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Discussion

ECMO

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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Well, transporting ECMO... sounds more like a sci-fi to me! For our ECMO team it was a great deal to transport it across the tiny park we have between our dept and radiology! Not to imagine transporting it across the ocean!

As far as Czech health care system doesn't have position of RT, there are just the RNs (RNs, who are not afraid of the machine, rather than being specially trained! - The situation I am trying to change!), perfusionists and doctors to care about ECMO. And our outcomes depend on the state of the patient before the cannulation... our last two cases were really a "cowboy" things, because even before the cannulation they were literally dead, having only the brain stem at work... MODS and SIRS included. I wish I understood our criteria for ECMO!

I wish I understood our criteria for ECMO!

My understanding, from the CNMC/ELSO ECMO Meeting this year, is that there really *aren't* any across-the-board criteria for ECMO. Oh, institutions may have guidelines, and there are certainly size limitations for equipment and such, but there's no universally recognized Standard of Practice. It started as such a cowboy thing that the old guard (including my hosp's Chief of Surgery, for full disclosure) are really wary of hard and fast rules about it. They had a breakout session at the conference to try to come up with universal guidelines that would apply to all ELSO members and people went NUTS. Like, literally walked out in a huff. We're putting smaller, younger gestational age kids on, keeping them on with Grade II bleeds, etc. Some of it's good, IMO, some of it's a little scary.

I think the thing to remember with ECMO or even HFOV is that these are rescue therapies, not standard treatment. When you reach the extent of the gold standards of treatment for very sick kids, all the bets should come off. I hate to think we are driven by success rates skewed by only accepting those patients we think can do well and eventually be decanulated. Our responsibility lies with providing the best care available. Sometimes, the most heroic intervention we can provide is a peaceful death. And sometimes we take the gamble and pray for miracles- and get them.

  • Experts

No one wouild ever accuse our physicians of padding our stats. We're well-known (and perhaps ridiculed) for doing things that no other center will do, and that perhaps we shouldn't do either. Things like giving a kid with a past history of neuroblastoma (which has a significant risk of relapse and mets) a heart transplant. Things like listing an infant for a heart transplant when he has chronic renal failure and severe neurological damage. Like prolonging the life of a child with a lethal metbolic disorder indefinitely. As a member of our pediatric ICU M&M committee I get to hear all the gory details of the decisions made, the complications along the way and the ultimate outcome. But as heelgal says, there are some that surprise us and not only survive but thrive. So who's to say?

I just wanted to thank all the posters in this thread. I know it's old but it has been so enlightening to read, particularly after working in a major cardiac and transplant centre that uses a lot of ECMO in a senior clinical.

on a previous post up above, HFOV as heroic measures?

  • Experts

Nah, not usually. Well, not beyond the whole mechanical-life-support-heroic-measures menu. It's a very effective short-term treatment for many reversible conditions and would be a step or two below ECMO on the escalation ladder.

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