Management of Extracorporeal Membrane Oxygenation for Obstetric Patients: Concerns for Critical Care Nurses

Critical care nurses are faced with many challenges, and one that is particularly stressful is caring for obstetric patients. This care can become more complex when the obstetric patient requires extracorporeal membrane oxygenation. It is imperative that critical care nurses have knowledge about this unique population, the expected physical changes of pregnancy, and the management of extracorporeal membrane oxygenation. Obstetric patients present unique challenges, and care is focused on the woman and her family. The purpose of this paper is to provide information for critical care nurses regarding care of obstetric patients who receive extracorporeal membrane oxygenation.

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Curriculum to Introduce Critical Care Nurses to Extracorporeal Membrane Oxygenation

American Journal of Critical Care ◽

10.4037/ajcc2020739 ◽

2020 ◽

Vol 29 (4) ◽

pp. 262-269

Author(s):

Whitney D. Gannon ◽

Lynne Craig ◽

Lindsey Netzel ◽

Carmen Mauldin ◽

Ashley Troutt ◽

...

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Reference Group ◽

High Volume ◽

Critical Care Nurses ◽

Care Nurse ◽

Membrane Oxygenation ◽

Written Examination ◽

Advanced User ◽

Before And After

Background Despite the growing use of extracorporeal membrane oxygenation (ECMO) in intensive care units (ICUs), no standardized ECMO training pathways are available for ECMO-naive critical care nurses. Objectives To evaluate a critical care nurse ECMO curriculum that may be reproducible across institutions. Methods An ECMO curriculum consisting of a basic safety course and an advanced user course was designed for critical care nurses. Courses incorporated didactic and simulation components, written knowledge examinations, and electronic modules. Differences in examination scores before and after each course for the overall cohort and for participants from each ICU type were analyzed with t tests or nonparametric equality-of-medians tests. Differences in postcourse scores across ICU types were examined with multiple linear regression. Results Critical care nurses new to ECMO (n = 301) from various ICU types participated in the basic safety course; 107 nurses also participated in the advanced user course. Examination scores improved after completion of both courses for overall cohorts (P < .001 in all analyses). Median (interquartile range) individual score improvements were 23.1% (15.4%-38.5%) for the basic safety course and 8.4% (0%-16.7%) for the advanced user course. Postcourse written examination scores stratified by ICU type, compared with the medical ICU/cardiovascular ICU group (reference group), differed only in the neurovascular ICU group for the basic safety course (percent score difference, −3.0; 95% CI, −5.3 to −0.8; P = .01). Conclusions Implementation of an ECMO curriculum for a high volume of critical care nurses is feasible and effective.

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Extracorporeal membrane oxygenation 2016: an update

F1000Research ◽

10.12688/f1000research.8320.1 ◽

2016 ◽

Vol 5 ◽

pp. 750 ◽

Cited By ~ 9

Author(s):

Warwick Butt ◽

Graeme MacLaren

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Critical Care Nurses ◽

Membrane Oxygenation ◽

Recent Trends ◽

Timing Of Initiation ◽

Novel Applications

The use of extracorporeal membrane oxygenation (ECMO) is an important issue for intensivists, critical care nurses, surgeons, cardiologists, and many others. There has been a continued increase in the number of centres performing ECMO. This review examines novel applications and recent trends in the use of ECMO over the last 2 years. These include ECMO to facilitate the safe use of other treatments, changing the timing of initiation, newer equipment and better biocompatibility, and the ability of ECMO programs to essentially choose which cluster of potential complications they are prepared to accept. ECMO continues to evolve, diversify in its applications, and improve in safety.

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Nursing Management of a Patient With COVID-19 Receiving ECMO: A Case Report

Critical Care Nurse ◽

10.4037/ccn2021929 ◽

2021 ◽

pp. e1-e10

Author(s):

Nestor Neil A. Peig ◽

Erica Djen ◽

Marielle Garalza ◽

Caroline Given ◽

Jasmine Henderson ◽

...

Keyword(s):

Critical Care ◽

Acute Respiratory Distress Syndrome ◽

Case Report ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Critical Care Nurses ◽

Nursing Management ◽

Membrane Oxygenation ◽

Venovenous Extracorporeal Membrane Oxygenation

Introduction Venovenous extracorporeal membrane oxygenation has been recommended as an effective rescue therapy for select critically ill patients with COVID-19. This case report describes a first experience caring for a patient with COVID-19 who received venovenous extracorporeal membrane oxygenation and expands the literature by discussing relevant nursing management and operational considerations. Clinical Findings A 46-year-old man presented to a hospital emergency department with pleuritic chest pain, dyspnea, anorexia, and chills. The patient was intubated for pneumonia-associated acute respiratory distress syndrome. Diagnosis A nasopharyngeal swab specimen was positive for SARS-CoV-2, and chest radiography confirmed a diagnosis of COVID-19 with acute respiratory distress syndrome. Interventions After no improvement with mechanical ventilation and prone positioning, the patient began receiving venovenous extracorporeal membrane oxygenation and was transferred to an extracorporeal membrane oxygenation center. Frontline critical care nurses played a vital role in coordinating patient care activities, monitoring changes in the patient’s condition, and detecting complications early. Outcomes The patient was decannulated on day 15 and extubated on day 17. The patient was successfully discharged home on hospital day 24. Conclusion Caring for a patient with COVID-19 receiving venovenous extracorporeal membrane oxygenation posed unprecedented challenges that required deviations from standards of care to optimize infection control measures and staff safety while providing quality care. This case report may inform, prepare, and guide other critical care nurses who will be caring for similar patients during this pandemic.

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Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant: Considerations for Critical Care Nursing Practice

Critical Care Nurse ◽

10.4037/ccn2020918 ◽

2020 ◽

Vol 40 (3) ◽

pp. 49-57

Author(s):

Brittany Koons ◽

Jennifer Siebert

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplant ◽

Quality Care ◽

Critical Care Nurses ◽

Critical Care Nursing ◽

Membrane Oxygenation ◽

Transplant Patients ◽

High Acuity

Topic Candidates waiting for lung transplant are sicker now than ever before. Extracorporeal membrane oxygenation has become useful as a bridge to lung transplant for these critically ill patients. Clinical Relevance Critical care nurses must be prepared to care for the increasing number of lung transplant patients who require this advanced support method. Purpose of Paper To provide critical care nurses with the foundational knowledge essential for delivering quality care to this high-acuity transplant patient population. Content Covered This review describes the types of extracorporeal membrane oxygenation (venovenous and venoarterial), provides an overview of the indications and contraindications for extracorporeal membrane oxygenation, and discusses the role of clinical bedside nurses in the treatment of patients requiring extracorporeal membrane oxygenation as a bridge to lung transplant.

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A Case Report of Combat Blast Injury Requiring Combat Casualty Care, Far-Forward ECMO, Air Transport, and All Levels of Military Critical Care

Military Medicine ◽

10.1093/milmed/usab354 ◽

2021 ◽

Author(s):

Lydia C Piper ◽

Jason J Nam ◽

John P Kuckelman ◽

Valerie G Sams ◽

Jeffry D DellaVolpe ◽

...

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Whole Blood ◽

Operative Management ◽

Blast Injury ◽

Esophageal Injury ◽

Resuscitative Thoracotomy ◽

Membrane Oxygenation ◽

Combat Casualty ◽

Cord Injury

ABSTRACT We describe a 34-year-old soldier who sustained a blast injury in Syria resulting in tracheal 5 cm tracheal loss, cervical spine and cord injury with tetraplegia, multiple bilateral rib fractures, esophageal injury, traumatic brain injury, globe evisceration, and multiple extremity soft tissue and musculoskeletal injuries including a left tibia fracture with compartment syndrome. An emergent intubation of the transected trachea was performed in the field, and the patient was resuscitated with whole blood prehospital. During transport to the Role 2, the patient required cardiopulmonary resuscitation for cardiac arrest. On arrival, he underwent a resuscitative thoracotomy and received a massive transfusion exclusively with whole blood. A specialized critical care team transported the patient to the Role 3 hospital in Baghdad, and the DoD extracorporeal membrane oxygenation (ECMO) team was activated secondary to his unstable airway and severe hypoxia secondary to pulmonary blast injury. The casualty was cannulated in Baghdad approximately 40 hours after injury with bifemoral cannulae in a venovenous configuration. He was transported from Iraq to the U.S. Army Institute of Surgical Research Burn Center in San Antonio without issue. Extracorporeal membrane oxygenation support was successfully weaned, and he was decannulated on ECMO day 4. The early and en route use of venovenous ECMO allowed for maintenance of respiratory support during transport and bridge to operative management and demonstrates the feasibility of prolonged ECMO transport in critically ill combat casualties.

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The Role and Impact of Extracorporeal Membrane Oxygenation in Critical Care

Methodist DeBakey Cardiovascular Journal ◽

10.14797/mdcj-14-2-110 ◽

2018 ◽

Vol 14 (2) ◽

pp. 110

Author(s):

Iqbal Ratnani ◽

Divina Tuazon ◽

Asma Zainab ◽

Faisal Uddin

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation

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Evolution of the United States Military Extracorporeal Membrane Oxygenation Transport Team

Military Medicine ◽

10.1093/milmed/usaa215 ◽

2020 ◽

Vol 185 (11-12) ◽

pp. e2055-e2060

Author(s):

Matthew D Read ◽

Jason J Nam ◽

Mauer Biscotti ◽

Lydia C Piper ◽

Sarah B Thomas ◽

...

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Demographic Data ◽

The United States ◽

Published Data ◽

Medical Treatment Facility ◽

Membrane Oxygenation ◽

Transport Distance ◽

Primary Indication ◽

The U.S

Abstract Introduction The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients. Materials and methods We conducted a single-center retrospective review of all patients transported by the sole U.S. military ECMO program from September 2012 to December 2019. We analyzed basic demographic data, ECMO indication, transport distance range, survival to decannulation and discharge, and programmatic growth. Results The U.S. military ECMO team conducted 110 ECMO transports. Of these, 88 patients (80%) were transported to our facility and 81 (73.6%) were cannulated for ECMO by our team prior to transport. The primary indication for ECMO was respiratory failure (76%). The range of transport distance was 6.5 to 8,451 miles (median air transport distance = 1,328 miles, median ground transport distance = 16 miles). In patients who were cannulated remotely, survival to decannulation was 76% and survival to discharge was 73.3%. Conclusions Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.

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