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ECMO RED:

Indications for ECMO RED:

  •        Indications (When in doubt, call ECMO​)

    • ·         Cardiac Arrest​

    • ·         Imminent Cardiac Arrest​

    • ·         Unstable Cardiac Patient (myocarditis, cardiomyopathy, CHD)​

  • Inclusion Criteria​

    • ·         Recoverable Condition​

    • ·         No Irreversible Neurologic Damage​

    • ·         No prolonged CPR

How to call an ECMO RED in the ED?

call 75555 (unit secretary in charge of this task), says: 

  • ECMO Red 

  • Unit: ED  

  • Room #

  • Patient weight in KG

Roles:

• ED Attending: 

     - call ECMO red (when in doubt, call an ECMO red) 

     - Discuss w/ PICU/CICU/surgery re: decision to cannulate. 

     - ED attending remains TEAM LEAD during cannulation. 

              - ensure correct compression:pause ratios (max time off chest = 60 sec) 

• PICU provider: 

     - responds to ED when ECMO red called 

     - can assist with resuscitation if needed during cannulation 

     - will assume care once ECMO initiated

• Surgery team:

     - cannulation (or CICU team cannulates if cardiac patient) 

• ED Bedside Nurse

     - administer meds to the patient

     -obtain IV extension tubing 

• ED CCTRN

     - asks unit secretary to activate ECMO red

     - use CCTRN checklist 

     - facilitate turning of the bed 180 degrees 

     - will record the resuscitation

     - if CPR in progress: verbalize how long we've been off the chest Q 30 sec

• ED Charge Nurse

     - utilize charge nurse ECMO checklist 

     - organize staff (need a runner, need resident to place use ECMO order set, etc)

     - in charge of crowd control

• ED RT

     - maintain secure airway/ ventilate

     - obtain extension tubing for ETT 

• ED Tech - will remove all unnecessary equipment from room and will perform chest compressions if necessary 

• NOTE: Surgery may want to clear the room of unnecessary staff, that is fine, but everyone who has a “role sticker” will stay.

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Other:

  • Blood: arrives in tube station (Tube station 412)

  • Meds:

    • Heparin must ALWAYS be given (have it ready; surgeon will notify you when ready to push) 

    • Cefazolin should be given 

    • A note on Epi: It is reasonable to stop epi after the 4th dose, to optimize chance of cannulation (unless patient is needing vasoconstriction i.e. pulses are still weak with compressions or end tidal isn’t great with compressions)

    • Calcium is often avoided during cannulation (it is a pro-coagulant and we don't need it for cardiac contractility) ​

  • Patient needs to be rotated so that head of bed is towards the door 

    • ensure ENTIRE team is ready to rotate.  "Is everyone ready to rotate?"  "We are rotating patient in 3, 2, 1"

    • green O2 extension tubing (bottom of code cart) may be needed

    • connector tubing may be needed

    • watch monitor cables for length  

    • “Sink” side of room = sterile side of the room (surgical team will set up here)

    • “Computer Station” side of room = ED team continues resuscitation

  • Acceptable compression to pause ratios are: 

    • 2 minutes compressions: 30 second pause

    • 3 minutes compressions: 1 minute pause

  • Communication:

    • We are expert communicators; we can control how this chaotic/high risk situation goes by how we communicate.   

    • Closed loop communication is CRITICAL (Examples: "Am I good to turn the bed now?" "Yes, you are clear to turn the bed"  or "Have we given heparin?"  "We are giving heparin now") 

    • Lots of new faces.  Role identification is key (please use role stickers) 

    • Volume down/crowd control 

    • Frequent mental models and fostering collaboration with consultants.  

  • PPE: “bunny suit,” cap, mask, etc 

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*search "ECMO" in the search tab
**we only run "ECMO RED" in the ED
(not ECMO yellow)

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