Authors (including presenting author) :
Poon ST(1)(2), Yuen WS(1), Yeung WY(1), Lam KN(1), Chu NW(2), Wong HL(2),Tang PY(1), Ho KM(2), Joynt GM(2)
Affiliation :
(1) Intensive Care Unit, North District Hospital
(2) Department Of Anaesthesia & Intensive Care, Prince of Wales Hospital
Introduction :
Extra-corporeal membrane oxygenation, ECMO, is a therapy that is used to support patient's lives when their heart or lungs are not functioning properly. Timely ECMO therapy initiation is significant because it has been associated with higher survival, preventing organ damage, better ventilation and oxygenation, and a decrease in comorbidities.
However, in the New Territories East Cluster (NTEC), ECMO therapy is only provided in the intensive care unit (ICU) of Prince of Wales Hospital (PWH). In the past, patients in need of ECMO setup in North District Hospital (NDH) needed support from PWH retrieval team in the form of personnel, equipment, and cannulation supplies. It took up to three hours from initiation to actual on-pump before escorting patient to PWH. To tackle this service gap, NTEC ICU collaborative care model of ECMO service was implemented in September 2020 with the goal of reducing the waiting time of preparation for the ECMO procedure and promoting the patient's benefit through timely ECMO therapy initiation.
In accordance with the collaborative care model, a structural program was established including theory, ECMO circuit priming practice, cannulation workshop, various simulation workshops and set-up of related protocols with scope of practices.
Objectives :
(1) To train up NDH’s nurse to achieve timely ECMO therapy initiation by priming and cannulation; (2) To shorten the overall ECMO procedure time ; (3) To reduce clinical risks and increase patient survival to maximize patient’s benefits.
Methodology :
Posttest only nonequivalent group design was employed. Subjects were NDH patients requiring ECMO setup, and ECMO procedure time were measured.
Result & Outcome :
Total twelve NDH patients who needed ECMO support between October 2015 and August 2023 were reviewed. Five patient’s ECMO initiation were handled under the ICU collaborative care approach with three V-A and two V-V ECMO established. Average ECMO procedure times were 213.5 minutes by retrieval teams and 98.2 minutes under care model respectively. The outcome showed a significant reduction in the duration of ECMO establishment, allowing for a quicker patient transfer to appropriate ECMO center for ongoing care.
By December 2023, total thirty nurses, approximately 40% of NDH ICU nurses, have been trained as ECMO team members to support 24 x 7 ECMO initiation service in NDH.
