
Many learners that opt to take this course will have some level of understanding of ECMO. However, now that ECMO is becoming an highly utilized intervention and it being implemented in community hospitals, the health care industry needs nurses and paramedics to be trained well with the management of the system. This includes the need for these professionals to be able to transport the patient on the system in a safe manner to a tertiary center. Because of the complexities of the system, it can be overwhelming to start from the beginning. This course will provide the most serious complications that can occur and what to do acutely to manage it.
Compare vv ECMO and VA ECMO to explain why vv is preferred for respiratory failure. Highlight venous access benefits, reduced arterial risks, avoidance of differential hypoxia, and improved lung oxygenation.
Explore how the ECMO pump drives blood flow and sweep gas to oxygenate blood and remove carbon dioxide, linking RPMs, flow, and ventilation to preload and afterload.
Review a quick ECMO quiz on post-oxygenator CO2 management. Learn to increase sweep gas flow to boost diffusion and blow off CO2, mirroring ventilator adjustments.
Monitor abdominal retroperitoneal and intrathoracic sites hourly to manage bleeding, the leading ECMO complication, identify sources, and implement predefined interventions to prevent oxygenator thrombus and fatal outcomes.
Identify circuit chatter from preload loss in ECMO and address hypertension with fluid bolus and rpm adjustments. Involve cannulating and ICU teams to rule out cardiac tamponade or abdominal issues.
Recirculation is a VV ECMO phenomenon where returned blood is withdrawn before oxygenation. Verify cannula position and ensure the return port faces the tricuspid valve; daily imaging guides correction.
Identify differential hypoxia in peripheral va ecmo, known as north-south syndrome, where brain and myocardium receive different oxygenation; detect with right-sided gases and discuss vent optimization and flow adjustments.
Identify loss of pulsatility on ECMO and assess mean arterial pressure to determine hemodynamic stability. If unstable, apply rapid interventions including epinephrine, flow adjustments, electrolytes, and LV unloading.
End tidal CO2 reflects native cardiac perfusion. Pre- and post-oxygenator gases assess oxygenator function; high post CO2 signals condensation, and a brief oxygen purge clears it, not for direct care.
Address hypothermia risk in ECMO during transport. Use environmental temps, warmed blankets, and dry linens, and regularly evaluate the circuit when heating is unavailable due to bacterial growth concerns.
This course walks the student through the basic physiology of the ECMO system. In addition, it teaches about the most common emergencies and how to intervene with limited resources, especially in transport. Students that would benefit from this course in any critical care nurse, paramedic, or physician.
Extracorporeal membrane oxygenation (ECMO), a term used to describe oxygenation that occurs outside of the body, is an increasingly common means of supporting the most critically ill patients. Because of the invasiveness and high probability of serious complications during ECMO, it is typically indicated only when there is a high likelihood of death with conventional treatment. With continued improvements in technology and increasing clinical experience, transport clinicians are increasingly likely to be called on to care for ECMO patients.
Highlights include:
Critical care transport clinicians must appreciate the differences between venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) as well as common indications for each and the physiology of both configurations
Traditional monitoring techniques such as peripheral capillary oxygen saturation may not be reliable
Preparation for emergencies is imperative because decompensation can be rapid and masked until death occurs
ECMO is a bridge to another option and is not a cure
Critical Care Providers must know if a patient is a candidate for ECMO support prior to making the decision