ECMO

  1. 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
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  2. 90 Comments

  3. by   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
  4. by   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.
  5. by   NotReady4PrimeTime
    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.
  6. by   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.
  7. by   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.
  8. by   Raquel1243
    Has anybody seen any positive results or good stories from kids who underwent ecmo? It doesn't happen often at my hospital.
  9. by   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.
  10. by   NotReady4PrimeTime
    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.
  11. by   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.
  12. by   Mags4711
    Just a reply from ECMO's birthplace. UM, We have RRT's and RN's on the ECMO staff. We regularly transport ON ECMO. Last year we did one from California to Michigan. The ECMO department also teaches an ECMO specialist course twice a year that you have to interview for. The class is several days and then concludes with an exam that if you pass allows you to become a back-up ECMO specialist at our institution. The course is also offered to RNs and RRT's.

    In terms of success, I offer a quote from an article published in the Detroit Free Press in January 2000:
    Of the first 1,000 patients with respiratory failure treated with ECMO since 1980, when data started to be collected, the survival rate is 88 percent among infants; 70 percent among children, and 56 percent among adults. The survival rate among patients with cardiac problems was 48 percent for children and 33 percent for adults...Each year, U-M hosts an ECMO picnic reunion, drawing more than 500 people. "We've watched many of the kids grow," Bartlett said. "Some have gotten to be good friends."

    Hope this offers some insight.

    Faith
  13. by   NotReady4PrimeTime
    Quote from Raquel1243
    Has anybody seen any positive results or good stories from kids who underwent ecmo? It doesn't happen often at my hospital.
    Further to my last post...

    The youngster I wrote about successfully separated from ECLS and despite the extremely poor condition he was in at the time it was initiated, he has recovered fully! This was the first pediatric patient to be transported on ECMO in Canada, and now we're developing an ECMO transport team. There were so many difficulties to overcome with this first effort, such as it being a major holiday in Canada and us not being able to access a Hercules cargo plane, and not having the appropriate means of moving the stretcher, pump and related equipment so having to improvise... The stretcher and pump wouldn't fit well into the referring centre PICU's sole elevator so they took the pump off the cart and sat it on the stretcher for that stage... and the fire department sent several brawny lads over to lift the equipment onto the flatbed they provided. Many lessons were learned and the plans are in the works.

    Sadly, the kiddie we have on now isn't likely to have the same outcome...
    Last edit by NotReady4PrimeTime on Jul 22, '04
  14. by   SarasLPN
    Are you at U of M? A woman who belongs to HopeforchildrenwithHLHS is there with her son. He has been off ECMO and is doing much better...it can be a great thing my child too is doing well after a 5 day sent on ECMO...


    Quote from faithmd
    Just a reply from ECMO's birthplace. UM, We have RRT's and RN's on the ECMO staff. We regularly transport ON ECMO. Last year we did one from California to Michigan. The ECMO department also teaches an ECMO specialist course twice a year that you have to interview for. The class is several days and then concludes with an exam that if you pass allows you to become a back-up ECMO specialist at our institution. The course is also offered to RNs and RRT's.

    In terms of success, I offer a quote from an article published in the Detroit Free Press in January 2000:
    Of the first 1,000 patients with respiratory failure treated with ECMO since 1980, when data started to be collected, the survival rate is 88 percent among infants; 70 percent among children, and 56 percent among adults. The survival rate among patients with cardiac problems was 48 percent for children and 33 percent for adults...Each year, U-M hosts an ECMO picnic reunion, drawing more than 500 people. "We've watched many of the kids grow," Bartlett said. "Some have gotten to be good friends."

    Hope this offers some insight.

    Faith

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