[3230]

I have been an ECMO R.N. for three years working side by side with another R.N.( one runs the pump the other doing pt. care) Now the PICU is training Respiratory Therapists to manage the pump. Does anyone else work in a hospital where this is common practice? Is nursing responsible for the actions (Comission or omission) of the therapist?wj

[ICUkids]

Never heard of RT's running the ECMO circuit. We send any ECMO pts to the ICN. They sometimes have a problem with the size issue (up to teenagers, but the PICU/ICN Critical Care Floats do the pt care side) we don't get enough ECMO pts to warrent training and maintaining competencies. In the ICN they have 2 RN's.
Diana

[HazelLPN]

Yes. Our ECMO patients are usually 2:1 care with a nurse responsible for patient care and an ECMO tech who runs the pump. The tech is either an RN, RRT or a perfusionist. The nurse caring for the patient is not in anyway responsible for the ECMO techs actions. I am an LPN so its rare that I take care of patients on ECMO, but it does not seem to matter if the tech is an RN or RRT on how good a job they do. There is always a perfusionist on call for emergencies. Techs have described the job as 95% boredom, 5% sheer terror.

[janfrn]

Our ECMO team has several RTs on it. The ones who do ECMO are very competent to do so. We always have an ECMO tech on the unit, and a primer on call.

[KailuaNurse]

Members of our ECMO Team are either RN's or RT. We don't usually have perfusionists doing it because they are in the OR (and we only have 3 on staff).

Our staffing Ratio is usually 2:1, however there have been times when the ratio is 3:1 (2 RNs to the pt) just because the kid is so sick.

[WedmathRN]

I work in a PICU that uses only RT's trained with perfusionists to run ECMO while the RN monitors the pt. I haven't worked there long, but I have found that the division of responcibility works well with the complicated pts. Not all of the RT's on the floor have the training to monitor the pump, but those that do are very competent.

[Raquel1243]

Has anybody seen any positive results or good stories from kids who underwent ecmo? It doesn't happen often at my hospital.

[heartICU]

I know the posting is for kids on ECMO but I have experience with adults on ECMO support. We do have some patients that are able to be weaned off and do well. Our patients who typically do better or on it for oxygenation reasons, not cardiac, mainly lung transplants. The ones who tend to have bad outcomes are often ones who have massive MIs in cardiogenic shock. I have no experience with pediatric ECMO...what are the indications for it?

We usually have ECMOs as 2:1...all of our nurses are trained as ECMO nurses, but we do have a perfusionist on call at home for emergencies.

[janfrn]

We have a kid on right now, who was successfully transported ON ECMO from another city !!! He's doing as well as can be expected. He's a cardiac patient and the ECLS is being used as a bridge to transplant, unless he's able to recover enough with the rest ECLS is giving him to hang on to his own.

Most of our ECLS patients are cardiac, since we are a major cardiac centre. Indications are post-arrest as bridge or to rest the heart and allow recovery, diaphragmatic hernia, rarely drowning, and we used it once to save a baby who had been frozen. Our outcomes aren't totally awful, but they're not as good as we'd like to see. So we're working on it.

[Elenaster]

Just to answer to OP's question....yes it is common practice at our Level I Trauma Center to have the Critical Care RRTs run the pump and the ICU RNs tend to the patient, whether the patient be adult or pediatric. We have 4 ECMO pumps and 1 backup, with the majority of ECMO cases done in the PICU or MICU.