Journal Article
Practice Pointers
Critical Care Nurse (CCN)
October 2024
Page: 80
Topics: MultiSystem
Population: Adult
Role:
Staff
In our program, ECMO specialists are the non-sterile technicians of the ECMO circuits. They are trained in ECMO fundamentals, ECMO daily management, ECMO in-hospital transport, circuit troubleshooting, and circuit emergencies. ECMO primers are the sterile technicians of the ECMO circuits; they are nurses and respiratory therapists who have specialized training. Typically, duties of a primer include building and priming, initiating and managing ECMO, ECMO decannulation, ECMO advanced troubleshooting, ECMO reconfigurations, ECMO emergency management, and training of the ECMO specialists.
Think about the north-south syndrome as 2 circulations: (1) native cardiac/pulmonary circulation and (2) ECMO circulation. Where these circulations meet is typically referred to as a “mixing cloud” or “watershed region.” This region is dynamic and can move up or down depending on cardiac function and ECMO flow. Increased native cardiac output can push the mixing cloud down and increased ECMO flow or (too much flow) can push the mixing cloud up. Native lung function must be considered because it will affect the overall composition of the mixing cloud.