Recommendations From the Professional Advisory Committee on Nursing Practice in the Care of ECMO–Supported Patients

Abstract

Background By July 2020, the Extracorporeal Life Support Organization had documented more than 133 000 extracorporeal membrane oxygenation (ECMO) implementations, with more than 61 000 implementations in adult patients. No clear policies regarding the authority and responsibility of nursing staff in the treatment of ECMO-supported patients are currently available. Objective To formulate evidence-based recommendations for nursing care of ECMO-supported patients. Methods The National Head Nurse’s office and the Professional Guidelines Department in the Nursing Division of Israel’s Ministry of Health formed the Professional Advisory Committee on Nursing Practice in the Care of ECMO-Supported Patients to address concerns regarding the current state of professional nursing practice in the care of these patients. The Professional Advisory Committee brought together 15 senior Israeli ECMO nursing experts who explored the potential of registered nurses in caring for ECMO-supported patients, considered the competencies of nurses treating ECMO-supported patients, discussed training programs and health care policy, and examined nursing outcomes for quality assurance. Results The Professional Advisory Committee formulated recommendations regarding the following priority issues: (1) determining boundaries of professional authority and nurses’ responsibilities, including designated activities for different professional ranks of registered nurses; (2) providing appropriate content for the training programs offered, such as generic/basic, above-basic, and clinical specialization nursing programs; and (3) defining relevant quality measures for nursing treatment of ECMO-supported patients. Conclusions Introducing international standards would ensure the safety and effectiveness of nursing care for ECMO-supported patients through quality and risk management and establishment of new evidence-based nursing practices.

Development of a Comprehensive Extracorporeal Membrane Oxygenation Program in a Cardiac Transplant Intensive Care Unit

“…Extracorporeal membrane oxygenation is continuing to become a popular therapy across the world, especially with the COVID pandemic. It is important for centers to continue to both address appropriate content for training programs to ensure evidence-based standards of practice are being taught to new ECMO specialists and define relevant quality measures for the nursing treatment of ECMO-supported patients 15 . The Extracorporeal Life Support Organization has published several articles describing ECMO treatment recommendations for centers to follow.…”

Developing a competency framework for extracorporeal membrane oxygenation nurses: A qualitative study

“…The guide for each group is not quite the same (File S2). The guides were developed based on the STAR principle of the CIT and literature review relating to nurses' roles, responsibilities and competencies in ECMO care (Alshammari et al, 2022; Daly et al, 2017; Melnikov et al, 2021). Two ECMO specialist nurses who met the participant selection criteria were invited to pre‐test the guide.…”

Implementing Nurse Extracorporeal Membrane Oxygenation Specialists to Maintain a Sustainable Program

“…A third model uses nurses or respiratory therapists to manage the ECMO devices independently of other responsibilities. 5 , 7 This program adopted a model that uses one bedside nurse with a 1:1 ratio to care for all aspects of the patient’s care while the NES manage the ECMO device. Our preferred ratio includes having each NES manage one or 2 ECMO devices, and our highest acceptable ratio is one NES to 4 ECMO devices.…”