As healthcare technology advances over time, different methods to treat what were once considered fatal medical problems also increase. Since its introduction in the 70s, (ECMO), Extracorporeal Membrane Oxygenation has recently become a fairly common therapy alternative for newborns experiencing respiratory failures (Rehder et al., 2014). For example, the procedure can be used in cases of severe respiratory damage that may lead to loss of life such as shock during a serious cardiovascular attack or chronic lung damage caused by infection. Despite its popularity in pediatric settings, there exists ethical issues regarding this therapeutic modality. These include the probability of fatal complications while applying ECMO and the cost of the procedure in relation to the results.
During severe lung and/or cardiovascular failure, ECMO is employed to circumvent the cardiopulmonary system, especially in situations where other therapeutic options are not feasible or fail entirely. The procedure involves surgically placing a catheter into a vein positioned close to the heart and another in a different vein (VV ECMO) providing respiratory support, or (VA ECMO), where it is positioned close to an artery especially when the patient needs respiratory and cardiac support (Makhoul et al., 2019). The catheters are then joined to an ECMO machine which pumps blood via into an oxygenator that removes carbon dioxide and instills oxygen. ECMO is mostly used in neonatal care, in pediatrics as well as in adult patients. Some medication required together with the procedure may include but not limited to; antibiotics to reverse underlying issues, sedation to reduce pain, anticoagulation to lower thrombotic risk, vasoactive medication to enable circulation and diuretic agents to help fluid balance (Cheng et al., 2018). Due to the complexity of the procedure and the risks involved, ECMO should only be done by trained clinicians with experience in the best practices. It is an expensive procedure with an average cost of about 70,000 USD and an average total hospital cost of about 200,000 USD (Mishra et al., 2009).
ECMO is beneficial to patients suffering from cardiorespiratory complications. It helps support the organ that is failing especially in acute deterioration cases independent of the etiology. Due to its complexity, the procedure requires expertise to avoid complications and promote healthy outcomes. One way to do this is to ensure that ECMO is only carried out in healthcare centers with suitable equipment since it is a kind of mechanically prolonged support system. The major complications include bleeding which happens to about 40% of the patients undergoing n ECMO and thromboembolism. Other complications include, cannulation related complications such as distal ischemia, arterial dissection, incorrect location, hemorrhaging and neurologic injuries especially in adult patients with respiratory failure (Bartlett, 2021). These complications can be avoided in a number of ways. Once ECMO has been determined necessary and has been initiated, the patient needs to be anticoagulated. When the original hemodynamic and respiratory objectives have been obtained, ventilator support is reduced, vasoactive drugs are decreased and blood flow is maintained, with the necessary re-evaluations and adjustments (Bartlett, 2021).
Healthcare institutions with a recognized ECMO program usually have a devoted multidisciplinary team that is specifically trained in performing ECMO. The team normally includes critical care nurses, a physiotherapist, a critical care physician and a respiratory therapist (Botsch et al., 2019). The critical care nurse is responsible for monitoring the ECMO circuit since they spend most time bedside with the patient. This is necessary in order to identify any arising complications. They are also tasked with mobilizing the patients, retrieving the ECMO and diagnostic procedures transfer (Alshammari et al., 2020). Due to the prolonged hospitalization on ECMO patients, they experience severe muscle loss due to immobilization. It is therefore the physiotherapist responsibility to lower the harmful effects of immobility by stimulating blood flow and increasing insulin and glucose activity in the muscles (Ferreira et al., 2019). The critical care team is also responsible for critical care transport, patient identification, ECMO catheter insertion and management. Additionally, it is necessary to include infectious disease experts and neurologists to aid with the procedure and any probable complications or specific patient care issues. One challenge of working with a multidisciplinary team is that for it to work effectively, it requires regular collaboration which at times may be difficult especially with nursing teams being overworked in most healthcare facilities.
A registered nurse needs to have the required skills and knowledge in order to qualify for ECMO patient care. He/she should have knowledge in complex hematological management and multiple organ support. Additionally, ECMO circuit management skills such as inspecting for circuit integrity, air accumulation, leaks, catheter and chest tube insertions, bronchoscopy and other surgical procedures (Daly, 2017). A registered nurse should also receive the appropriate ECMO training, supervised practice and theme-based discussion skills with the multidisciplinary team in order to plan specific ECMO care interventions. A nurse should also be patient and understanding and pay a lot of attention to the patient’s family who are part of the care team.
Patients and family members of patients undergoing ECMO are prone to experiencing stress before, during and after being admitted. Healthcare providers involved in the care process need to be aware of individual and family needs and provide support to help them manage this stressful situation (Tramm et al., 2017). The information they need to be taught includes explaining what is ECMO, who needs ECMO, how ECMO works, the different types of ECMO, the objectives and the success rates of the procedure, the risks and complications involved, the care team responsible for the patient and the procedure, what will be happening in the duration and after, pain considerations, medication used and nutritional plans. This information needs to be taught with a lot of patience and understanding. Caregivers must be prepared to incorporate input from family members on medical issues (Caswell et al., 2015). In a healthcare context, information is always confidential and therefore the discussions should take place in private rooms when the patient is present if possible, to avoid any misinterpretation from either party. Additional research is needed to explore the regional and cultural differences of the patients and family members that may hinder communication or the therapeutic modality. The teach-back method can be used to gauge the effectiveness of the teaching. This is where clinicians gauge whether a patient comprehends medical information by asking them to “teach-back” and gauging their understanding based on their response (Talevski et al., 2020).
As discussed in this paper, an ECMO is a complex procedure that requires expertly trained healthcare personnel and other available staff familiar with therapy to provide the multidisciplinary care required. The ECMO also demands regular monitoring to prevent complications. The patient and family members also need to be well-educated and part of the care team in order for the patient to have high chances of a positive outcome.

References

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