Abstract
BackgroundExtracorporeal membrane oxygenation (ECMO) is effective in a selected critically ill patient population with promising results in refractory hypoxemia related to the novel coronavirus disease (COVID-19). However, it requires specialized clinicians and resources in advanced technology. Moreover, the COVID-19 remains an ongoing global emergency, and there is no evidence-based practice in preparedness. This article proposes an innovative and optimized nursing care protocol, the Standard Operating Procedure (SOP), that regulates safety and efficiency in using personal protective equipment (PPE) during ECMO-relevant procedures while providing ECMO therapy for patients with COVID-19.MethodsAfter performing a narrative literature search, we developed a high-fidelity translational simulation scenario. It included practicing appropriate donning and doffing PPE during work organization, ECMO-related procedures, and routine daily nursing care and management of ECMO over nine hours. In addition, we held supplementary constructive debrief meetings to consult international expert in the field.ResultsA proposal for nursing standardized operating procedures was created, divided into categories. They included work organization, workload references, competences, infrastructural conditions, cannulation equipment, daily routine nursing care, and procedures during ECMO.ConclusionsHigh-fidelity medical simulation can play an important role in staff training, improvement in previously gained proficiency, and development of optimal SOP for nursing care and management during ECMO in patients with COVID-19. Optimal SOPs may further guide multidisciplinary teams, including intensive care units and interventional departments.
Highlights
Extracorporeal membrane oxygenation (ECMO) is effective in a selected critically ill patient population with promising results in refractory hypoxemia related to the novel coronavirus disease (COVID-19)
A few publications focus on extracorporeal membrane oxygenation (ECMO) and nursing [1,2,3], with formal guidelines provided by the Extracorporeal Life Support Organization (ELSO) [4]
Based on evidence and our experience, translational simulation, and expert consultations, we developed innovations in three main areas, (A) work organization, (B) daily nursing care and management of patients on ECMO and COVID-19, and (C) ECMO cannulation and related procedures
Summary
Extracorporeal membrane oxygenation (ECMO) is effective in a selected critically ill patient population with promising results in refractory hypoxemia related to the novel coronavirus disease (COVID-19). It requires specialized clinicians and resources in advanced technology. This article proposes an innovative and optimized nursing care protocol, the Standard Operating Procedure (SOP), that regulates safety and efficiency in using personal protective equipment (PPE) during ECMO-relevant procedures while providing ECMO therapy for patients with COVID-19. No guidelines are specific to nursing care and clinical management of ECMO and the use of personal protective equipment (PPE) during a disaster state such as the current pandemic, leaving ECMO centres to develop their institutional procedures. The constant presence of at least two ECMO-trained clinicians is necessary for emergent life-saving interventions
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