ECMO

Pediatric Critical Care Columnist · May 7, 2006

faithmd, you say you're using ECMO less and less, but we seem to be using it more and more. We had two kids on V-A at the same time in March, but lately we've been running V-V ECMO mostly, usually after HFOV has failed. We successfully decannulated a baby last week who had a 34 day run for ARDS post living-related-donor liver transplant... kid went to the OR with a WBC of 26 and positive for adenovirus, parainfluenza and human metapneumovirus, but they HAD to do the transplant... Then yesterday we cannulated another little one who came in with adenovirus and rapidly deteriorated. Sats in the 30s by the time the surgeon got there to cannulate. Then last night we got a call from one of our referring hospitals in another province telling us they had a severe ARDS patient that they wanted to send us for ECMO. Our resources are getting pretty thin due to morale and management problems for both out ECLS specialists and our regular staff; people are either quitting the team (which isn't a dedicated team) or the entire unit in ever-increasing numbers. The overtime is unbelievable. And I think it will get a lot worse before it gets better.

Pediatric Critical Care Columnist · Jun 14, 2006

The child I referred to in my last post who had been cannulated for severe ARDS is STILL on V-V ECMO, day 40 now. The amount of sedation this child needs to prevent flow problems is unbelievable. She's still needing flows of 80-90 mL per kg and she is still failing her O2 challenges. Her ventilator pressures on rest settings are still very high (PIP 28, PEEP 15) and her x-ray is looking cystic. The team has agreed to keep her on for a total run of 8 weeks, so 16 days to go; then there will have to be a decision made... The other day the circuit entrained some air and in the 30 seconds or so it took to de-air it, she dropped her sats to the 30's, her heart rate went to 40 and her BP bottomed out. The team has not been able to change the circuit (which is full of fibrin, clots and precipitated-out lipids), and no one is willing to even contemplate it! I expect that once they stop the pump, she'll go to Heaven very quickly.

Anybody out there have experience with a prolonged run like this? What were the outcomes?

joycgrl · Jun 27, 2006

Duke University Medical Center, the University of North Carolina Medical Center, and the Boston and New york Hospitals all use RT's to run their pumps.

Gompers, BSN, RN · Jun 27, 2006

The NICU where I worked as a nursing assistant during college did ECMO and they had both RNs and RTs trained on the machine.

justjenny · Jun 27, 2006

The RTs manage ECMO at Childrens Hosp. of Mich.

Jenny

PICU-RN · Jul 1, 2006

Not really. Had one on ECMO in March and they passed away. Had another one in May and is off ECMO, but on a vent still. Massive heart issues. Don't get a good vibe on this one either.

Pediatric Critical Care Columnist · Jul 3, 2006

Our little one who holds the record for the longest run of ECMO in our unit has finally gone to Heaven. She was on for 56 days, with no improvement whatsoever in her lungs, even with HFOV. She passed in her parents' arms very gently after the pump was stopped and she was extubated. Her dad, who had been very volatile throughout her stay with us, hugged the intensivist and thanked him for all our efforts in trying to make her better. It was all very bittersweet.

PICNICRN, BSN, RN · Oct 8, 2006

I have been a PICU RN for 11 years an have worked at 3 different large children's hospitals as an ECMO nurse -all of which used RTs on pump. They were highly skilled and wonderful! You are no more responsible for their actions as you would be another RN's. Don't be afraid :)!

augigi, CNS · Oct 9, 2006

We have perfusionists running the pump (supervising in and out) and ECMO-trained RNs looking after the patients. We started using peripheral ECMO several years ago and now get fantastic results. Easy to put in, much better to bridge patients to VADs instead of getting multi-organ failure.

bwpcicuube · Oct 12, 2006

Actually all of the hospitals I have worked in the ECMO team consists of both RTs and RNs. The RT works under their own registered license and are not an RN responsibility.

JennieJenRN · May 23, 2007

Hello fellow U of Mer you should have not said anything:lol2: we had 3 up stairs a couple of days ago! and several in NICU.

ECMOismygame · Jun 4, 2007

so how stressful is it working on an ECMO team? how rewarding is it? does it ever get old? im currently in RT school and doing this type of work seems very interesting and i just want to get a better inside look from people who work on these TEAMS.

thanks