PolicyGuidelineAdultExtraCorporealMembrane分析.docVIP

Policy Guideline: Adult Extra Corporeal Membrane Oxygenation (ECMO) Campuses Royal Prince Alfred and Liverpool Public Hospital Intensive Care Units Policy Guideline Category Continuum of Care Responsibility for Review ICU Clinical Nurse Educator ICU Medical Consultant Medical Perfusionist Date Approved June 2009 Review Date: June 2011 PURPOSE/EXPECTED OUTCOME: This document describes the standardised management of adult patients receiving Extracorporeal Membrane Oxygenation (ECMO) in ICU.  Contents 1. Introduction 3 2. General Indications for ECMO referral 5 3. NSW ECMO referral guidelines 7 4. Equipment 8 4.1 Additional connections to the ECMO Circuit 94.2 Monitoring trans-membrane pressure 10 5. ECMO Cannulation 11 6. Maintenance of ECMO and Staffing 13 7. Nursing Policy and Procedures 178. Troubleshooting guide 20 8.1 Veno-venous ECMO 21 8.1.1. Worsening hypoxia 21 8.1.2. Worsening hypercarbia 21 8.1.3. Increasing ECMO flow does not improve oxygenation 21 8.2 Veno-arterial ECMO 21 8.2.1. Worsening hypoxia 21 8.2.2. Worsening hypercarbia 21 8.3 Veno-arterial and veno-venous ECMO 8.3.1. ECMO pump flow not maintained 22 8.3.2. SIG alarm on pump 23 9. ECMO Complications 25 9.1 Emergency ECMO Responses: Veno-Arterial ECMO 26 9.1.1. Pump failure 26 9.1.2. Decannulation 27 9.1.3. Circuit Rupture 28 9.1.4. Circuit Air Embolism 29 9.1.5. Cardiac Arrest 31 9.1.6. Oxygenator failure 32 9.2. Emergency ECMO Responses: Veno-Venous ECMO 33 9.2.1. Pump failure 34 9.2.2. Decannulation 35 9.2.3. Circuit Rupture 36 9.2.4. Circuit Air Embolism 36 9.2.5. Cardiac Arrest 37 9.2.6. Oxygenator failure 38 1. Introduction Patients who are hypoxaemic despite maximal conventional ventilatory support, who have significant ventilator-induced lung injury or who are in cardiogenic shock may be considered for ECMO support. For respiratory failure, the basic premise is that ECMO will allow the level of ventilatory support to be reduced, which may allow time for recovery from