ECMO

Pediatric Critical Care Columnist · Jul 22, 2004

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...

SarasLPN · Nov 28, 2004

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...

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

Mags4711, RN · Dec 3, 2004

Yes I am at UM. HLHS presents so many other problems in itself, but I am very glad to hear that both of these children are doing well.

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...

anndor · Jan 5, 2005

We have relatively good ECMO results, as we are very choosey about who goes on. We do both adult and paed patients, and the circuit is nearly always run by an ECMO nurse specialist with perfusion back-up (on call). The patient is cared for by an RN, who has very little to do with the circuit. The two nurses have quite seperate roles. We don't have RTs at our hospital. The patients who have the best results are neonates with meconium aspiration. Our cardiac kids do fairly well, too. Adults with overwhelming pneumonias do best as adults. We haven't had good results with lung transplants on ECMO.

CarVsTree · Jan 30, 2005

Out of curiosity, how is the prognosis for kids on ECMO? Do they usually have permanent deficits? Do they ever fully recover? I'm sure circumstance plays a lot, but just curious.

TIA.

Pediatric Critical Care Columnist · Jan 30, 2005

One of our nurses just completed a multi-year study on kids who have received major invasive life-saving treatment to look at developmental outcomes. They looked at a lot of things: ECMO, the Norwood procedure and organ transplants being some of them. It seems to me that most of our ECMO survivors have some deficits, particularly in math skills; whether they can directly be attributed to ECMO isn't clear, because most of these kids were in cardiac arrest for some time before being cannulated and put on bypass. I'm sure it's something that will be reexamined in the future.

Pediatric Critical Care Columnist · Feb 14, 2005

We've once again successfully transported a child on ECMO from another city. This time we had access to amilitary cargo plane which made it all so much easier. This child is an infant, and the sending facility does not have equipment or supplies to run ECMO on one so small. They're to be commended for their improvisational skills and the excellent care provided to this child until we could get her to our unit. Time will tell the outcome, but for now, it looks like it will be fine.

Super RT · Nov 29, 2005

Has anybody seen any positive results or good stories from kids who underwent ecmo? It doesn't happen often at my hospital.

We actually had a baby cannulated twice due to Diaphragmatic hernia that went home. The baby had a g-tube, but from what I understand, the baby is doing fine!

JenACNPICU · Apr 5, 2006

I have never heard of RT's running an ECMO circuit. Only a portion of our PICU staff (all are RN's) are trained in ECMO. I have been certified for almost 5 years. I also teach the lab with another co-worker. I will keep posted to see if other centers are doing this... I will also talk with our ECMO Coordinators. Why is your center looking at using RT's???

indagenes · Apr 5, 2006

To answer 3230's ? and Raquel's ?. I worked at a Level one Trauma Center

for 3 years in the PICU. RRTs who had advanced training and passed a

hospital-designed exam on ECMO were called ECMO techs. The ECMO patient was thus cared for with 2:1 care by ECMO tech and RN. It's a small

circle of people who do this type of care, so we helped each other out, within the limits of our legal scope of practice. (i.e., ecmo tech would help move patient when giving baths, help monitor hemodynamics.) I have a lot

of respect for most of the ECMO techs I worked with. The only ones I did

not care to work with were the techs who were too cavalier about

what they were doing. (Being cavalier with ECMO just because it can get

boring is folish and IMHO an indication of ignorance.)

Raquel: We did have success at my institution with ECMO, but primarily ONLY when the guidelines for the initiation of ECMO were properly observed.

Some of the peds CT surgeons used ECMO as a means of prolonging the

patient's life in the face of nearly inevitable negative outcome; the pt. would clearly not meet the criteria for ECMO, yet the surgeons would put them on it anyway. Those are the patients that almost always died. I could go on and on about the medical ethics issue with regards to ECMO, but I'll refrain for now.

jenpicuRN · Apr 17, 2006

At our hospital, RTs are on the pump while the RN treats the patient. The RT can leave unless relieved by another trained RT. The RT has to become certified in ECMO. The perfusionist comes in to set up the pump and then reports off to RT because he has to go back to surgery.

Mags4711, RN · May 6, 2006

I have never heard of RT's running an ECMO circuit. Only a portion of our PICU staff (all are RN's) are trained in ECMO. I have been certified for almost 5 years. I also teach the lab with another co-worker. I will keep posted to see if other centers are doing this... I will also talk with our ECMO Coordinators. Why is your center looking at using RT's???

Here at UM, our ECMO Specialists are either RN's *or* RRT's. Tehy do have to go through a training course and pass a test. (RRT, big distinction!)

A couple of times a year the ECMO program actually holds an ECMO class for other ICU-trained staff (RN's and RRT's) who are interested in being on-call as ECMO back-up. The class is taken on your own time, and there is again an exam that must be passed, then there is an orientation and a sign-up requirement. It isn't used as much as it once was, but it happens occasionally (the back-up, I mean). It seems we are doing less and less ECMO.