ICU nurses and ecpr

Abstract

Introduction: Mortality from refractory cardiac arrest is greater than 90%. Survival may be significantly improved with Extracorporeal Membrane Oxygenation Cardio Pulmonary Resuscitation (ECPR). Objectives: To enable ICU nurses to participate in the ECPR team by preparing the ECPR trolley and/or console. Additional goals: maintain 66% ECPR accreditation following May 2016; plan ECPR nursing training at approximately 2 per month; and maintain ECPR outcomes comparable to reported rates. Methods: Training for nurses commenced May 2015. There were 10 planned sessions employing didactic explanations and simulated demonstrations. From 2016 to 2019 there were approximately two sessions per month booked. Additional hig- fidelity multidisciplinary simulations were provided by the Simulation Coordinator involving ED, Ambulance and Interventional Cardiology staff. Audits of ECMO outcomes were conducted biannually with comparisons made to international registries and literature. Results: By May 2016 greater than 66% of ECMO nurses had been accredited for ECPR. This rate was maintained and is currently 69/84 (82%). Of the planned education sessions from 2015 to 2018; the following were respectively documented as achieved 4/10, 13/23, 10/18 and 13/21. ECPR outcome from 2015-2018 was 39% survival to hospital discharge. Accredited ICU ECPR nurses were assigned every day to the ECPR team and attend ECPR emergency calls as they occurred. Conclusion: It is feasible for ICU nurses to participate as valuable members of the ECPR team. Whilst the potential numbers of patients in NSW who may require ECPR per year for refractory cardiac arrest may remain relatively low (i.e approximately 130/yr) it appears that the possible improvement in survival outcome for this group may be significantly increased from dismal to around 30%. The ICU ECMO ECPR nurse's role in assisting with this survival benefit for the patient is an important part of the function of the team.