ECMO: Most Advanced ICU Technology?

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Two of the ICUs at my institution utilize ECMO. I have a very limited understanding of ECMO, including its value and prognosis of pts on it. I'm wondering though is ECMO the most advanced type of technology available to ICU pts?

Ecmo is an advanced life saving technology used for patients with heart and lung failure. This type of technology is not available at all hospitals. As mentioned, patients on Ecmo are very sick and require close monitoring and critical thinking. Attached is a good article about the types of patients on Ecmo and an idea about survival. ECMO Buys Time for Heart, Lung Patients | Heart and Vascular Center News Winter 2

BIS monitors are neat. Not wildly advanced tech but it's something you might use in the ICU when you paralyze a patient. They're not perfect by any means - and most people who regularly read EEGs think they're nonsense. But i think the future of this kind of technology is bright.

Specializes in Adult and pediatric emergency and critical care.

I think that many of the most "advanced" technologies have more to do with what we are using to change practice than the equipment itself. The availability of a bedside ultrasound that I can run (and I mean that in a literal sense) across the hospital with, boots up in 10 seconds, and we can perform imaging that helps to determine care decisions in minutes rather than hours. POC testing that gives a CBC, BMP, Blood gasses... etc in two minutes. Non-invasive cardiac output monitoring that can tell us SV, CO, and countless other hemodynamic parameters in seconds. Equipment becoming so mobile that I can truly have an ICU room in the ED, in the hallway, in CT, in MRI, and anywhere else we need it in the hospital. Widespread use of EHRs that we can pull outside data from. Moving towards secure phone connects so that we can have uncensored conversations with prehospital providers before they arrive.

Im not sure if I would say "most advanced" been around for a while.

depending on the type of ECMO of course.. If its initiated for the lungs (VV) I would say the a newer technology are the rotoprone beds. but that all depends on the facility and physician preference

Specializes in Cardiothoracic ICU.

I was reading and re-reading this question and responses all through last night and wanted to give my two cents. To start, as others have mentioned, it is rather difficult to adequately answer your question; it's vague, really, and so I am left wondering if you are broadly asking about ALL medical gadgets and technology, or simply the devices that are used in direct patient care. ECMO, in brief, is really quite amazing. VV cannulation takes de-oxygenated blood from the patient, runs it through a pump (of which there are different kinds, but most commonly seen are the centrifugal type), and subsequently runs it through an oxygenator membrane, then routes it back to the patient's venous system, bypassing the native lungs. VA ECMO follows the same series of events but subsequently returns the blood to the patient's arterial system, in a way bypassing both the heart and lungs. As stated by someone prior, this is cardiopulmonary bypass; this technology has been around for a while, just not necessarily used as commonly in the supportive ways we are seeing it used now.

Stepping back and thinking about this technology really is fascinating. Patient outcomes are variable, as with any invasive therapy. Some hospitals' programs are extremely selective about who they accept for ECMO in order to augment their positive outcome numbers (which, IMO, is deceitful and just rotten). Other hospitals will accept just about any ECMO case. We have had patients in our unit who are placed on ECMO to be later decannulated with little to no residual deficits. There are, however, definitely complications of this type of therapy, though, with your most obvious ones being clot formation (including stroking, or excessive bleeding with residual neurological deficits) and compartment syndrome resulting in limb amputation if fem-fem cannulation is used without proper monitoring.

However, as a nurse working in a unit where ECMO and other mechanical circulatory support devices are common place, I have to offer up an alternative for your "most advanced" technology, that being VADs. I am not going to get into specifics, but for those completely unfamiliar with VADs, the brief summary would be that they are what they say: ventricular assist devices. Some are temporary, some patients can go home on and carry on with their lives (although not without some changes, obviously) as opposed to being confined to a hospital bed on multiple inotropes until they do (or don't) get to the top of the transplant list, and some are what we call destination therapy. All in all, patient outcomes associated with VADs are a lot more positive than those placed on ECMO for support. Just my opinion, of course, and I'm sure there are others who would disagree. It's just hard to inclusively compare every technology across the board when they are supplementing various physiological functions and organs. VADs do not offer oxygenation benefits, but they do offload the ventricle(s) and augment overall cardiovascular function with resultant improvements in perfusion, even possible recovery of the ventricle(s). ECMO allows both the lungs and heart to recover, but looking at outcomes, it can be a grave picture.

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