What is the exclusion criteria for ECLS therapy?

The decision to cannulate a patient on ECLS must be a bridge to a treatment plan, decision, device, transplant or recovery. Every facility should determine specifics around contraindications for ECLS and develop their own standardized inclusion and exclusion criteria.
The most common contraindications include:

• High mechanical ventilation settings for more than seven days

• Pharmacologic immunosuppression

• CNS hemorrhage or irreversible brain injury

• Non-recoverable comorbidity or terminal condition

• Contraindication for anticoagulation

• Prolonged CPR without adequate tissue perfusion

• Not a candidate for a transplant or VAD

• Multi-system organ failure or chronic organ failure

What backup and safety supplies should I have at bedside?

A backup pump with the circuit primed or ready to prime, ECLS supply cart with all items you could need in an emergency situation, volume (most medical centers will give Albumin, NS or LR in an emergency volume replacement situation), 4-6 clamps, flashlight, hand crank, 60cc syringe for de-airing of the line if needed.

My medical center does not have an organized ECMO Program. How can I help?

• Start an ECLS patient registry for quality and process improvement with ELSO

• Identify a Medical Director for the program, or a physician/surgeon champion

• Identify an ECMO Coordinator or nursing lead for the program. This may initially be the CVICU or NICU director or nurse manager if there is not an organized program.

• Identify your facility goals for the program

• Consider starting a multidisciplinary ECMO committee (physicians, nurses, perfusion, respiratory therapy, pharmacy)

• Identify qualifications to become bedside ECMO nurse vs ECMO specialist 

• Develop a training program for bedside ECMO nurses

• Develop a training program for ECMO specialist 

• Develop a training program for ECMO physicians

• Develop quarterly wet labs/crisis training for involved physicians and ECMO Specialists

• Develop continuing assessment and competency validation strategy for the team

• Develop multidisciplinary case reviews for patients who have received ECLS therapy in an effort for the team to learn and grow 
  
  If the hospital you work for does not have ECMO capabilities this should not deter you from learning and immersing yourself in the world of ECMO. In this situation, understanding the principles of ECMO, especially indications and contraindications is highly beneficial. 

How can I get in touch with someone on your team?

Email us here!
A member of our team will connect with you as soon as possible!

Do you consult or teach ECMO classes for our team?

Yes we do! We offer a wide variety of virtual LIVE or in person sessions where our team will meet your needs online or at your medical center with your team. Visit our Connect page and request more information.

What are the most common alarms for adult ECLS patients?

Low SV02 alarm with the Maquet Cardiohelp Machine is very common. It will appear as four dashes when the mixed venous drops below 40%. This alarm is sensitive to changes in hemoglobin, oxygen status and cardiac function. The four main causes for a low mixed venous reading are: low hemoglobin, decreased oxygen, decreased cardiac function and increased metabolic demand. Assess the patient for the cause to intervene and correct if necessary.

pVen (Venous Access Pressure) alarm with the Maquet Cardiohelp machine is a more common alarm. This indicates access insufficiency, is the negative pulling pressure that the pump is pulling from the patient to the circuit and indicates that the machine is working too hard to pull blood from the patient into the pump at the designated RPM and goal flow for the patient. If the pVen pressure becomes too negative and impacts the flow, this is called suction event. 

The most common causes of this event include: 
Volume status of the patient: an underfilled status can cause insufficiency – if there is not enough volume to support the flow through the machine. Again, if the vessel is not filled enough the wall can be sucked down onto the cannula openings causing insufficiency and low or no flow into the cannulae. 
Location of the cannula: if the access cannula is in too far or coiled this can cause high access pressures or more negative pVen pressure
Clot: if there is a clot forming at some point in the access cannula, eventually the access pressure will rise and potentially occlude blood from traveling through the circuit

Low flow or no flow alarm with a Rotoflow, Soren or Centrimag pump may be an indication of the above reasons as well.

You will generally see associated “line chatter or chugging” which appears as swaying or jumping of the cannulas.

 How can I become an ECMO Specialist?

Qualifications are typically set by a designated facility. Some common requirements may include but are not limited to:

• Critical care experience 2 years minimum at a high volume acute care medical center, preferably with a transplant or high level cardio-thoracic surgery program (CVICU for adults, NICU for pediatric experience preferred)

• Pass the CCRN exam

• BLS/ACLS certified

• Current RN License

• Complete accredited Perfusionist program

• Current RRT License

• Complete facility required Bedside ECMO Class

• Complete facility required ECMO Specialist Class

• Pass oral, demonstration and written exams on content presented in class

• Complete facility required pump hours and pass training with an ECMO Specialist preceptor

• Complete facility required wet lab/crisis management drills

• Work at a facility or organization that employs ECMO Specialists

Visit the ECMO Specialist resource page here for more information.