Friedrich, Tammy

Disclaimer: These guidelines are intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing extracorporeal life support (ECLS)/ECMO and describe what are believed to be useful and safe practice for ECLS and ECMO. The aim of clinical guidelines was to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge, and expertise. These guidelines do not take the place of physicians’ and other health professionals’ judgment in diagnosing and treatment of patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or being deemed inclusive of all proper methods of care nor exclusive of other methods of care directed at obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient considering all the circumstances presented by the individual patient, and the known variability and biologic behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but ELSO is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.

Abstract Background: Extracorporeal membrane oxygenation (ECMO) therapy is proven to be efficient in a selected critically ill patient population and is showing promising results in refractory hypoxemia in the novel coronavirus disease (COVID-19). However, it necessitates specialized clinicians and advanced technological resources. While COVID-19 is an ongoing global emergency, there is no evidence-based practice in preparedness. This article proposes an innovative and optimized nursing care protocol, the Standard Operating Procedure (SOP), that increase safety, and prevents overuse of personal protective equipment (PPE) without interfering with therapy during ECMO in COVID-19 patients. Methods: A high-fidelity simulation scenario was developed. It included practicing safe and proper PPE donning and doffing during work organization, ECMO cannulation and ECMO-related procedures, and routine daily nursing care and management of patients on ECMO over nine hours. Results: Results were collected in three parts – proposal of nursing standardized operating procedures. They provide including work organization, work load references, competences and infrastructural conditions. Additionally, the cannulation equipment checklist proposal and daily routine nursing algorithm with other procedures during extracorporeal support were created.Conclusions: High-fidelity medical simulation can play an important role in staff training, improvement in previously gained proficiency, and development of optimal SOP for nursing care and management during ECMO in patients with COVID-19. Optimal SOPs may further guide multidisciplinary teams including intensive care units and interventional departments.

This column discusses the factors affecting hemostasis and the common coagulation studies used to assess patients with bleeding disorders.

Extracorporeal membrane oxygenation (ECMO) is used to treat severe hypoxemic respiratory failure and as a rescue therapy for patients with cardiopulmonary arrest within a narrow window of time. A failure modes and effects analysis (FMEA) was conducted to analyze the clinical and operational processes leading to delays in initiating ECMO. FMEA determined these highest-risk failure modes that were contributing to process failure: (1) ECMO candidacy not determined in time, (2) no or incomplete evaluation for ECMO prior to consult or arrest, (3) ECMO team not immediately available, and (4) cannulation not completed in time. When implemented collectively, a total of 4 interventions addressed more than 95% of the system failures. These interventions were (1) ECMO response pager held by a team required for decision, (2) distribution of institutionally defined inclusion/exclusion criteria, (3) educational training for clinicians consulting the ECMO team, and (4) establishment of a mobile ECMO insertion cart.

This column discusses the use of thromboelastographic studies when assessing patients with bleeding disorders. J Contin Educ Nurs 2008;39(1):14–15.