scholarly journals Needs Assessment and System Design of an Extracorporeal Membrane Oxygenation Simulation Learning System

2021 ◽  
Author(s):  
Kai-Ling Chi ◽  
Shwu-Fen Chiou
Keyword(s):  
Intensive Care Unit ◽  
Extracorporeal Membrane Oxygenation ◽  
System Design ◽  
Learning System ◽  
Learning Needs ◽  
Membrane Oxygenation ◽  
System A ◽  
Knowledge Practice ◽  
Simulation Learning ◽  
Self Examination

Nurses require training to manage extracorporeal membrane oxygenation (ECMO). Thus, the aim of this study is to investigate intensive care unit nurse needs and design an ECMO simulation learning system. A systemic needs analysis included interviews and a literature review. Nurses had three learning needs: pre-ECMO placement care, daily care during placement, and care for preparation of removal. The system design includes ECMO care knowledge, practice in simulations, and self-examination with a flexible learning methodology.

Outcomes of pediatric oncology and hematopoietic cell transplant patients receiving extracorporeal membrane oxygenation

Perfusion ◽  
2019 ◽  
Vol 34 (7) ◽  
pp. 598-604
Author(s):  
Danielle K Maue ◽  
Michael J Hobson ◽  
Matthew L Friedman ◽  
Elizabeth AS Moser ◽  
Courtney M Rowan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Membrane Oxygenation ◽  
Transplant Patients

Background/objectives: There is controversy regarding the utilization of extracorporeal membrane oxygenation in pediatric patients with an underlying oncologic diagnosis or who have undergone hematopoietic cell transplant. We hypothesized that these patients have higher mortality, more bleeding complications, more blood product utilization, and a higher rate of new infections than the general pediatric intensive care unit population supported with extracorporeal membrane oxygenation. Design/methods: This is a retrospective chart review at a single center quaternary care pediatric hospital including all pediatric intensive care unit extracorporeal membrane oxygenation patients from 2011 to 2016. Patients were categorized as either oncology/hematopoietic cell transplant or general pediatric intensive care unit. Patients from the cardiovascular intensive care unit or the neonatal intensive care unit were excluded. Results: A total of 38 patients met inclusion criteria of which 7 were oncology/hematopoietic cell transplant patients. The oncology/hematopoietic cell transplant group had lower platelets at the start of extracorporeal membrane oxygenation (p = 0.02) but other pre-extracorporeal membrane oxygenation characteristics were similar. Extracorporeal membrane oxygenation survival was lower in the oncology/hematopoietic cell transplant group (29% vs 77%, p = 0.02). The incidence of bleeding complications and new infections did not differ. The oncology/hematopoietic cell transplant group received more platelets (median of 15.9 mL/kg/day (interquartile range 8.4, 36.6) vs 7.9 mL/kg/day (3.3, 21.9), p = 0.04) and fresh frozen plasma (14.0 mL/kg/day (3, 15.7) vs 1.8 mL/kg/day (0.5, 5.9), p = 0.04). Conclusion: Oncology and hematopoietic cell transplant patients had a higher mortality and received more blood products while on extracorporeal membrane oxygenation than the general pediatric intensive care unit patients despite similar pre-extracorporeal membrane oxygenation characteristics. Physicians should use caution when deciding whether or not to utilize extracorporeal membrane oxygenation in this population.

scholarly journals Mobile extracorporeal membrane oxygenation service for severe acute respiratory failure – A review of five years of experience

2019 ◽  
Vol 21 (2) ◽  
pp. 134-139 ◽  
Author(s):  
Ada M Krzak ◽  
Jo-Anne Fowles ◽  
Alain Vuylsteke
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Qualitative Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Equipment Failure ◽  
Quality And Safety ◽  
Regular Reflection ◽  
Membrane Oxygenation

Provision of extracorporeal membrane oxygenation as part of support escalation in severe refractory acute respiratory failure in England is provided by five specialist centres that operate within a well-defined quality and safety framework. We conducted a qualitative study of the extracorporeal membrane oxygenation retrieval service provided by one of the five centres. We analysed 176 consecutive debrief reports written between October 2013 and April 2018 by the consultant. Main identified issues were short delays in retrieval predominantly due to insufficient communication or equipment failure. All issues were addressed in subsequent practice. Our results suggest a need for improved communication between the referring intensive care unit and retrieving team. Our findings highlight the value of regular reflection-based evaluation to ensure continued provision of safe and efficient service.

Learning curve for multidisciplinary team setup in veno-venous extracorporeal membrane oxygenation for acute respiratory failure

Perfusion ◽  
2019 ◽  
Vol 34 (1_suppl) ◽  
pp. 30-38 ◽  
Author(s):  
Hye Ju Yeo ◽  
Woo Hyun Cho ◽  
Dohyung Kim
Keyword(s):  
Intensive Care Unit ◽  
Confidence Interval ◽  
Extracorporeal Membrane Oxygenation ◽  
Learning Curve ◽  
Odds Ratio ◽  
Discharge Rate ◽  
Intensive Care Unit Discharge ◽  
Unit Discharge ◽  
Membrane Oxygenation ◽  
Cumulative Sum Analysis

Background: Quality control is essential for a successful extracorporeal membrane oxygenation program. We investigated the learning curve for outcome improvement and focused on factors associated with failure of extracorporeal membrane oxygenation treatment. Methods: Between August 2011 and May 2017, 150 patients were supported with veno-venous extracorporeal membrane oxygenation for acute respiratory failure. The learning curve was examined using cumulative sum analysis. We defined successful extracorporeal membrane oxygenation treatment as intensive care unit discharge, acceptable failure rate as 40%, and unacceptable failure rate as 60%. We chronologically divided patients into three periods with 50 consecutive patients each and retrospectively compared the clinical outcomes by period. Results: Overall, weaning and survival to discharge rates were 72.7% and 56%, respectively. Cumulative sum analysis indicated that the extracorporeal membrane oxygenation team achieved nearly acceptable performance after 56 cases and consistently acceptable performance after 104 cases. Clinical outcomes were improved by period: weaning rate (58% vs. 80% vs. 80%, p = 0.017); intensive care unit discharge rate (42% vs. 60% vs. 78%, p = 0.001); survival to discharge rate (40% vs. 58% vs. 70%, p = 0.010); and 1 year survival rate (40% vs. 56% vs. 70%, p = 0.010). In multivariate analysis, infection (odds ratio: 4.54, 95% confidence interval: 1.83-11.27, p = 0.001), immune compromise (odds ratio: 5.78, 95% confidence interval: 1.66-20.14, p = 0.006), extracorporeal membrane oxygenation team period (odds ratio: 2.12, 95% confidence interval: 1.14-3.92, p = 0.017), and age (odds ratio: 1.09, 95% confidence interval: 1.05-1.14, p < 0.001) were associated with extracorporeal membrane oxygenation failure. Conclusion: More than 100 cases of extracorporeal membrane oxygenation experience were necessary for acceptable performance and stabilization of outcomes.

scholarly journals Physical Rehabilitation of Patients in the Intensive Care Unit Requiring Extracorporeal Membrane Oxygenation: A Small Case Series

2013 ◽  
Vol 93 (2) ◽  
pp. 248-255 ◽  
Author(s):  
Rod A. Rahimi ◽  
Julie Skrzat ◽  
Dereddi Raja S. Reddy ◽  
Jennifer M. Zanni ◽  
Eddy Fan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Physical Function ◽  
Case Series ◽  
Physical Rehabilitation ◽  
Care Utilization ◽  
Rehabilitation Therapy ◽  
Membrane Oxygenation

Background and Purpose Neuromuscular weakness and impaired physical function are common and long-lasting complications experienced by intensive care unit (ICU) survivors. There is growing evidence that implementing rehabilitation therapy shortly after ICU admission improves physical function and reduces health care utilization. Recently, there is increasing interest and utilization of extracorporeal membrane oxygenation (ECMO) to support patients with severe respiratory failure. Patients receiving ECMO are at great risk for significant physical impairments and pose unique challenges for delivering rehabilitation therapy. Consequently, there is a need for innovative examples of safely and feasibly delivering active rehabilitation to these patients. Case Description This case report describes 3 patients with respiratory failure requiring ECMO who received physical rehabilitation to illustrate and discuss relevant feasibility and safety issues. Outcomes In case 1, sedation and femoral cannulation limited rehabilitation therapy while on ECMO. In the 2 subsequent cases, minimizing sedation and utilizing a single bicaval dual lumen ECMO cannula placed in the internal jugular vein allowed patients to be alert and participate in active physical therapy while on ECMO, illustrating feasible rehabilitation techniques for these patients. Discussion Although greater experience is needed to more fully evaluate the safety of rehabilitation on ECMO, these initial cases are encouraging. We recommend systematically and prospectively tracking safety events and patient outcomes during rehabilitation on ECMO to provide greater evidence in this area.

scholarly journals H3N2 Virus as Causative Agent of ARDS Requiring Extracorporeal Membrane Oxygenation Support

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Adriano Peris ◽  
Giovanni Zagli ◽  
Pasquale Bernardo ◽  
Massimo Bonacchi ◽  
Morena Cozzolino ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Extracorporeal Membrane Oxygenation ◽  
Influenza A ◽  
Seasonal Influenza ◽  
Influenza Season ◽  
Influenza Viruses ◽  
H3n2 Virus ◽  
Membrane Oxygenation ◽  
Viral Aetiology ◽  
Increased Risk

Pandemic influenza virus A(H1N1) 2009 was associated with a higher risk of viral pneumonia in comparison with seasonal influenza viruses. The influenza season 2011-2012 was characterized by the prevalent circulation of influenza A(H3N2) viruses. Whereas most H3N2 patients experienced mild, self-limited influenza-like illness, some patients were at increased risk for influenza complications because of age or underlying medical conditions. Cases presented were patients admitted to the Intensive Care Unit (ICU) of ECMO referral center (Careggi Teaching Hospital, Florence, Italy). Despite extracorporeal membrane oxygenation treatment (ECMO), one patient with H3N2-induced ARDS did not survive. Our experience suggests that viral aetiology is becoming more important and hospitals should be able to perform a fast differential diagnosis between bacterial and viral aetiology.

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