new job on dedicated ECMO unit

Biffbradford · May 17, 2014

Well, here's my take on it, however warped it might be. ECMO patients are the sickest of the sick. For whatever reason, they are on cardio-pulmonary bypass for days, maybe a week. Sure, it's 'cool' technology, you have to manage all the drips (multiple stacks of pumps), the paralytic and sedation, watch the vent, perhaps on CVVH, even an IABP if they haven't pulled it yet. However, that's a person in there (somewhere). They have family, friends. Now, I guess 'survival' rates are somewhere between 30 and 50%, and some do very well (you can search on YouTube for ECMO stories). But if they do well, how will you know? I imagine that once they are off ECMO and stable, then they get transferred to a different ICU to make room for the next one. NEXT! You ask the NPs or PAs: "Hows Mr. Jones doing?" - Oh, fine. (That's all you get, HIPPA you know). If they do badly, then you know. It's YOUR problem! Personally, after almost 15 years of CVICU (including a healthy handful of ECMO patients), that's not what I want to look forward to every day. If you've got a tough spirit, would this be a great experience? You bet. Put in your couple of years, and move on. That's my 2 cents. I'm sure others have a different view.

meanmaryjean, DNP, RN · May 17, 2014

I do pediatric ECMO and LOVE it!

A couple questions you should ask- are you being hired to do 'pump side' or 'patient side'? In my world, a dedicated pump specialist runs the pump and CVVH - another person (me) cares for the patient. It takes oodles of training to run pump, and frankly- while I've been asked- it is NOT my thing. The 'patient side' nursing in ECMO is interesting, busy and difficult. Almost every drip you could imagine, lots of blood product on a frequent basis, and the logistics of patient care when you cannot really turn your patient in some cases. Our unit staffs ECMO cases on a 2:1 basis (one RN and one pump person per patient- pump person can be RN or RT)

ALSO, in my Peds ICU, the pump specialist is always in the room with the patient. In other words, the pump is never unattended. Ask about that as well.

Esme12, ASN, BSN, RN · May 20, 2014

Staffing ask about staffing

lafutura · May 23, 2014

honestly, i think it depends on the hospital/unit. where i work we seem to have quite good success with ecmo, but then again it also depends on if you're looking at v-v or v-a. i would agree that when they initially come to your unit, they are super super sick. but we've had patients on ecmo for quite some time and after a bit more and more machines and drips get removed and pretty soon you have patients that are up and walking around while on ecmo.

i think you have to ask yourself how specialized you want to be. i know i went from a generalized unit to a specialized one and often i wonder if i made the right choice. it works for some people, not for others - just depends on what fuels your fire, i guess.

and the advice to ask about patient side vs pump side and staffing are very important. we have perfusionists do our ecmo, so for me it really is just another machine in the room. if anything i have more involvement with a centrimag than i do an ecmo device.