this may have influenced future career paths.
Methods: A 32-question electronic survey was distributed to current and previous fellows of known pediatric EF programs. Study participants were identified via communication with current EF program directors (PD). Five of the 8 PD responded. Participants were anonymously queried on pertinent demographic data, motivation for pursuing an EF, experience during EF and current career position. Summary statistics were performed. IRB approval for the study was obtained.
Results: Of the 50 individual surveys distributed, 27 (54%) responses were obtained. Twenty-four (89%) respondents identified as surgeons and 3 (11%) as critical care intensivists. EF completion date ranged from 1985-2023. Most (82%) EF experiences were 2 years. Of the surgeons, motivation for pursuing an EF included an interest in applying to pediatric surgery fellowship in the future (92%), an interest in critical care (30%) or an interest in performing ECLS-related research (44%). Of the intensivists, the desire to specialize in a career focused in ECLS was the dominant motivation for pursuing an EF (100%). During EF, 10 (37%) fellows managed 10-20 ECLS patients during any one year and 5 (19%) managed > 50 ECLS patients. Clinical responsibilities during EF included determining ECLS candidacy (96%), leading rounds in the NICU and PICU (74% and 67%) and taking ECLS call (100%). Most (73%) EF programs did not have a formal ECLS-specific didactic curriculum. Most respondents were responsible for ECLS M&M (89%), and 67% had responsibilities as part of ECLS leadership meetings. Few fellowships required dedicated rotations on ECLS-related services. Twenty-one (96%) of graduates indicated comfort managing a straightforward ECLS run while twenty (91%) indicated comfort managing a complex run. Sixteen (73%) respondents agreed that an ECLS fellowship was critical to achieving career goals and 7 (31.8%) currently hold an ECLS leadership position at their institution.
Conclusion: Pediatric EF training greatly varies in regard to clinical, didactic and administrative experiences. As ECLS utilization continues to expand standardized pediatric specific EF training and benchmarks for certification should be considered in order to prepare graduates for future ECLS leadership positions.