[PICNICRN]

I have been a PICU RN for 11 years an have worked at 3 different large children's hospitals as an ECMO nurse -all of which used RTs on pump. They were highly skilled and wonderful! You are no more responsible for their actions as you would be another RN's. Don't be afraid !

[augigi]

We have perfusionists running the pump (supervising in and out) and ECMO-trained RNs looking after the patients. We started using peripheral ECMO several years ago and now get fantastic results. Easy to put in, much better to bridge patients to VADs instead of getting multi-organ failure.

[bwpcicuube]

Actually all of the hospitals I have worked in the ECMO team consists of both RTs and RNs. The RT works under their own registered license and are not an RN responsibility.

[JennieJenRN]

Hello fellow U of Mer you should have not said anything we had 3 up stairs a couple of days ago! and several in NICU.

[Ventjock]

so how stressful is it working on an ECMO team? how rewarding is it? does it ever get old? im currently in RT school and doing this type of work seems very interesting and i just want to get a better inside look from people who work on these TEAMS.

thanks

[janfrn]

I'm not on the ECMO team, but I am one of the primary RNs who provide nursing care to the patient on ECMO. We have an average of 12-15 runs a year, ranging from a few days to 8 weeks. Our ECLS specialists typically work only 6 hour shifts on the pump; they're very busy for much of the time. The entire circuit is inspected hourly looking for air, fibrin and clots. The activated clotting time of the blood in the circuit is tested hourly as well. All bloodwork is interpreted by the ECLS specialist and any blood products required by the patient are ordered by them. Only albumin and packed cells are given via the circuit; everything else (platelets, cryoprecipitate, fresh frozen plasma, anti-thrombin III, and often packed cells too) are given on the patient side by the nurse. The ECLS specialist has his/her own documentation. A stable run can be "boring" because everything is routine. But there are a variety of complications that can occur. The circuit can clot off, or entrain a bunch of air, the pump can fail, the circuit can spring a leak, the cannulae can become dislodged... and the patients usually bleed A LOT, even when everything goes well. I've been the bedside nurse for all of these except the pump failure. Sometimes the patient needs surgical intervention, such as a mediastinal wash-out for tamponade, or to be recannulated. And sometimes they have to go for CT scan or to the cath lab... that's a waking nightmare. It can be very stressful at times. But it never gets old. I spent two days with a toddler a couple of weeks ago who was being bridged to transplant. We had to open his chest on the first day; the second day was quieter but it gave me a chance to educate the family about heart transplants and to provide emotional support. I was off for nine days to attend a conference, and when I came back he'd had his transplant and was doing well. Love it!

[bbluvnursing]

Our RT's do not run the ECMO pump on my unit... just one RN running the pump and the other doing pt. care

[Polednice]

Hello!
I am so sorry for having found this forum this late!! I would like to share my experience with ECMO and read your comments just to learn how to manage better! Well, ECMO occurs in my ward (Cardiosurgery Post-op Intensive Care) two or three times a year. Our nurse to patient ratio is 1:1 and we have also at least one OR perfusionist on call. Now I have my second ecmo patient under the care. The first one survived it successfully, being weaned in two weeks...but with this one...well...we have a hard time with his anticoagulation management. We take patient's ACT and APTT every 3 hours, with all the other coagulation factors every 24 hours and consult the results with a doctor and some perfusionist, and according to them we change the speed of heparin infusion (usually 15,000IU/50ml). But despite the care we give the matter, blood started to coagulate in the oxygenator. First on the arterial pole of the membrane and when this started to disappear another clotting on the venous pole occured. Even if there was DIC diagnosed in my patient, the clotting appeared 5 days earlier. Has it ever happened to you as well?? How did you manage then??

[janfrn]

Our ECMO patients are monitored much more closely for DIC and other clotting abnormalities. ACTs are done hourly; PT, INR, fibrinogen and platelets are run q8h, and antithrombin III levels are run at least once a day. It's not uncommon for us to be giving platelets q8h, giving AT III daily and tweaking coags with FFP and cryoprecipitate as needed. Packed red cells are given as needed to maintain hemoglobin within our target range. Our ECLS orders give very detailed instructions about where our targets are and what to do if they're not met; the ECMO specialist has a good deal of autonomy in decision-making in those situations. We rarely have problems with the circuit clotting off although we may have fibrin deposits or stable clots in the venous limb. We ran a patient on V-V ECMO for eight weeks on a single circuit a couple of years ago.

We do a lot more ECMO than you do in your unit, Polednice. We might do 30 runs in a year, and a while back we had three kids on at the same time. We have one right now, an infant with a complex defect who came from the OR yesterday on ECMO. She had surgical bleeding that required the CV surgical staff to come in at 11 pm to re-explore her chest, which was done right in the unit. By morning she was much more stable. Our ECMO patients survive about 90% of the time, and the majority of those do so without major neurological insult.

[Polednice]

<P>Janfrn, I have to admit I envy you all the experience you have with ECMO!! We deal with adult patients only and ECMO is the last possible therapy we can offer as a heart support when other means fail to help. And we mostly privide A-V extracorporeal oxygenation. But as you can see, there are not many opportunities for the whole team&nbsp;to gain more experience, with just two or three cases per year occuring. But still, our OR perfusionists with&nbsp;a help from haematology specialist&nbsp;are now trying to work out some standards, too. I wish we'd had them before the first problems appeared!! </P>
<P>Is there any possibility I could have a look at your dept. standarts?? I would really appreciate it! </P>
<P>And one more question: Do you avoid using acetylsalycylate with ECMO patinents?</P>
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