[indagenes]

To answer 3230's ? and Raquel's ?. I worked at a Level one Trauma Center
for 3 years in the PICU. RRTs who had advanced training and passed a
hospital-designed exam on ECMO were called ECMO techs. The ECMO patient was thus cared for with 2:1 care by ECMO tech and RN. It's a small
circle of people who do this type of care, so we helped each other out, within the limits of our legal scope of practice. (i.e., ecmo tech would help move patient when giving baths, help monitor hemodynamics.) I have a lot
of respect for most of the ECMO techs I worked with. The only ones I did
not care to work with were the techs who were too cavalier about
what they were doing. (Being cavalier with ECMO just because it can get
boring is folish and IMHO an indication of ignorance.)

Raquel: We did have success at my institution with ECMO, but primarily ONLY when the guidelines for the initiation of ECMO were properly observed.
Some of the peds CT surgeons used ECMO as a means of prolonging the
patient's life in the face of nearly inevitable negative outcome; the pt. would clearly not meet the criteria for ECMO, yet the surgeons would put them on it anyway. Those are the patients that almost always died. I could go on and on about the medical ethics issue with regards to ECMO, but I'll refrain for now.

[jenpicuRN]

At our hospital, RTs are on the pump while the RN treats the patient. The RT can leave unless relieved by another trained RT. The RT has to become certified in ECMO. The perfusionist comes in to set up the pump and then reports off to RT because he has to go back to surgery.

[faithmd]

Originally Posted by JenACNPICU

I have never heard of RT's running an ECMO circuit. Only a portion of our PICU staff (all are RN's) are trained in ECMO. I have been certified for almost 5 years. I also teach the lab with another co-worker. I will keep posted to see if other centers are doing this... I will also talk with our ECMO Coordinators. Why is your center looking at using RT's???

Here at UM, our ECMO Specialists are either RN's *or* RRT's. Tehy do have to go through a training course and pass a test. (RRT, big distinction!)

A couple of times a year the ECMO program actually holds an ECMO class for other ICU-trained staff (RN's and RRT's) who are interested in being on-call as ECMO back-up. The class is taken on your own time, and there is again an exam that must be passed, then there is an orientation and a sign-up requirement. It isn't used as much as it once was, but it happens occasionally (the back-up, I mean). It seems we are doing less and less ECMO.

[janfrn]

faithmd, you say you're using ECMO less and less, but we seem to be using it more and more. We had two kids on V-A at the same time in March, but lately we've been running V-V ECMO mostly, usually after HFOV has failed. We successfully decannulated a baby last week who had a 34 day run for ARDS post living-related-donor liver transplant... kid went to the OR with a WBC of 26 and positive for adenovirus, parainfluenza and human metapneumovirus, but they HAD to do the transplant... Then yesterday we cannulated another little one who came in with adenovirus and rapidly deteriorated. Sats in the 30s by the time the surgeon got there to cannulate. Then last night we got a call from one of our referring hospitals in another province telling us they had a severe ARDS patient that they wanted to send us for ECMO. Our resources are getting pretty thin due to morale and management problems for both out ECLS specialists and our regular staff; people are either quitting the team (which isn't a dedicated team) or the entire unit in ever-increasing numbers. The overtime is unbelievable. And I think it will get a lot worse before it gets better.

[janfrn]

The child I referred to in my last post who had been cannulated for severe ARDS is STILL on V-V ECMO, day 40 now. The amount of sedation this child needs to prevent flow problems is unbelievable. She's still needing flows of 80-90 mL per kg and she is still failing her O2 challenges. Her ventilator pressures on rest settings are still very high (PIP 28, PEEP 15) and her x-ray is looking cystic. The team has agreed to keep her on for a total run of 8 weeks, so 16 days to go; then there will have to be a decision made... The other day the circuit entrained some air and in the 30 seconds or so it took to de-air it, she dropped her sats to the 30's, her heart rate went to 40 and her BP bottomed out. The team has not been able to change the circuit (which is full of fibrin, clots and precipitated-out lipids), and no one is willing to even contemplate it! I expect that once they stop the pump, she'll go to Heaven very quickly.

Anybody out there have experience with a prolonged run like this? What were the outcomes?

[joycgrl]

Duke University Medical Center, the University of North Carolina Medical Center, and the Boston and New york Hospitals all use RT's to run their pumps.

[Gompers]

The NICU where I worked as a nursing assistant during college did ECMO and they had both RNs and RTs trained on the machine.

[justjenny]

The RTs manage ECMO at Childrens Hosp. of Mich.

Jenny

[PICU-RN]

Not really. Had one on ECMO in March and they passed away. Had another one in May and is off ECMO, but on a vent still. Massive heart issues. Don't get a good vibe on this one either.

[janfrn]

Our little one who holds the record for the longest run of ECMO in our unit has finally gone to Heaven. She was on for 56 days, with no improvement whatsoever in her lungs, even with HFOV. She passed in her parents' arms very gently after the pump was stopped and she was extubated. Her dad, who had been very volatile throughout her stay with us, hugged the intensivist and thanked him for all our efforts in trying to make her better. It was all very bittersweet.