RNs running ECMO on adult patients - page 2

by pbear

I had my first patient on ECMO this past week. A very intense experience but one that was made much easier because a perfusionist was at the bedside 24/7. I knew next to nothing about ECMO, other than what is was being used for.... Read More


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    I'm all about taking care of ECMO patients as an RN cause they are super sick and very challenging and require every ounce of critical thinking. That said, I would not want to be responsible for running the pump without going through the ECMO specialization course and getting tons of clinical experience with it, prior to running it alone. ECMO is one of those high risk/low volume devices, so you may not get as much experience with it in comparison to other devices like a balloon or vad. Having witnessed an ECMO circuit clot off and 2 perfusionists and a fellow frantically having to crash them onto the spare ECMO pump, as well as witnessing an ECMO decanulation which involved a hot bloody mess in which they re-cannulated, I wouldn't feel confident in doing the same things without an in depth training and clinical exp. Even if there were "on-call" perfusionists for emergencies, they may or may not get there in time in those types of situations so the responsibility would rest on you.
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    Quote from IDoNotGiveOut
    I am an ECMO specialist but my day job is being an ICU nurse, and I can tell you it is not even close. Let's be honest, when we have a balloon pump or VAD, mostly we just write down numbers, we had to learn a few assessments/checks to do and a few precautions to follow, and it is extremely rare for anything to go wrong, and if it does we just do what minimal, simple interventions we know how to do, panic, and call perfusion. Not necessarily in that order But you're still doing typical ICU nursing, it's another machine in your patient's room and it is critical, but it doesn't significantly change the general job duties. Being an ECMO specialist is an entirely different ball of wax. ECMO specialists require a few weeks of full-time additional training to become certified, it is not like getting VAD or ballon pump certified. When the ECMO managing physician isn't present, the specialist is the leader of the team caring for that patient, and you are responsible for anything that happens. You have to make complex decisions regarding management of anticoagulation, clotting, bleeding, and hemodynamics/oxygenation (the physiology and management is very different than any other ICU patient). You have three circuit pressures you are monitoring, three separate blood gasses to interpret to determine how to adjust your sweep gas and pump flow, but must also take into account pt. BP, native CO, gtts, patient lung function, vent settings, volume status, cardiopulmonary anatomy (e.g. in our congenital heart babies or neonates with shunts), type of support (VA, VV, VAV), where they are cannulated, patient assessment, circuit assessment, etc. etc. And even just the routine necessary things you do often require accessing the circuit, which is extremely high risk, as in if you turn one stop cock the wrong way you could cause a massive catastrophe. And if there is some kind of circuit catastrophe, until the ECMO doc, perfusionist, and other ECMO specialists get there to help, you alone are responsible for fixing it, while the rest of the ICU team that is coding the patient is screaming at you "how much longer?" Don't get me wrong, there are times on very stable patients where it's mainly just watching blood pump in a circle and jotting down numbers. That's why they say being an ECMO specialist is 90% boredom and 10% sheer terror.

    To answer the OP's question, ECMO is scary and hard and it is not for everyone. It requires a certain level of passion, you have to be a little obsessive to soak in all the knowledge needed, and you have to be the type of person who is willing to be the only person in the room who knows anything about this crazy machine that is usually the only thing keeping the patient alive. I disagree with your statement that only perfusionists should staff ECMO pumps. With proper classroom, lab and clinical training experienced ICU nurses/RTs are qualified and capable to do the job, and do at most ECMO centers. It is not like you'll (usually) be doing full CBP with circ arrest. But that doesn't mean it's simple enough for a "ten minute crash course." That is completely insane. Our initial training is 80 hours, plus 4 hour comps every 3 months. Also, if they aren't offering you a nice pay differential, they are robbing you. When we sit a pump we get paid the same rate perfusionists get paid to run bypass in the OR. ECMO requires you dedicate much of your personal life to learning this, being on-call, and shouldering huge responsibility and high stress levels, and being exposed to some of the most emotionally demanding situations possible, above and beyond the demands of being an ICU nurse. The job absolutely deserves additional compensation.

    Sorry for the long post and I know this is two years old. But when I saw one person say that only perfusionists should run ECMO and then another say it's just like a VAD, I couldn't help myself.
    With all due respect, it IS just like a VAD. They are both pretty mechanical circulatory support devices. I have worked with ECMO, IABP, VAD etc for 15 years +. VAD and ECMO both require the same knowledge of technology mixed with advanced anatomy and physiology. The degree and depth of knowledge required is obviously variable depending on your role and responsibilities. As both a biomedical engineer, CCRN, and now nurse practitioner, I absolutely maintain that ECMO is like any other piece of equipment. I do not mean to minimize the criticality of the therapy, but with adequate training (and yours sounds great), there's no reason the right RNs can't learn to manage ECMO circuits.
    StayLost and PMFB-RN like this.
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    RN's do run ECLS at our institution with the Mechanical Circulatory Support team on call for higher level troubleshooting. The intensity of the workload (more frequent assessments, labs) make it justifiable to have 2 nurses assigned to the patient each shift.
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    I agree with this comment. ICU is ICU is ICU. although miracles do happen and most people respond well to the treatments we provide, not everyone makes it. Plus, its more fun and interesting to deal with more machines, have more under your belt and develop more skills and use your brain more, there is only so much you can learn about turning someone and cleaning them, day after day. How about learning new things and making yourself indispensable, thats how I feel. Just an opinion.
    PMFB-RN likes this.
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    Absolutely!
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    Quote from BigCliffCCRN
    I agree with this comment. ICU is ICU is ICU. although miracles do happen and most people respond well to the treatments we provide, not everyone makes it. Plus, its more fun and interesting to deal with more machines, have more under your belt and develop more skills and use your brain more, there is only so much you can learn about turning someone and cleaning them, day after day. How about learning new things and making yourself indispensable, thats how I feel. Just an opinion.
    Well said brother! We are is the same wavelength !
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    Look at it this way every new skill you add to your tool bag will net you more money at you next job. As nurses we always have to look forward for increase in pay and to do that we have to become more valuable to future employers. I work a cardiac PCU floor and I recently got trained and certified for Aquaphoresis ( kind of mini dialysis for CHF patients) I don't get any more money now but when i move out of state end of the year my next employer will take all skills into consideration. Good luck


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