Awake, alert, oriented & non ventilated...on ECMO?? - page 3

by umcRN | 20,410 Views | 28 Comments

Just a random question. I was doing some research on my own and stumbled across this youtube video: I don't know who the child is or why she is on ECMO but what caught me off guard was that she was sitting up, not... Read More


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    I do ECMO in the adult world and if the patient is cannulated through the neck with a cannula that can both take blood out and push blood back in (like a giant dialysis catheter). We have them out of bed and when we can they are extubated and can eat. This is not often as it can only be used for respiratory failure. Our AV ECMO is almost always cannulated in the groin and this patients can't sit up so are usually kept intubated and sedated
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    Lately we've had a couple of patients facing long-term V-A ECMO and had Berlin heart cannulae placed instead of conventional ECMO cannulae. These cannulae allow the patient to be up and walking around because of where they're placed. They tunnel through the upper abdominal wall and have Dacron velour covers that create a very secure bond with the skin and tunnels. Of course, going for walks is a huge undertaking!

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    Quote from janfrn
    Lately we've had a couple of patients facing long-term V-A ECMO and had Berlin heart cannulae placed instead of conventional ECMO cannulae. These cannulae allow the patient to be up and walking around because of where they're placed. They tunnel through the upper abdominal wall and have Dacron velour covers that create a very secure bond with the skin and tunnels. Of course, going for walks is a huge undertaking!

    How long term are we talking, Jan?

    Thanks in advance for the info. This stuff fascinates me!
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    Indefinitely... months or more!
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    Janfrn I always read your posts with curiosity and interest. Thanks so much for sharing your expertise with us.
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    @janfrn: You all ran ECMO through the VAC cannula? Thats interesting. What Size? and how much flow are you getting through it? I guess if it is VAD cannula you are pulling from the LV and infusing to the AO? If so, there is no need for a membrane oxy. I think I would like working at your hospital!

    To others about the equipment. It is important to know the difference between the machine (console) and the ECMO circuit. You can have a big bulky console that takes up a lot of floor space but still have a small circuit. The console is just the machine that has the controls on it . Some of them have big integrated computer systems that control a lot of things from a touch screen, etc. Like janfrn said the quadrox and centrifugal pumps have helped us all decrease the amount of blood in our circuit and decrease the amount of plastic surface that the patient comes in contact with. These things help the lungs stay clear rather than whiting out. With clear lungs we are able to have patients extubated and talking while on ECMO.
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    Quote from AUicuRN
    @janfrn: You all ran ECMO through the VAC cannula? Thats interesting. What Size? and how much flow are you getting through it? I guess if it is VAD cannula you are pulling from the LV and infusing to the AO? If so, there is no need for a membrane oxy. I think I would like working at your hospital!
    This patient actually had 4 cannulae because originally we tried biVAD Berlin support and it didn't do the job. I'm trying to remember where they were going... the LVAD circuit was LV to aorta and the RVAD circuit was RV to PA if memory serves. There was an oxygenator because the patient's lungs weren't in good shape and we were also running CRRT into the circuit. It was a complex case. Recently we placed a Heartware device in a pediatric patient for the first time and it was a roaring success... patient was discharged home with it. We do some very creative things here.
    umcRN likes this.
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    I know the original post here is a little old, but I just stumbled across it. At my center, we actually had our first pediatric ECMO patient to be extubated not too long ego (VA ECMO). I'm not sure whether this has been done before in the US on a pediatric patient, but I know it was our first. This patient was cannulated through the neck. It was a pretty amazing (and scary!) thing to be able to witness! Really awesome for the family to be able to interact with their child as opposed to him needing to be sedated and/or paralyzed the for the whole ECMO run.
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    I saw my first paediatric ECMO patient this week.

    The last time I posted in this thread I was a student nurse. I've now been a registered nurse for six months - a new grad on the neurosurgery ward and about to commence my second six month rotation of my program in the paediatric intensive care unit. There's a baby in our CICU on ECMO at the moment and the nurses that work there organised for me to go and see the patient and the circuit.

    I'll be very interested to start on my first day in CICU on this week and see the baby's progress. At the end of the week they were looking at decreasing the flows on the circuit to see whether the baby would maintain his own MAP/circulation. He was six days old and cannulated at roughly 6-8 hours of age.

    I don't really know much about ECMO at all (having seen it a few times in adults and this being my first time in a paediatric patient) but I'm interested to learn more.. Though of course I won't be looking after these patients for a very long time to come. This thread has been so interesting and informative to read so thanks to everyone who has contributed.


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