[janfrn]

Polednice, we take our ECMO patients on road trips all the time! We take them to CT when there's been a change in their neuro status, we take them to the cath lab to see if their hearts are recovering and we've even taken them to MRI. I haven't been on one of those and don't ever wish to! I can't even imagine the prep work required. On our road trips we usually take everything from the bedside except the vent, as is. Fitting everything into the elevator is always interesting... radiology is one floor below us. My last trip was to the cath lab. When everything that had to go with the patinet was in the elevator, along with two ECMO specialists, a cardiologist and two resp techs, I opted to take the stairs. I got there just as the doors opened.

With our new cardiac sciences building, we have a supersized elevator, but because the new building hasn't been commissioned yet, it hasn't been put into service. It would sure be nice to have it NOW!

[califalcon]

Originally Posted by Polednice

Hello!!

What an interesting topic with ECMO!! I'm sorry I can't contribute, just wonder... well, except a tiny bit. We had a 64 years old ECMO patient about two months ago. He was acutely admitted for massive ischemia of myocardium, with the major part of his heart out of work, and with 1 sqcm large hole in his ventricular septum. Those were just "our" diagnoses, cardiosurgical, further he suffered from severe renal failure and severe form of diabetes. They planned to operate on him, but first they wanted to find out what's in his head, so he had to be transported to CT within the area of our hospital. Our perfusionists managed to disconnect the pump and the oxygenator from the rest of the machine... and with only a source of oxygen...they fixed them to the pole of the patient's bed. Although they went just a few meters away, it cost the whole team nerves. Anyway, the patient had the brain's death diagnosed and soon afterwards his ECMO session was terminated.

I'm not sure this procedure is possible with all types of the machine and definitely not sure for how long can the patient cope without the ECLS heat exchanger / warming unit (Sorry, I don't know the exact term for this in English!)... but this one "survived" this transportation.

Thanks for the contribution....no matter how small it may seem now, in the future (Longer transports like from europe to the US) are possible (in a limited way now) but that is our intent...to make it available worldwide.

Manny (Califalcon)

[gal220RN]

I have absolutely seen RT's running ECMO circuits. The RN usually is running CVVH at the same time along with doing patient care. Better hope for a good working relationship among the two!

[gal220RN]

Just a comment about transporting on ECMO- damn! I had no idea that happened. I can't imagine the logistics.

Our institution is also very choosy about who meets criteria for ECMO. I know they want their successes to soar and usually I agree with their assessment about who has the greatest chance of successful decannulation. It seems our SIRS and MODS patients are the ones that have the poorest outcomes. Our severe pneumonias do the best, along with cardiac kids.

Kudos to you ECMO cowboys out there!

[Polednice]

Well, transporting ECMO... sounds more like a sci-fi to me! For our ECMO team it was a great deal to transport it across the tiny park we have between our dept and radiology! Not to imagine transporting it across the ocean!

As far as Czech health care system doesn't have position of RT, there are just the RNs (RNs, who are not afraid of the machine, rather than being specially trained! - The situation I am trying to change!), perfusionists and doctors to care about ECMO. And our outcomes depend on the state of the patient before the cannulation... our last two cases were really a "cowboy" things, because even before the cannulation they were literally dead, having only the brain stem at work... MODS and SIRS included. I wish I understood our criteria for ECMO!

[elizabells]

Originally Posted by Polednice

I wish I understood our criteria for ECMO!

My understanding, from the CNMC/ELSO ECMO Meeting this year, is that there really *aren't* any across-the-board criteria for ECMO. Oh, institutions may have guidelines, and there are certainly size limitations for equipment and such, but there's no universally recognized Standard of Practice. It started as such a cowboy thing that the old guard (including my hosp's Chief of Surgery, for full disclosure) are really wary of hard and fast rules about it. They had a breakout session at the conference to try to come up with universal guidelines that would apply to all ELSO members and people went NUTS. Like, literally walked out in a huff. We're putting smaller, younger gestational age kids on, keeping them on with Grade II bleeds, etc. Some of it's good, IMO, some of it's a little scary.

[gal220RN]

I think the thing to remember with ECMO or even HFOV is that these are rescue therapies, not standard treatment. When you reach the extent of the gold standards of treatment for very sick kids, all the bets should come off. I hate to think we are driven by success rates skewed by only accepting those patients we think can do well and eventually be decanulated. Our responsibility lies with providing the best care available. Sometimes, the most heroic intervention we can provide is a peaceful death. And sometimes we take the gamble and pray for miracles- and get them.

[janfrn]

No one wouild ever accuse our physicians of padding our stats. We're well-known (and perhaps ridiculed) for doing things that no other center will do, and that perhaps we shouldn't do either. Things like giving a kid with a past history of neuroblastoma (which has a significant risk of relapse and mets) a heart transplant. Things like listing an infant for a heart transplant when he has chronic renal failure and severe neurological damage. Like prolonging the life of a child with a lethal metbolic disorder indefinitely. As a member of our pediatric ICU M&M committee I get to hear all the gory details of the decisions made, the complications along the way and the ultimate outcome. But as heelgal says, there are some that surprise us and not only survive but thrive. So who's to say?