116 - Optimization of Initiation to Cannulation – Neonatal (OPTIC-NEO)

Publication Number: 3110.116

Vonny Chong, University of Texas Southwestern Medical School, Dallas, TX, United States; Abhishek Makkar, University of Texas Southwestern Medical School, Dallas, Texas, United States, TX, United States; Syed T. Ahmed, University of Texas Southwestern Medical School, Dallas, TX, United States; Donna M. Taylor, Children's Medical Center Dallas, Dallas, TX, United States; Adam Phillips, University of Texas Southwestern, Heath, TX, United States; Kate Louise Mangona, University of Texas Southwestern Medical School, Dallas, TX, United States; Lasya Gaur Gaur, University of Texas Southwestern Medical School, Dallas, Texas, TX, United States; Chelseá B.. Johnson-Hence, University of Texas Southwestern Medical School, Dallas, TX, United States; Ethan L. Sanford, UTSouthwestern Medical Center, DALLAS, TX, United States; Lauren A. Gillory, University of Texas Southwestern Medical School, Dallas, TX, United States; Tetyana H. Nesterenko, University of Texas Southwestern, Dallas, TX, United States

Background: Extracorporeal membrane oxygenation (ECMO) provides lifesaving support for neonates with severe cardiopulmonary failure; however, delays in initiation are associated with increased morbidity and mortality. Pre-cannulation diagnostic studies, head ultrasound (HUS) and echocardiography (echo), are essential for eligibility and procedural safety. Despite evidence linking diagnostic readiness to ECMO success, workflow-related delays in neonatal ECMO remain underexplored. The Level IV NICU at Children's Medical Center Dallas launched its ECMO program in July 2023. Early data revealed wide variation in admission-to-cannulation times, largely related to inconsistent timing and reporting of pre-ECMO imaging.

Objective: To standardize coordination among Radiology, Cardiology, Surgery, and NICU teams to increase proportion of ECMO-eligible neonates cannulated within 3.5 hours of admission from 55% to >80% by December 2026, improve diagnostic turnaround times, and establish a replicable framework for high-reliability neonatal ECMO readiness.

Design/Methods: A multidisciplinary team conducted a retrospective chart review of patients evaluated for ECMO between 7.2023 and 10.2025. The primary outcome was admission-to-cannulation time. Secondary outcomes/drivers, derived from cause-effect analysis (Fig 1) included timeliness of HUS, echo, and coagulation study reporting, as well as intervals from ECMO huddle and circuit iSTAT to cannulation (Fig 2). Process and balancing measures monitored adherence to guidelines and patient safety. Process mapping identified workflow inefficiencies for HUS and echo report availability. Statistical process control charts were used to establish baseline and monitor prospective data. All data are entered into an IRB-approved database, with quarterly review to guide iterative PDSA cycles.

Results: Retrospective analysis (N=40) showed 81% of HUS and 68% of echo orders were placed before NICU arrival. Only 29% of HUS reports were available within 2 hours of admission, and 65% of echo studies were initiated within 2 hours (Fig 3). Median admission-to-cannulation time (N=11) was 196 minutes, 55% of infants cannulated within 3.5 hours of admission. PDSA Cycle 1 (10.2025) targets standardizing "time zero" for ECMO huddle-to-cannulation intervals. PDSA Cycles 2 and 3, focusing on timely completion and reporting of HUS and echo, are scheduled for implementation in November 2025.

Conclusion(s): Multidisciplinary collaboration and data-driven quality improvement can optimize ECMO readiness reducing time to initiation. OPTIC-NEO initiative serves as a model for safer, more efficient neonatal ECMO care.

Fishbone Diagram
Fishbone Diagram illustrating the multifactorial causes of delayed ECMO cannulation. Areas highlighted in red and pink represent the area of major contributing factors for delayed cannulation.

Key Driver Diagram
Key Driver Diagram outlining the aims, primary and secondary drivers, and targeted interventions to reduce time from admission to ECMO cannulation and optimize overall neonatal ECMO program efficiency and safety.

HUS and Echo Baseline Data
Baseline data on (a) percentage of HUS studies reported within 2 hours of admission; (b) percentage of echo studies started within 2 hours of admission.