EDECMO Episode 12 – The Nurse-Based ECMO Program at Sharp Memorial Hospital with Suzanne Chillcott RN, BSN

What this episode covers

In this episode Joe talks with Suzanne Chillcott, the Mechanical Circulatory Support (MCS) Lead RN at Sharp Memorial Hospital to discuss the nuts and bolts of establishing a "nurse-run" ECLS program. There is no lack of enthusiasm over the concept of doing ECPR in the Emergency Department. As most of you already know, we think ECPR is the wave of the future for resuscitation. Suzanne Chillcott BSN, RNMechanical Circulatory Support Lead So you think you want to set up the next ED/ICU ECPR program? You think you want to do ECPR in your Emergency Department or ICU? But where to begin? Hopefully this episode will hopefully answer many of those questions: ECLS Program Models Physician resuscitationists cannulate. But you need an "ECMO team" to prime the circuit, help initiate bypass, trouble-shoot the machine, and manage the patient after bypass is initiated. But who is going to do that? Who has jurisdiction over your ECMO program? Well, if you are working at an institution with an active cardiothoracic surgery program, chances are you already have these roles established; and I recommend you speak to the Chief of your CT surgery team. But for the sake of argument lets pretend you are starting an ECMO/ECLS/ECPR program de novo. What are your options? Well, whomever is going to do this MUST be "in-house." In the ED, Emergency Physicians should be cannulating because we are already right there. We are running the code. We should be the ones doing the cannulation. And the same goes for intensivists in the ICU. There simply isn't time to call in a specialist to cannulate. The same goes for your ECMO team: they must be "in-house." It would seem to make sense that perfusionists would be the first-responder ECMO team, however at many institutions (ours included) perfusionists aren't "in-house 24/7." So there are now 3 main 'models' to address this: * Perfusionist-based: Some facilities, usually teaching hospitals with very active ECMO programs, have in-house perfusionists. In those cases the perfusionist is usually the "first-responder." In some cases the perfusionists handle all bedside activities from start to finish. In other cases the perfusionists help initiate ECMO and RN's or respiratory therapists (RT's) will 'babysit" the machine when active adjustments aren't being made. * RT-based: When Shinar and I were at the University of North Carolina Chapel Hill, we witnessed this type of program. While the perfusionists there are doing all the heavy lifting, they have trained their RT's in supervising ECMO. * Nurse-based: ICU nurses are cross-trained in ECMO. This is the model we use at Sharp Memorial Hospital in San Diego. ICU nurses are trained in all aspects of ECMO and the ICU staffing is setup such that there is always at least 2 RN's in the SICU who are ECMO-ready. If we have an ECPR case in the ED we call the SICU. Quickly those nurses temporarily hand-off their assignments and come to the ED. Establishing an ECMO Program at Your Hospital Key Players: * CT Surgery * Nursing * Perfusionists * Hospital Administration The SMH Mechanical Circulatory Support Team These are the key components. Of course, if you are doing ECPR in your ED then you also need an ED doctor champion. If you are reading this, I assume that will be you. So welcome to your new role! Who Cannulates? * CT surgeons * Interventional Cardiologists * Intensivists/Pulmonologists * Interventional Radiologists * Emergency Physicians The Sharp Memorial Hospital ECMO Nursing Training Program * Staffing: * SICU nurses must apply to be on the ECMO team

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