Critical care clinics
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Critical care clinics · Oct 2017
ReviewStaffing, Equipment, Monitoring Considerations for Extracorporeal Membrane Oxygenation.
Although the reasons for the recent growth in adult extracorporeal membrane oxygenation (ECMO) are multifactorial, much of the success may be attributed to the development of well-trained staff and the technological innovations in equipment and monitoring devices used during extracorporeal support. In this article, the authors discuss general educational formats for the ECMO bedside provider, staffing support models, and devices designed to best meet the needs of the patient while simultaneously ensuring the proper delivery of ECMO-related care.
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The development of a successful extracorporeal membrane oxygenation (ECMO) program requires an institutional commitment and the multidisciplinary cooperation of trained specialty personnel from nursing, internal medicine, anesthesiology, pulmonology, emergency medicine, critical care, and surgery and often pediatrics as well. The specialized training necessary to cultivate an integrated team capable of providing life-saving ECMO cannot be underestimated. The development of a successful ECMO program is best suited to a tertiary medical center that is centrally/regionally located and capable of financially supporting the level of expertise required as well as managing the program's overall cost effectiveness.
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Critical care clinics · Oct 2017
ReviewVascular Complications in Extracoporeal Membrane Oxygenation.
Venoarterial extracorporeal membrane oxygenation is a rescue therapy in patients with severe cardiopulmonary failure. Often, cannulation is done emergently and the femoral vessels are most readily accessible for venous and arterial access. Unfortunately, complications with arterial femoral access can lead to devastating complications, primarily related to limb ischemia. A coordinated protocol of diligent limb examination by trained intensive care unit staff, near infrared spectroscopy monitoring of limbs, and placement of a distal perfusion catheter at the time of femoral cannulation or when signs of ischemia develop, can lead to successful limb salvage.
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Critical care clinics · Oct 2017
ReviewIssues in the Intensive Care Unit for Patients with Extracorporeal Membrane Oxygenation.
The care of patients on extracorporeal corporeal oxygenation support takes a coordinated effort among the team of nurses, midlevel providers, perfusionists, respiratory therapists, pharmacists, and physicians. Attention on the details of the circuitry and its interactions with the patient, the resolution of the disease process and the ongoing plan of care, and unique issues in the intensive care unit are crucial for success.
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Critical care clinics · Oct 2017
ReviewMedication Complications in Extracorporeal Membrane Oxygenation.
The need for extracorporeal membrane oxygenation (ECMO) therapy is a marker of disease severity for which multiple medications are required. The therapy causes physiologic changes that impact drug pharmacokinetics. ⋯ The pharmacokinetic changes are drug specific and largely undefined for most drugs. We review available drug dosing data and provide guidance for use in the ECMO patient population.