ECMO in the PICU or peds cardiac ICU

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Specializes in ICU, ED.

Just wondering....

Is ECMO done strictly in CVICU/pedsCVICU or can it be done in PICU? I am a PICU new grad RN who is absolutely fascinated by ECMO and hope that I will get to see it in action, and learn to take care of kids on it.

I know it all depends on the hospital, but I was just wondering if you all see ECMO in your PICUs

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Specializes in Pediatric critical care.

Hi! I'm a new grad too working in PICU!!! Our PICU does ECMO. I haven't seen it in action yet, but I start with my preceptor tomorrow so hopefully I will soon!!!

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Specializes in PICU/NICU.

ECMO can be used for MANY "non cardiac" patients- in fact, I have used it more in the non cardiac population. I have taken care of ECMO kids for many dx including aspiration pneumonia, chickenpox, chemical ingestion/aspiration, GVHD, ect. It can be used anytime "resting" the lungs(very simply put) for a short period of time can be beneficial. These are some of the most challenging pts- I LOVE it!!

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Specializes in NICU, PICU, PCVICU and peds oncology.

I've submitted an abstract to AACN for a presentation on the nursing care of the pediatric ECLS patient at next year's National Teaching Institute. I won't hear from them until October 10 but I'm assuming they'll just love me enough to give me a shot!

ECLS is usually not done in the general PICUs, because it's most often used in cardiac patients and the cannulations are most often done by cardiac surgeons. As well, there has to be a perfusion program at the facility as a rule. ECLS is a very complex therapy and consumes a LOT of resources. It is also one of those skills that needs to be practiced to keep sharp.

Our unit averages between 20 and 30 runs a year. Some runs have lasted weeks. More than once we've had several kids on at the same time. (See below for three!) The smallest child we've done recently was 2.1 kg, and the oldest was 17. It's a really interesting mode of treatment and if the run is going well, it can be very routine for both the ECLS specialist who runs the pump and for the bedside nurse who cares for the patient. When it's complicated, it can be the busiest and most intense experience of one's career. I've been to the cath lab, CT and the OR with patients on ECLS, I've been the bedside nurse when a child is cannulated, and a few have been recannulated, I've been there when the circuit filled with air... Those road trips are always the stuff of nightmares; anything can happen while you're out of the unit and it could be very ugly. You have to be very confident in your assessments and your skills to look after these kids, either as bedside nurse or ECLS specialist.

http://www.picu.med.ualberta.ca/images/EcmoPatients.jpg

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Specializes in NICU, PICU, PCVICU and peds oncology.

True, some of the most challenging ECLS patients are the respiratory ones. We have had an asthmatic need it twice (in the early fall in farm country!) and we've had a couple of babies with bad adenovirus. The resp kids tend to be on longer, one of ours was eight full weeks. (She died.) We've also run one child with ALL who had radiation pneumonitis. That was not a good outcome either. Then there was a child with hepatopulmonary syndrome post liver transplant. So yeah, we can't forget them.

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Specializes in Adolescent Psych, PICU.

I work in the PICU and we have ECMO on our unit, both types (cardiac/lungs and cardiac). Our PICU is a cardiac and a "regular" PICU.

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Specializes in Nursery, L&D, PICU, SICU.

Our PICU does both VA and VV ECMO ( mostly VV sine we have a CICU that does the cards cases.)

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Specializes in Pediatrics (Burn ICU, CVICU).

We do ECMO in our CVICU, PICU and NICU. We also do mobile ECMO. VA and VV.

Typically we have 4-6 ECMO's in house at any given time.

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Specializes in NICU, PICU, PCVICU and peds oncology.

Would you mind wandering over to this thread https://allnurses.com/forums/f95/nurse-patient-ratios-acuity-your-picu-326090.html and offering your two cents? Thanks!

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Specializes in Post Partum, PICU, CRRT, Divahood.

We do ECMO in both the PICU and CICU, mostly the PICU

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Specializes in PICU.

We also do ECMO in our PICU, we can have several pts at one time on the most we had on at one time in our unit was 4. We do it for all kinds of things, most recently we did it for C-A MRSA of the lung. We do VA and VV. Most of the time we have been coding the pts and it becomes a rapid deployment. Other times the pt has not tolerated the oscillator even with nitric so the move is made to ECMO.

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Specializes in NICU, PICU, PCVICU and peds oncology.

Our unit is pretty similar. In June we had three neonates s/p Norwood who needed ECLS for several days. Only one came out of the OR already on, one just didn't "look good" and one arrested on the cardiology ward with a torn PA who had 22 minutes of CPR while they cannulated. Our experience with respiratory ECLS is not great for older kids, many don't tend to survive.

RNNPICU, have you been to https://allnurses.com/forums/f95/nurs...cu-326090.html yet? I'd love to know your details.

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