RNs running ECMO on adult patients

[pbear]

I had my first patient on ECMO this past week. A very intense experience but one that was made much easier because a perfusionist was at the bedside 24/7. I knew next to nothing about ECMO, other than what is was being used for. I had a "crash course" for 10 minutes from our unit educator before taking over this very sick patient 45 minutes out of OR. I had a "helper" nurse who also was invaluable to run labs, help with IV's, and checking/hanging blood.

Now it seems I'm a seasoned veteran after two shifts of caring for this patient. I have been "asked" to attend a seminar so that I can run the ECMO myself. At first, I was a bit flattered then really got to thinking about it. Do I really want this responsibility? Do I really want to be on call 24/7 in case an ECMO case rolls through the door? Do I really want to save my department $$$ by doing this and getting no compensation for it myself?

I'm thinking NO!

I have heard that it is commonplace for RN's to run ECMO on adult patients. I just don't believe it. I think that is a perfusionist pervue and don't want the job, thank you very much.

What say you?

PBear

[MYSTICOOKIEBEAR]

You had a perfusionist at the bedside 24/7?! Lucky!!! My First deviced patient was an ECMO/IMPELLA. Mind you, I had never had either and lo and behold I had both, in front of me, in the same patient! Oh and as a kicker the patient was on CVVH as well. I would say learn about it it, get comfortable with it, become proficient with it, and then ask for the monetary compensation. It is a good experience that will ONLY make you a better Critical Care Nurse (in terms of skill set).

My sickest patient was an open chest VA ECMO, with a Tandem running the right, that went to OR to get the Tandem decannulated but ended up needing a balloon pump along with everything else including CVVH . So we had the Open chest with ECMO cannulas coming out of everywhere that were also Y'd together in the most random places and it literally took me 30 minutes to draw everything out to see what was pulling from where and returning into what part of the heart or the vasculature.

If you want a challenge, I would say go for the Gold. But if you are not comfortable or not ready, be honest, and let them know that.

[PMFB-RN, RN]

But as a BSN that went on to get my MS and CCP, I have to disagrees with your statement. VADs and ECMOs are not remotely the same.

I'm curious how much education about ECMO your received in your BSN program?

[ghillbert, MSN, NP]

Hi Ghillbert,

I can understand perhaps in your experience that an ECMO is just like a VAD. But as a BSN that went on to get my MS and CCP, I have to disagrees with your statement. VADs and ECMOs are not remotely the same.

I run a variety of VADs and ECMOs. From biVADs, HeartMate2, impellas, Syncardia TAHs, and using a cardiohelp for picking up ECMO/VAD patients.

Each curcuit, machine, and (obviously patient) is different. The insertion process and discussion and decision of which to use is quite complex. How can you say a post partem heart failure patient on a syncardia or heartmate2 that will go home with the device is anything like an ARDS ECMO patient?

I understand that while you watch them and chart every hour, it may feel the same. However, I've been in the room when RNs have described an ECMO/VAD as "just like dialysis".

Statements like "ECMO and VADs are the same" or it's just like IABP or dialysis show a major lack of understanding

I just saw this 1yr+ old post to me... trust me when I say with all due respect that I have worked all over the world with multiple ECMO and VADs, in many capacities: device engineer/CCRN/MCS coordinator/CRNP... "a major lack of understanding" is not something I suffer from.

How can you say a post partem heart failure patient on a syncardia or heartmate2 that will go home with the device is anything like an ARDS ECMO patient?

I am not sure what you read, but I did not say or suggest anything that even resembles that comment. I said a pump is a pump.

Obviously as I said, the tasks involved in MANAGEMENT of the devices differs according to your role. I did not address selection criteria, pathophysiologic etiology, insertion site or suggest that the patients are the same. I'm not suggesting a critical care nurse can manage a critical care patient on either of the devices independently, or that one patient population is not sicker than the other.

I maintain however that in terms of managing the DEVICE only in technical terms, ECMO and VAD are just the same. They are mechanical pumps. They may vary as axial/centrifugal or have hydrodynamically suspended or mag-lev rotors, but at the end of the day they are pumps. You can add oxygenators, or adjust cannulation sites, but they are still pumps. Speed, rpms/bpm and flow.

If you can learn one, you can learn the other.

My point was - re the OP's proposition: I would not do it as a new nurse, I wouldn't do it as an almost-new nurse, and I wouldn't do it for no extra money. But IF the training and compensation were appropriate, and the job role (hours, call etc) matched my interests, I would not advise permitting fear of a complicated device make the decision for me.

[catamounts30, BSN, RN]

Just take the class. I've seen some colleagues with very questionable skills running ECMO; of which we have to watch very closely; anybody can learn it.