Extracorporeal Membrane Oxygenator Withdraw Protocol: Avoiding Chaos (SA522)

Abstract

•Present the results of ECMO patient tracers and an institutional needs assessment, which was used to create a withdraw policy.•Show audience members a video of ECMO withdraw in the SIM lab to display the results of our streamlined process.•Share the ECMO policy and educational handouts to help institutions create their own policies and education modules. The use of extracorporeal membrane oxygenators (ECMO) is increasing in the United States. It has been used consistently in the pediatric patient populations for decades. In recent years, VenoVenous ECMO has become standard of care for refractory adult respiratory distress syndrome at quaternary care centers. In addition, VenoArterial ECMO is being used for viral cardiomyopathy, failed cardiotomies, and as a temporary bridge to transplant. With survival on VV ECMO at 60% and VA ECMO at 40%, there are growing numbers of Americans dying after ECMO withdraw. The process of ECMO withdraw is complex. Tracer patients at our health system have as many as 15 family members and 25 clinicians involved in the discontinuation. Technology withdraw often involved multiple medical devices and multiple teams of providers, leading to poor communication and increased distress. Death is unique and sudden following discontinuation, which adds additional moral distress for family members and members of the care team. Our institution conducted a needs assessment across multiple departments and constructed an ECMO withdraw protocol with an accompanying ECMO education program. Our goal for the initiative was to improve clinical efficiency, improve staff knowledge about ECMO withdraw to change attitudes and values, and ensure patient comfort at end of life.