Extracorporeal membrane oxygenation in a Scottish intensive care unit

Abstract

I reflected on the training I had on an extraordinary treatment for profound respiratory failure. The result of training enabled us to successfully treat a young female with the influenza A virus with extracorporeal membrane oxygenation (ECMO). I report the positive outcome that occurred, while continuing to run a busy general intensive care unit (ICU). She was the first of six patients who were all successfully treated with ECMO. Ten trained and experienced critical care nurses and two doctors attended the ECMO training course provided by the national centre in the UK. Five patients had already received ECMO therapy in the Scottish specialist unit (over the period of 8 years). As our Scottish specialist unit purchased exactly the same equipment as the national centre, it was easier for the multidisciplinary team to utilize their new-found knowledge and treat future patients with ECMO. With the predicted swine flu (H1N1) pandemic and the subsequent demand for critical care beds, funding was obtained to facilitate ECMO training. The potential need for increased provision of ECMO therapies was highlighted by recent events in Australia and New Zealand. Their most recent winter produced 68 patients requiring ECMO, whereas the previous year had manifested only three. Using our new equipment and adapted protocols from the national centre, we used these new skills to treat our first patient in October 2009. Johns' reflective practice tool was used to evaluate the care provided. Our patient was on ECMO for 9 days. She went on to make a remarkable recovery and was discharged from the ICU 1 week after ECMO was discontinued. She was discharged to the cardiothoracic high-dependency unit, where she was successfully rehabilitated. We were able to successfully treat a young lady, while providing the care for all other patients. This was a complex treatment, one that uses many resources including time and finance. Now that we have all the equipment, the necessary training and the knowledge, we can continue to deliver this service to the public in our locality.

A cost-reducing extracorporeal membrane oxygenation (ECMO) program model: a single institution experience

“…On the other hand, concerns on the additional time needed to train new ECMO specialists and the possibility of adverse events deterred an institution from recruiting non-perfusionist staff as ECMO specialists [7]. The nurses in a Scottish ICU who were new ECMO specialists also reported the feeling of inadequacy and the need for regular competency tests to maintain their skills in managing the ECMO [6].…”

“…Ever since the inception of non-perfusionist personnel in the monitoring of ECMO patients, there were mixed opinions in the benefits of implementing a non-perfusionist run ECMO model [5,6,7]. The University of Michigan reported an expansion in the availability of ECMO with no adverse safety events or complications related to nurses in the Primary Care…”

“…This could potentially lead to the lack of confidence and the erosions of skills in handling ECMO patients [6]. To prevent this, we conducted regular competency tests and training courses.…”

“…Although this has been shown to expand ECMO availability, financial concerns have been reported in training all ICU providers' as potential ECMO specialists [5,6]. The failure of the ELSO guidelines has been to not recognize that dedicated ECMO specialists at the bedside are not the answer; a dedicated ECMO educated team at the bedside with up to date technology addresses the shortage.…”

Witnessing History: A Personal View of Half a Century in Public Health

“…57 Several patients required extracorporeal membrane oxygenation for profound respiratory failure. 58 Communicable disease challenges continued to dominate public health as the new millennium progressed. The highly transmissible Ebola virus, which had fi rst been identifi ed in 1976 and had been causing sporadic outbreaks in Africa, now gave rise to the largest-ever outbreak which ran from 2013-2016 in West Africa, resulting in a reported 28,616 cases and 11,310 deaths.…”