https://doi.org/10.4081/scenario.2023.570
Nursing management of the patient undergoing ECMO: competences and treatment outcomes. A literature review
Published: 21 November 2023
Abstract Views: 2516
PDF (Italiano): 965
Materiali Supplementari (Italiano): 127
Materiali Supplementari (Italiano): 127
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Introduction: Extracorporeal membrane oxygenation (ECMO) is an external device that uses invasive technique to treat critically ill patients using mechanical support for respiratory and cardiovascular function when all other conventional treatments are ineffective. The management of these patients relies on a multidisciplinary and multispecialist team, to which the nurse belongs, and whose members must possess specific knowledge, supported by a programme of continuous training and updating.
Aim: Analyze the literature to explore, in depth, as a first aim what the nursing skills should be in the patient management of the undergoing ECMO of all types known to date and as a second aim the treatment outcomes in these high care complexity patients.
Methods: Literature review by consulting the main biomedical banks: PubMed, CINAHL, Cochrane Library, Embase and some peer-reviewed journals, as well as the Extracorporeal Life Support Organisation (ELSO) Guidelines. Inclusion criteria were applied with respect to English and Italian language, age 18 years or older.
Results: The analysis of the 17 studies included in this narrative review of the literature showed that the nursing activity performed by the nurse plays a key role in the management of these highly critical patients through the ability to manage all aspects of care. The nurse practitioner's skills include medication administration, possession of the specific technical knowledge for the safe use of the ECMO circuit, and a perfusion background for machine management. Prevention and early detection of caregiver complications are the key elements of successful, nursing care based on careful all-around monitoring. Adherence to existing guidelines and standardization of procedures implemented by the nurse are key elements, which reduce mortality and improve patient outcomes.
Conclusions: In order to care for patients undergoing ECMO, the nurse practitioner must be adequately trained and specialised. Continuous updating of knowledge and consolidation of skills increase the value of the nurse, who will be able to provide the patient with attentive, precise and informed care, with the aim of improving outcomes.
Kurniawati E, Weerwind P. Extracorporeal Life Support in Adult Patients: A Global Perspective of the Last Decade. Dimens Crit Care Nurs 2019;38:123–130.
Lo Coco V, Lorusso R, Raffa G, et al. Clinical complications during veno-arterial extracorporeal membrane oxigenation in post cardiotomy and non post-cardiotomy shock: still the achille’s heel J Thorac Dis 2018;10:6993–7004.
Mossadegh C, Combes A, eds. Nursing Care and ECMO. Cham: Springer International Publishing; 2017. Disponibile presso: http://link.springer.com/10.1007/978-3-319-20101-6
Calhoun A. ECMO: Nursing Care of Adult Patients on ECMO. Crit Care Nurs Q 2018;41:394–398.
Frenckner B. Extracorporeal membrane oxygenation: a breakthrough for respiratory failure. J Intern Med 2015;278:586–598
Fraboni E, Ortolani S. Gestione infermieristica del paziente con extra-corporeal membrane oxygenation: una revisione della letteratura. Confronto professionale Periodico OPI Ancona 2019;1.
Chiumello D, Caccioppola A, Froio S, Coppola S. La Circolazione Extracorporea nell’Insufficienza Respiratoria Acuta: alto flusso verso basso flusso. Infermiere Critical Care 2020;VII(63).
St.George, Extra Corporeal Membrane Oxygenation (ECMO). gennaio 2013. Disponibile preso: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0005/306473/stgeorgeECMO_CLIN_ICU.pdf
Direttiva 2013/55/UE del Parlamento Europeo e del Consiglio del 20 novembre 2013 recante modifica della direttiva 2005/36/CE relativa al riconoscimento delle qualifiche professionali e del regolamento (UE) n. 1024/2012 relativo alla cooperazione amministrativa attraverso il sistema di informazione del mercato interno («regolamento IMI»). Disponible presso: https://eur-lex.europa.eu/eli/dir/2013/55/oj/ita/pdf
Linee guida EFN per l'applicazione dell'articolo 31 ai fini del riconoscimento delle competenze previste dalla Direttiva 2005/36/CE, modificata dalla Direttiva 2013/55/CE. EFN Competency Framework Documento approvato dall'Assemblea generale EFN, Bruxelles, aprile 2015.
Competenze infermieristiche, European Federation of Nurses Associations. [Internet]. [Consultato 06 giugno 2023]. Disponibile presso: https://www.nurse24.it/infermiere/professione/competenze-infermieristiche-le-linee-guida-europee.html
Caironi G, Pinto F. Infermieristica in emergenza urgenza 2021.
Vuylsteke A, Brodie D, Combes A, Fowles J, Peek G. ECMO in the Adult Patient. In ECMO in the Adult Patient (Core Critical Care, p. I). Cambridge: Cambridge University Press. 2017. Available from: https://www.cambridge.org/core/books/ecmo-in-the-adult-patient/BF4836A8C7B8E218E5F733550A05233C
Extracorporeal Life Support Organization (ELSO) General Guidelines for all ECLS Cases. Version 1.4. August, 2017.
Antonazzo A, Conte M. Assistenza Infermieristica al Paziente in ECMO degente in terapia intensiva. IJN 2022;40 50-59.
Hong L, Hou C, Chen L, et al. Developing a competency framework for extracorporeal membrane oxygenation nurses: A qualitative study. Nurs Open 2023;10:2449–2463
Binda F, Lazzarini A, Accardi R. Complicanze emorragiche nell’assistenza infermieristica al paziente adulto in circolazione extracorporea: revisione della letteratura. Scenario 2021;38:45-51.
Zhang M, Li X, Bai Y. Prone position nursing combined with ECMO intervention prevent patients with severe pneumonia from complications and improve cardiopulmonary function. Am J Transl Res 2021;13:4969-4977.
Ludwigson L, Boin M, Oster CA. Critical care nurse perception of self-efficacy following an ECMO education program. Appl Nurs Res 2020;55:151298.
Alshammari M, Vellolikalam C, Alfeeli S. Perception of other healthcare professionals about the nurses' role and competencies in veno-venous extracorporeal membrane oxygenation care: A qualitative study. Nurs Open 2022;9:996-1004.
Tu Z, Xia Q, Xu M, Lu Y. Nursing of Patients Critically Ill With Coronavirus Disease Treated With Extracorporeal Membrane Oxygenation. J Emerg Nurs 2020;46:862-868 e862.
Li X, Zhou X, Zhang M. Application value of high-quality nursing in patients with severe pneumonia under the treatment of extra corporeal membrane oxygenation. Int J Clin Exp Med 2020;13:224-231.
NB. T, Kunt A, Günaydın S, et al. Cardiovascular critical care nursing procedures in patients on venoarterial extracorporeal membrane oxygenation. Cardiovasc Perf Nurs 2022;1:1-4.
Lucchini A, Bambi S, De Felippis C, et al. Oral Care Protocols With Specialty Training Lead to Safe Oral Care Practices and Reduce Iatrogenic Bleeding in Extracorporeal Membrane Oxygenation Patients. Dimens Crit Care Nurs DCCN 2018;37:285–293
Hackmann AE, Wiggins LM, Grimes GP, et al. The Utility of Nurse-Managed Extracorporeal Life Support in an Adult Cardiac Intensive Care Unit. Ann Thorac Surg 2017;104:510-514.
Daly KJ, Camporota L, Barrett NA. An international survey: the role of specialist nurses in adult respiratory extracorporeal membrane oxygenation. Nurs Crit Care 2017;22:305-311.
Hsieh FT, Huang GS, Ko WJ, Lou MF. Health status and quality of life of survivors of extra corporeal membrane oxygenation: a cross-sectional study. J Adv Nurs 2016;72:1626-1637.
Boling B, Dennis DR, Tribble TA, et al. Safety of Nurse-Led Ambulation for Patients on Venovenous Extracorporeal Membrane Oxygenation. Prog Transplant 2016;26:112-116.
Redaelli S, Zanella A, Milan M, Isgro S, Lucchini A, Pesenti A, et al. Daily nursing care on patients undergoing venous-venous extracorporeal membrane oxygenation: a challenging procedure! J Artif Organs 2016;19:343-349.
Ko Y, Cho Y, Park Y, et al. Feasibility and Safety of Early Physical Therapy and Active Mobilization for Patients on Extracorporeal Membrane Oxygenation. ASAIO J 2015;61:564–568.
ELSO Guidelines For Training And Continuing Education Of ECMO Specialists. Version 1.5. February 2010. .
Antonini V. s.d., Monitoraggio & nursing in corso di assistenza extracorporea alla funzione respiratoria, Anestesia e Rianimazione Azienda Ospedaliero Universitaria Parma 1. Disponibile presso: online https://docplayer.it/4945976-Monitoraggio-nursing-incorso-di-assistenza-extracorporea-alla-funzione-respiratoria.html
Alfred Health, Guideline, novembre 2015. Disponible presso: http://www.alfredicu.org.au/assets/Documents/ICUGuidelines/ECMO/ECMOGuideline.pdf
ChinaNews.com. Officially released technical guidelines for the prevention and control of new coronavirus infection in medical institutions. Article in Chinese. http://www.chinanews.com/m/gn/2020/01-23/9068147.shtml. Published January 23, 2020. Accessed January 23, 2020.
Moll V, Teo E, Grenda D, et al. Rapid Development and Implementation of an ECMO Program. Asaio J 2016;62:354–358.
Bhatia M, Katz JN. Contemporary Comprehensive Monitoring of Veno-arterial Extracorporeal Membrane Oxygenation Patients. Can J Cardiol 2020;36:291-299.
L. 8 marzo 2017, n. 24. Disposizioni in materia di sicurezza delle cure e della persona assistita, nonché in materia di responsabilità professionale degli esercenti le professioni sanitarie. (17G00041) (GU Serie Generale n.64 del 17-03-2017). Disponibile presso: https://www.gazzettaufficiale.it/eli/id/2017/03/17/17G00041/sg
Abrams D, Javidfar J, Farrand E, et al. Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care 2014 27;18:R38.
Abrams D, Madahar P, Eckhardt CM, et al. Early Mobilization during Extracorporeal Membrane Oxygenation for Cardiopulmonary Failure in Adults: Factors Associated with Intensity of Treatment. Ann Am Thorac Soc 2022;19:90-98.
Mitchell D, Seckel M. Acute Respiratory Distress Syndrome and Prone Positioning AACN Adv Crit Care 2018;29:415–425
How to Cite
D’Arrigo, V., Furcieri, L., Roberti, V., Lomuscio, S., Alberti, A., Tremamondo, J., … Tinti, S. (2023). Nursing management of the patient undergoing ECMO: competences and treatment outcomes. A literature review. Scenario® - Il Nursing Nella Sopravvivenza, 40(3). https://doi.org/10.4081/scenario.2023.570
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Aniarti has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Tommaso Piani, Luca Peressoni, Davide Zanardo, Rita Maricchio, Paola De Lucia, Un modello innovativo per la valutazione delle competenze infermieristiche nell’ambito dell’emergenza territoriale , Scenario® - Il Nursing nella sopravvivenza: Vol. 37 No. 4 (2020): SCENARIO 4 2020
- Michele Stellabotte, Floriana Pinto, Advanced nursing competencies in critical care: education and evaluation tools. A narrative review , Scenario® - Il Nursing nella sopravvivenza: Vol. 40 No. 3 (2023)
- Direttivo ANIARTI ANIARTI, Il nursing della “sopravvivenzaâ€: costruire il futuro , Scenario® - Il Nursing nella sopravvivenza: Vol. 34 No. 3 (2017): Scenario 3 2017
- Roberta Colagrossi, Giulia Venturini, Giuseppe Esposito, Alessandro Sili, Rosaria Avaro, L’autovalutazione delle competenze cliniche infermieristiche in Area Critica , Scenario® - Il Nursing nella sopravvivenza: Vol. 29 No. 3 (2012): Scenario 3 2012
- Nicola Seganti, Analisi del corretto utilizzo del monitoraggio EtCO2 nel percorso emergenza-urgenza ed in terapia intensiva , Scenario® - Il Nursing nella sopravvivenza: Vol. 33 No. 3 (2016): Scenario 3 2016
- Alessio Caratelli, Camilla Bartalini Bigi, Giulia Delle Donne, Francesco Diodato, Noemi Dragoni, Moris Rosati, Francesco D’Ambrosio, Lorenzo Righi, Procurement from Non-Heart-Beating Donor, a path under construction: a descriptive observational study on Italian nurses' knowledge , Scenario® - Il Nursing nella sopravvivenza: Vol. 40 No. 1 (2023)
- Luci Fontanella, Pietro Serena, Federico Munarin, Il ruolo chiave dell’infermiere territoriale nella assistenza alla persona con Ossigenoterapia a Lungo Termine (OTLT) a domicilio , Scenario® - Il Nursing nella sopravvivenza: Vol. 29 No. 3 (2012): Scenario 3 2012
- Susanna Maria Petracca, Paola Graciotti, Paola Massei, Maurizio Mercuri, Analisi e comparazione tra il modello di emergenza extraospedaliera italiano ed anglosassone. Organizzazione, formazione e ruolo infermieristico , Scenario® - Il Nursing nella sopravvivenza: Vol. 28 No. 3 (2011): Scenario 3: 2011
- Francesca Carra, Fabio Mozzarelli, Andrea Contini, La valutazione delle abilità infermieristiche attraverso la Nurse Competence Scale: un esperienza del sistema di emergenza sanitaria preospedaliera dell’azienda USL di Piacenza. , Scenario® - Il Nursing nella sopravvivenza: Vol. 33 No. 2 (2016): Scenario 2 2016
- Beatrice Persiani, Cecilia Cesari, Viola Tini, Stefano Trapassi, Moris Rosati, Francesco D’Ambrosio, Lorenzo Righi, Tools for assessing the risk of violence in the emergency room: a narrative review of the literature , Scenario® - Il Nursing nella sopravvivenza: Vol. 40 No. 2 (2023)
You may also start an advanced similarity search for this article.