The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

RAPID EXPANSION OF AN ECMO PROGRAM: A NOVEL, SIMPLIFIED VENOVENOUS SYSTEM FOR ADULT PATIENTS

Anthony J. Diez1, W. Lee Williford1, Michelle Peters1, Rich Walczak2, Ian Shearer2, Jan Thalman1, Ira Cheifetz2, David Turner2; 1Department of Respiratory Care, Duke University Medical Center, Durham, NC; 2Duke University Medical Center, Durham, NC

Background: The H1N1 pandemic caused significant life-threatening, refractory hypoxemia in the adult population. As a result, our hospital administration charged the ECMO Leadership Committee with rapidly expanding our ECMO program to include adults within an 8 week period. One of the major obstacles was to develop a simplified venovenous (VV) system that could be quickly and easily integrated into the current program infrastructure. Methods: A multidisciplinary team developed a simplified VV ECMO system for patients > 40 kg. This new system included a Maquet Centrifugal pump, a Quadrox D oxygenator, and a greatly simplified circuit with minimal monitoring and only one access port. Results: In comparison to traditional ECMO, new challenges and advantages became apparent with the new VV ECMO system. The largest change in practice resulted from the simplicity of the new circuit, which does not allow for administration of blood products, volume, or medications (including heparin) directly to the pump. The circuit includes only one access port, which is used solely for ACT sampling. This change requires the administration of all medications directly to the patient. Additionally, the new simplified system displays only revolutions per minute (rpm) and liters per minute (lpm) and requires significantly less monitoring equipment as compared to traditional systems. A major advantage of the decreased requirement for both monitoring and interventions was the creation of a staffing model with one ECMO specialist managing two ECMO pumps rather than our traditional one specialist per pump. This model was a critical element in the expansion of our ECMO program, which allowed for a doubling in the capacity of our ECMO program with only a 25% increase in ECMO staff and no increase in nursing staff. Conclusions: Expansion of an existing ECMO program to include adult patients is an extremely complex process with numerous hurdles. With an interdisciplinary approach and adequate administrative support, a simplified VV ECMO system can be quickly, efficiently, and safely implemented to expand an established ECMO program in response to an emerging healthcare crisis. Sponsored Research - None