Nursing management of the patient undergoing ECMO: competences and treatment outcomes. A literature review

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.