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Extracorporeal Membrane Oxygenation (ECMO)
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Introduction
Since its introduction in the 1970s, the successful utilization of “Extracorporeal
Membrane Oxygenation (ECMO)” is widely welcomed by medical professionals. As ECMO is
both a high-risk and intrusive procedure, its effective implementation requires the cooperation of
many different types of medical professionals (Makdisi & Wang, 2015). The application of
ECMO aids in the maintenance of normal respiratory and the heart (Guglin, et al., 2019).
Extracorporeal membrane oxygenation (ECMO) relies on “cardiopulmonary bypass technology,
which redirects venous blood via an extracorporeal circuit and back into the body through a
semi-permeable membrane” (Puslecki, et al., 2021).
Mrs. B, 45, had difficulty breathing because she had contracted the covid-19 virus. After
two weeks of mechanical ventilation, the patient had not shown any signs of improvement.
Urgent medical attention was required due to the inability of oxygenated blood to be pumped out
of the patient's heart and into their lungs, the patient ultimately passed away. The decision to
start Mrs. B on ECMO was made to help her. Throughout the period from December 2019 to
March 2020, 30.5 million illnesses and 950,000 fatalities were attributed to the COVID-19 viral
pandemic (Trikha et al., 2021). Because just around 5 percent of those infected with COVID-19
could be saved without resorting to extreme measures, it is safe to say that this virus poses a
significant public health risk. Provisional recommendations for ECMO were made for very ill
patients Those infected with COVID-19 who had a poor response to assisted ventilation (ELSO,
2021). Extracorporeal membrane oxygenation (ECMO) was utilized to treat a total of 14950
individuals with Covid-19. ("Extracorporeal Life Support Organization") (Bertini, et al., 2022).
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Explanation and Background
ECMO is cutting-edge medicine put to use for the benefit of patients in severe condition.
While a patient is on ECMO, the machine functions similarly to a set of lungs, mostly by
simulating the lungs' ability to exchange gas. After being hooked up to the ECMO machine, a
patient will have their blood removed from their body and placed in the machine. The gadget
exchanges the carbon IV oxide already present in the patient's blood with oxygen. VAECMO
(Venoarterial) and VV-ECMO (Venovenous) are two types of extracorporeal membrane
oxygenation (Puslecki, et al., 2021). Patients on the covid-19 protocol get VV-ECMO. Premature
infants commonly have this problem since their lungs have not fully formed. Nonetheless, it is
very important to remember that starting VV-ECMO requires a healthy circulatory system. To
clarify, during VVECMO, blood is removed from the patient's veins, sent through the ECMO to
be oxygenated, and then returned to the patient's systemic venous circulation (Huang, et al.,
2021).
Because to lung damage, patients with Covid-19 often suffer from “hypoxic respiratory
failure”. When a patient has a pulmonary problem, VVECMO may be used to temporarily
replace their lungs (Huang, et al., 2021). A patient's lungs may rest, recuperate, and mend while
on VV-ECMO. In order to rescue the patient, the VV-ECMO equipment may be weaned off and
the patient can be restored to their native pulmonary function.
Risks and Benefits
The use of ECMO is not without potential complications and advantages. However,
ECMO is only used for the most critically sick patients due to the high level of risk involved.
Individuals whose hemoglobin oxygen saturation levels have not improved after seven to
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fourteen days of mechanical ventilation. The biggest danger of ECMO is that patients have a
30% chance of bleeding due to the need of using bulky catheters. For this reason, heparin is
given before, during, and after ECMO procedures to eliminate the risk of blood clots (Warren, et
al., 2020).
Critically sick individuals may benefit from ECMO because it keeps their organs
working. The ECMO system's portability and adaptability are enhanced by the machine's small
size. It may thus be transported to the bedsides of very sick patients (Warren, et al., 2020). As the
patient is now stable and on the road to recovery, they may be moved to a hospital for further
ECMO therapy. It is crucial that the ECMO protocols be followed to the letter. In addition, there
must be constant communication between the many specialists involved and close observation of
the patient's reaction to any abnormalities. A patient's adherence to their prescribed medicine is
also crucial for the avoidance of complications.
Interdisciplinary Team’s Roles and Responsibilities
In ECMO, a multidisciplinary group is essential. Nonetheless, it is fairly uncommon for a
patient to need treatment more than once, which might be harmful if the drug being administered
is itself repeated. This is due to the team's inability to effectively communicate with one another.
“Specialists in extracorporeal membrane oxygenation (ECMO) surgery and medicine,
cardiologists, respiratory therapists, intensive care unit nurses, dietitians, pharmacists, intensive
care unit consultants, and medical perfusionists and pump technicians make up the
interdisciplinary team responsible for this therapeutic modality” (Warren, et al., 2020). An
extracorporeal membrane oxygenation (ECMO) specialist will implant a catheter in the groin or
the neck. It is common practice to have a cardiologist present during cardiac surgery to monitor
the patient's heart, assess the patient's health, and ultimately choose whether or not to proceed
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with the procedure. The equipment is operated by respiratory therapists, who also adjust the
settings to meet the needs of each particular patient.
The intensive care nurse will do an evaluation and keep close tabs on the patient in order
to ensure they'll get the most out of the gear. They help in monitoring for problems like bleeding
and infection as well. It is the responsibility of the intensive care unit nurse to ensure that the
patient is as relaxed as possible before, during, and after the procedure by maintaining a steady
position, relieving pressure points, monitoring vital signs and other observations at regular
intervals, responding quickly to any complications that arise, and keeping the doctors in the loop.
The role of the dietician is to ensure the patient is eating enough nutritious food to support their
body's functions. The pharmacist verifies that the individual has enough supplies of tranquilizers,
anticoagulants, and pain medications. The consultant working in the ICU has to be reachable at
all times (Warren, et al., 2020). This necessitates leaving the patients' information at the bedside.
All ECMO-related medical decisions are made by an ICU specialist. When ECMO is first
started, the medical perfusionist as well as pump technician provide nursing assistance, prime the
circuits, and keep the machines running smoothly.
Nursing Scope of Practice
The ECMO nursing paradigm requires a nurse with experience in the ICU, but not
necessarily competence in ECMO. The nurse, however, has to be familiar with ICU regulations
and very ill patients. A nurse-to-patient ratio of one-to-one is recommended during ECMO
treatment. The patient's vital signs will be monitored and interpreted accurately, the IV line will
be established and maintained properly, a thorough physical examination will be conducted,
communication with the patient and their loved ones will be maintained, and patient education
will be offered. An RN with an interest in extracorporeal membrane oxygenation (ECMO)
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should possess a variety of skills and knowledge bases. First, you should be able to identify a
normal range for a person's temperature, a normal skin tone, the absence or abnormality of pedal
pulses and capillary refill, and hematuria (Kiersbilck et al., 2016). The nurse is also responsible
for ensuring the circuit is in good working order and reporting any leaks or seeping, checking
that the patient's ventilatory goals are being fulfilled, determining a starting point for
anticoagulant treatment, and measuring the patient's respiration rate.
The medical care provider’s skill in repositioning the patient should be excellent. In
addition, the medical care provider should manage to do a complete evaluation to exclude the
appearance of complications. The medical care provider must also be familiar with antibiotics
and other treatments for preventing stress ulcers (Warren, et al., 2020). It is essential that the
nurse be capable of connecting and maintaining the circuit. Throughout the ECMO process, the
nurse's focus must also be on the patient's requirements and comfort. The nurse's duties include
both carrying out the doctor's instructions and offering advice based on their observations.
Hence, this is helpful for patient care and guarantees a rapid recovery (Baran, 2017).
Patient Education
Educational possibilities may be beneficial not just to the patient, but also to the patient's
loved ones. It teaches kids how to become an integral part of the trip. When a patient is placed on
extracorporeal membrane oxygenation (ECMO), it is important to let their loved ones know that
they will be sedated in order to relax and recuperate. It is essential to persuade the patient's
relatives that the bloated look of the patient is due to the need of more fluids being consumed.
Because of this, it is possible that the patient may need to have a nasogastric tube inserted in
order to be fed while they are receiving ECMO treatment. It is also essential to provide patients
with information on the possible adverse effects of the drug (Baran, 2017). It is possible that they
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have a reduced oxygen level, which may be addressed with "nasal cannula oxygen treatment",
which they can use either at home or while they are traveling. Fatigue, brought on by
compromised lung function, is another issue that may be addressed with rigorous physiotherapy.
Patients using ECMO also need breathing support. Briefing the patient about the
procedure and its execution is therefore crucial. Before beginning therapy, it’s vital to make sure
the patient as well as their family members recognize the seriousness of the circumstance and
know what to expect. The patient and their loved ones must be aware that extracorporeal
membrane oxygenation (ECMO) is not a curative but a supportive technique. The change in the
patient's physical appearance from the administration of fluids and blood should be part of the
patient's educational process (Guglin, et al., 2019). It's typical for the patient to seem puffy. The
patient's loved ones will have a deeper comprehension of the treatment process if they are able to
keep track of their loved one's improvement.
The provision of information to patients on the need of personal hygiene is equally
essential. In order to keep diseases at bay, the family should be encouraged to practice good
hygiene. It's important to practice infection control measures including hand washing, wearing a
mask, donning a sterile gown, and covering one's head (Warren, et al., 2020). The surrounding
area must to be tidy as well. The patient should not be exposed to anybody in the family who has
the flu or a cold. In order to guarantee that the knowledge is retained, it is crucial that it be
conveyed vocally via visual arts. While educating patients, it is important to take their cultural
background into account. This is significant because there are faiths and civilizations that view
the application of contemporary technology or artificial assistance to the human body with great
suspicion (Makdisi & Makdisi, 2017). Several cultures and faiths have myths and
misunderstandings about the proper use of technology. As a result, it's important to dispel myths
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and provide direction to the sufferer and their loved ones. This aids in their comprehension of
ECMO's significance.
Conclusion
In the event that mechanical ventilation fails, the patient's lungs and heart may be
protected from overuse with the use of ECMO therapies. The method facilitates lung healing.
ECMO has the potential to relieve stress on the heart and lungs, facilitating rest and
rehabilitation. Patients' ability to recover from the coronavirus has been greatly aided by ECMO.
A proper level of monitoring is necessary for patients on ECMO. To secure a successful outcome
for ECMO patients, it takes a multidisciplinary group of doctors, nurses, and other medical
professionals working together. The ECMO technique is an invasive one, thus the patient and
their family need to be prepared for it.
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References
Baran, D. A. (2017). Extracorporeal Membrane Oxygenation (ECMO) and the Critical Cardiac
Patient. Current Transplantation Reports, 4(3), 218-225.
Bertini, P., Guarracino, F., Falcone, M., Nardelli, P., Landoni, G., Nocci, M., & Paternoster, G.
(2022). ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis. Journal
of Cardiothoracic and Vascular Anesthesia, 36(8), 2700-2706.
ELSO. (2021, September 29). Extracorporeal Membrane Oxygenation (ECMO) in COVID19.
Retrieved from Extracorporeal Life Support Organization:
https://www.elso.org/COVID19.aspx
Guglin, M., Zucker, M. J., Bazan, V. M., Bozkurt, B., Banayosy, A. E., Estep, J. D., . . . Pinney,
S. P. (2019). Venoarterial ECMO for Adults: JACC Scientific Expert Panel. Journal of
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Huang, S., Zhao, S., Luo, H., Wu, Z., Wu, J., Xia, H., & Chen, X. (2021). The role of
extracorporeal membrane oxygenation in critically ill patients with COVID-19: a
narrative review. BMC Pulmonary Medicine, 21(1), 1-13.
Kiersbilck, C. V., Gordon, E., & Morris, D. (2016). Ten things that nurses should know about
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Trikha, A., Venkateswaran, V., & Soni, K. D. (2021). Extracorporeal Membrane Oxygenation
in COVID-19 Patients: More Hype than Substance? Indian Journal of Critical Care
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