For patients with COVID-19 in acute respiratory distress, extracorporeal membrane oxygenation (ECMO) can provide lifesaving support. However, use and management of ECMO machines requires highly trained staff, and ECMO specialists have been in high demand during the pandemic.
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“During the delta surge that started in the summer of 2021 and extended into the fall, we had many patients placed on ECMO,” says Erin Turner, DNP, RN, Associate Chief Nursing Officer, Cleveland Clinic Weston Hospital. “We didn’t have the necessary resources to provide training to our staff, so we sought help from our colleagues within the Cleveland Clinic Health System.”
ECMO machines facilitate drainage of venous blood from a patient to an oxygenator, which allows for effective oxygenation and ventilation. The machines provide a complete or partial substitution of the patient’s cardiopulmonary system.
Two ECMO-experienced nurses from the health system’s main campus traveled to Weston Hospital in late October 2021 for a week and provided training to nearly 90 caregivers in the medical and surgical intensive care units (ICUs), including clinical nurses, advanced practice providers, physician assistants and residents.
When nursing leaders at main campus considered candidates to conduct the training, Scott Flerchinger, BSN, RN, CCRN, and Jennifer Morr, BSN, RN, CCRN, were at the top of the list. Flerchinger is the lung transplant clinical manager and an ECMO specialist. Morr cares for patients on ECMO and others in both the cardiovascular ICU and eHospital program, through which she remotely monitors critically ill patients across the health system. Within a day of accepting the training assignment, the nurses were on an airplane headed for south Florida.
“Scott and Jenn uprooted their lives for a short time — and on short notice — to come down and help us,” says Dr. Turner. “They saw the need and responded.”
“Our goal was to bring main campus to Weston,” says Flerchinger. “Our units at main campus have nursing-driven ECMO management. Perfusionists are available, but nurses have the autonomy and resources to competently manage the ECMO device once it is placed.”
Flerchinger and Morr used Cleveland Clinic guidelines for extracorporeal life support and an ECMO hands-on competency checklist to train the caregivers at Weston Hospital on patient admissions, assessment of cannulation sites, peripheral pulses and oxygenation function, and troubleshooting and intervention skills. They also used a wet lab — a circuit primed with saline — to review potential emergencies that caregivers might encounter.
“The main goal was to reach as many nurses as we could and provide a fundamental comfort level with ECMO — the nuts and bolts,” says Flerchinger. “As the week went on, Jenn and I were able to sit down with the staff and talk about individual patients’ clinical pictures and trajectories.”
Patient conversations varied. In the MICU, for example, nurses helped the team by discussing patients’ hemodynamics, cannulation tactics and veno-venous versus veno-arterial ECMO. In the SICU, which had more long-term patients, communication often revolved around daily needs to support the bridge to recovery or to lung transplantation.
“Because of the volume of COVID-19 patients on ECMO that we have at main campus — and for me, the nightly experience of caring for them at the bedside — we were able to help the nurses at Weston understand what patients will go through and what nurses will go through,” says Morr.
Receiving hands-on training, as well as emotional support, was invaluable to the caregivers at Weston Hospital.
“We have on-site perfusionists, but because of the sheer volume of patients on ECMO, it was important for our nurses to have more knowledge about the population and machinery,” says Dr. Turner. “The training really made them feel more comfortable taking care of these patients.”
Partners in a cohesive system
Operating within a healthcare system helped facilitate smooth training.
“Being able to call on our colleagues in Ohio during our time of need was phenomenal,” says Dr. Turner. “Having similar systems and processes in place made it a lot easier than if someone from outside the organization came in to provide training.”
Flerchinger says he felt at home the moment he arrived at Weston Hospital. “I’ve spent my whole life in Cleveland, and when I walked into Weston’s ICU, it felt like I was just floated to a different ICU at main campus,” he says. “They had a strong, engaged group of nurses who were eager to learn and took a lot of pride in the care they provided.”
“Nurse engagement and training has contributed to positive patient outcomes,” says Dr. Turner. Several patients who had lung transplants at other facilities following ECMO have returned to Weston Hospital to visit staff.
“Despite the everyday challenges nurses experience taking care of the COVID-19 population, it has been extremely rewarding to see patients who have gone through so much have a chance at a longer life,” says Dr. Turner.