ECMO for Complex Adult Patients

Introduction

ECMO has emerged as a therapeutic approach to managing complex adult patients with severe respiratory and cardiac failure. This unconventional life-support method has received attention in recent years. ECMO allows the heart and lungs to rest and heal using a machine. It oxygenates and removes carbon dioxide from the patient’s blood via a membrane. The patient receives oxygenated blood for essential support. ECMO can support cardiac and respiratory failure patients for recovery or further treatment. ECMO improves oxygenation and circulation, saving patients with few therapeutic alternatives. ECMO has dangers. Bleeding, clotting, infection, and organ damage may occur. Physicians, percussionists, respiratory therapists, pharmacists, and nurses must collaborate to address these hazards. Each member monitors patients, manages equipment, administers prescriptions, and handles difficulties. ECMO nurses are vital. They monitor patients, check vital signs, manage ECMO equipment, provide drugs, and assist patients and families. Nurses educate patients about ECMO, its risks and advantages, and post-ECMO rehabilitation. ECMO patients need education.

Explanation and Background

Extracorporeal membrane oxygenation is a medical technique that oxygenates and removes carbon dioxide from patients. It involves oxygenating a patient’s blood outside the body before returning it. This method allows the lungs or heart to rest and recuperate, saving people who cannot respond to traditional treatments. ECMO is used in the critical care unit (ICU) and needs particular skills to operate and monitor patients. ECMO may help patients with severe acute respiratory distress syndrome (ARDS), cardiogenic shock, post-craniotomy failure, and other disorders that fail conventional care (Flécher et al., 2019). ECMO medication considerations vary. Artificial surfaces may activate the body’s clotting cascade. Hence ECMO circuits must be anticoagulated. To balance clotting and bleeding, coagulation parameters must be monitored. ECMO patients get sedation and analgesia. ECMO safety involves careful circuit control, infection avoidance, vital sign and laboratory parameter monitoring. ECMO circuit management must avoid air or clot embolism, optimize blood flow, and reduce circuit problems. Aseptic procedures and circuit adjustments lessen bloodstream infection risk. Vital signs, oxygenation levels, blood gases, electrolytes, and coagulation factors must be monitored continuously to detect changes and problems (Ulrich et al., 2019). Multiple variables affect ECMO cost. These include support length, case complexity, and local healthcare regulations. ECMO involves sophisticated equipment, skilled medical staff, and constant monitoring. ECMO costs include equipment, staff, and money for addressing problems like infections and bleeding.

Risks and Benefits

ECMO supports crucial organ function and gives patients a chance to recover. This lifesaving method may improve patient outcomes. ECMO rests and heals the heart and lungs by boosting oxygenation and circulation (Flécher et al., 2019). ECMO bridges recovery. ECMO may support organ function during medical treatments in serious circumstances. ECMO may temporarily sustain severe respiratory insufficiency or cardiac dysfunction. ECMO may also bridge lung or heart transplants. ECMO may keep patients alive as they wait for organ transplants. This raises the odds of successful transplantation and gives the patient time to stabilize, improving post-transplant outcomes. ECMO has drawbacks. ECMO may cause bleeding, infection, organ failure, thrombosis, and hemolysis. These problems need careful prevention and monitoring (Ulrich et al., 2019). Anticoagulation prevents bleeding. Continuous blood flow via artificial tubing and membrane oxygenators causes clotting in ECMO circuits. Anticoagulant medication must be carefully maintained to preserve circuit patency and reduce bleeding. ECMO care also requires infection prevention. Invasive lines and catheters used in ECMO must be inserted and maintained aseptically. Prevention requires regular infection screening and timely treatment (Ulrich et al., 2019). Monitoring organ dysfunction provides prompt intervention. Healthcare personnel may quickly diagnose organ failure by monitoring vital signs, laboratory data, and clinical conditions. Prompt intervention reduces problems and aids organ recovery.

Interdisciplinary Team’s Roles and Responsibilities

The interdisciplinary team include respiratory therapists, assistive staff, critical care providers, case managers, clinical nurse specialists, and researchers. Each team member has a role in patient care. Respiratory therapists manage the ECMO circuit, ventilate patients, check blood gases, and troubleshoot equipment. They ensure ECMO system performance and patient respiratory condition. ECMO teams benefit from nursing assistants and technologists (Tonna et al., 2021). They help shift and position patients, check vital signs, and clean and maintain the surroundings. They let other team members concentrate on more specialized responsibilities. Intensivists, cardiologists, and cardiac surgeons monitor patient care. They initiate and wean ECMO, alter medicines, and direct patient care. Case managers handle patient care and team communication. They aid with discharge planning, multidisciplinary meetings, and care transitions from the ICU to other facilities or homes. ECMO nurses are critical care experts. They offer specialized treatment, train employees, enhance quality, and adopt evidence-based methods. ECMO researchers study and promote evidence-based practice. They improve ECMO results and comprehend this brutal treatment (Tonna et al., 2021). ECMO nurses have several roles. They evaluate hemodynamic state, monitor vital signs, administer medicines, give psychological support to patients and families, and work with other team members to maximize treatment. Nurses connect patients, families, and the multidisciplinary team. Communicating and coordinating with an interdisciplinary team is difficult (Ulrich et al., 2019). To overcome this issue, roles and duties should be clearly defined so everyone knows their role in patient care. Interdisciplinary gatherings enable open dialogue, cooperation, and problem-solving. Maintaining continuity of care requires good shift handoff communication and patient transfers.

Nursing Scope of Practice

ECMO nurses must understand critical care, physiology, ECMO principles, and joint problems. These nurses must understand the ECMO circuit, the equipment, and troubleshooting. They should also be able to continuously evaluate, and maintain hemodynamic stability, provide drugs, monitor the ECMO circuit, and detect problems (Ulrich et al., 2019). These nurses must be flexible, adaptable, and collaborative to ensure multidisciplinary team coordination and optimum treatment. Registered nurses must be trained in ECMO, a lifesaving treatment for severe respiratory or heart failure. Nurses may deliver personalized treatment and interventions by remaining current on critical care principles. ECMO’s physiological processes and effects on bodily systems must be well understood. Nurses should also understand ECMO fundamentals, including how the circuit works, what each component does, and how to fix frequent problems. This understanding lets them see and fix issues quickly (Tonna et al., 2021). Nurses must constantly examine ECMO patients and the circuit. They should be skilled in managing hemodynamic stability, adjusting medications, and recognizing and treating ECMO-related problems. Nurses must also collaborate with doctors, respiratory therapists, and percussionists. Interdisciplinary cooperation improves patient outcomes through coordinating treatment.

Patient Education

ECMO Patient and family education play a vital role. To improve knowledge and results, it covers several crucial themes. ECMO’s role in preserving organ oxygenation and perfusion during critical sickness must be explained (Flécher et al., 2019). Additionally, patients and their families must be informed of the predicted duration of ECMO support to ensure they comprehend the probable length of treatment and its consequences. Education should also include ECMO problems. By being informed, patients and families may better anticipate and recognize these potentially harmful outcomes. Emphasize the family’s support, involvement, and engagement in the patient’s rehabilitation. Weaning patients and families requires education. As the patient recovers, ECMO assistance is reduced and eventually discontinued (Tonna et al., 2021). Review weaning criteria, obstacles, and possible treatments or assistance to moderate expectations. Verbal explanations, visual aids, and textual resources may help educate. To communicate clearly and culturally, language limitations and health beliefs must be considered (Ulrich et al., 2019). Return demonstrations, open-ended inquiries, and patient feedback are needed to evaluate training success.

Conclusion

ECMO provides crucial organ support and the possibility of recovery for patients with severe respiratory and cardiac failure. ECMO use is risky. Thus, ECMO patients need a cohesive multidisciplinary team, including nurses, to enhance results. Nurses require ECMO-specific knowledge, abilities, and attitudes to offer high-quality treatment. Patient education ensures understanding, adherence, and active participation in care. Nurses examine, monitor, and care for ECMO patients. They must understand ECMO principles, indications, and problems. Nurses must also handle ECMO monitoring devices, blood pumps, and oxygenators. Nurses need technical skills and critical thinking to detect and react to patient changes. Nurses educate patients and their families on the goal, process, and possible results of ECMO treatment. Nurses can calm patients, resolve concerns, and promote teamwork by providing straightforward answers. Patient education also encourages compliance and decision-making.

References

Flécher, E., Guihaire, J., Pozzi, M., Ouattara, A., Baudry, G., Berthelot, E., … & Lebreton, G. (2019). Extracorporeal membrane oxygenation support in acute circulatory failure: A plea for regulation and better organization. Archives of cardiovascular diseases, 112(6-7), 441-449.

Tonna, J. E., Abrams, D., Brodie, D., Greenwood, J. C., Mateo-Sidron, J. A. R., Usman, A., & Fan, E. (2021). Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): a guideline from the extracorporeal life support organization (ELSO). ASAIO journal (American Society for Artificial Internal Organs: 1992), 67(6), 601.

Ulrich, B., Barden, C., Cassidy, L., & Varn-Davis, N. (2019). Critical care nurse work environments 2018: findings and implications. Critical Care Nurse, 39(2), 67-84.