Reviewed and updated by Robin Haskell, MSN, RN, CRNP: August 19, 2024
My first experience with extracorporeal membrane oxygenation (ECMO) occurred when I was a new nurse in the intensive care unit. ECMO therapy was being utilized as a bridge to left ventricular assist device (LVAD) placement for a patient in cardiopulmonary shock following open-heart surgery. This large academic hospital had the essential mix of clinical expertise and resources to employ the latest life-saving technologies.
To say I was in awe is an understatement. I knew patients were commonly placed on bypass for surgery, however implementing this high-risk machinery at the bedside for days, and sometimes weeks, was simultaneously fascinating and frightening. Even as I gained experience, it was always stressful to care for patients on ECMO. Twenty years later, while ECMO remains a highly specialized therapy, more hospitals are adopting this temporary form of life support for a wider variety of clinical indications.
What exactly is ECMO? (Abrams, 2023)
ECMO is used for both cardiac and pulmonary failure when conventional measures are no longer effective to support life. Rather than providing a cure for the underlying disease process, ECMO delivers oxygen-rich blood to vital organs, which gives the heart and lungs time to repair. During ECMO, blood is drained from the patient’s vascular system and then circulated outside the body by a mechanical pump through an oxygenator and heat exchanger. Carbon dioxide (CO
2) is removed and oxygen-saturated blood is returned to the body.
The one major contraindication for ECMO is a pre-existing condition that would prevent recovery, such as severe neurological injury or end stage cancer. Relative contraindications include uncontrolled bleeding and poor prognosis from a primary diagnosis. For patients with severe acute respiratory failure, research has shown that ECMO should be used early in the course of a patient’s illness (within the first seven days) rather than employing it as a rescue therapy.
Patients on ECMO are among the sickest of the sick. The patient’s room will be full of an array of highly trained staff and advanced life support technologies: the ECMO machine, a ventilator, continuous dialysis, infusion pumps, etc. While this technology may be very intimidating, much of the nursing care of ECMO patients consists of the fundamental elements of intensive care given to all critically ill patients: calibrated accurate invasive monitoring, administration of vasoactive drugs to support blood pressure and heart rate, the use of care bundles to prevent ventilator-associated pneumonia and vascular access-related infection, monitoring the effectiveness of sedation and neuromuscular blocking agents, and diligent skin care and pressure injury prevention.
The challenges of caring for ECMO patients are offset by the rewards. ECMO nurses are in high demand and never stop learning. There is tremendous satisfaction in witnessing patients recover from such devastating illness.
To learn more, check out the additional reading and resources below as well as the
guidelines provided by the
Extracorporeal Life Support Organization.
References:
Abrams, D. Agerstrand, C., Fried, J., & Brodie, D. (2023, July 19). Extracorporeal life support in adults in the intensive care unit: Overview. UpToDate. https://www.uptodate.com/contents/extracorporeal-life-support-in-adults-in-the-intensive-care-unit-overview
Fowles, J. & Hadley-Brown, A. (2023). Nursing care of the patient on extracorporeal membrane oxygenation. In, Cardiopulmonary Bypass. Academic Press, pp 1041-1053. https://doi.org/10.1016/B978-0-443-18918-0.00067-X.
Naddour, M., Kalani, M., Ashraf, O., Patel, K., Bajwa, O., & Cheema, T. (2019). Extracorporeal Membrane Oxygenation in ARDS. Critical care nursing quarterly, 42(4), 400–410. https://doi.org/10.1097/CNQ.0000000000000280
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