Application of Extracorporeal Membran Oxygenation in Children and Nursing Care

Yıl 2019, Cilt: 6 Sayı: 2, 398 - 405, 01.06.2019

Gizem Kerimoğlu Yıldız , Birsen Mutlu

https://doi.org/10.17681/hsp.435687

Öz

DOI:10.17681/hsp.435687

Extracorporeal Membrane Oxygenation (ECMO) is a life-saving application which is used
as a temporary and artificial support in providing acute circulatory support or
respiratory failure of infants/children who have had recent cardiopulmonary
insufficiency or cardiac arrest. ECMO is applied as Veno-venous ECMO and
Veno-arterial ECMO according to the veins of the cannulation. Patients usually
need to be supported by ECMO for days and weeks to be able to recover. However,
since ECMO is a highly invasive and complex procedure, it can also cause
serious complications in newborns and children. Therefore, ECMO needs to be
performed by a specially trained health professionals team. Nurses as members
of the team should be active both in providing care for children in intensive
care setting and in preparing the family for the process and the procedure.
ECMO nurse needs to follow all the vital parameters, arterial blood gases, ECMO
parameters, fluid intake and output and neurologic conditions of the patient
and needs to be careful about the risk of any complications and inform the
physician when necessary. The nurse should do daily care of the child and
provide proper nutrition to the child. Despite the fact that in the world and
in Turkey ECMO is an increasing application in intensive care, as a result of
the literature reviews, it is noticed that the studies and publications about
this subject are low in our country. Therefore, it is aimed to compile and
share information about this subject.

Anahtar Kelimeler

Extracorporeal membrane oxygenation, Child, Nursing care

Çocuklarda Ekstrakorporal Membran Oksijenasyonu Uygulaması ve Hemşirelik Bakımı

Öz

DOI:10.17681/hsp.435687

Ekstrakorporal Membran Oksijenasyonu (EKMO) son dönem kardiyopulmuner
yetersizlik veya kardiyak arrest geçiren bebeklerde/çocuklarda akut dolaşım
desteğini sağlayabilmek amacıyla ya da solunum yetmezliğinde, geçici ve yapay bir destek olarak
kullanılan kurtarıcı bir uygulamadır. EKMO
kanülasyonun yapıldığı
damarlara göre Venö-venöz EKMO ve Venö-arteriyel EKMO olarak uygulanmaktadır. Hastaların
iyileşebilmesi için genellikle günlerce ve haftalarca EKMO ile desteklenmeleri
gerekmektedir. Ancak EKMO uygulaması oldukça invazif ve kompleks bir uygulama
olması nedeniyle yenidoğanlarda ve çocuklarda ciddi komplikasyonlara da neden
olabilmektedir. Bu nedenle EKMO özel olarak eğitim almış sağlık çalışanları ve
bir ekip tarafından uygulanmalıdır. Ekibin bir üyesi olan hemşirenin hem
çocuğun yoğun bakım ortamındaki bakımının sağlanmasında hem de ailenin işleme
ve sürece hazırlanmasında oldukça aktif olması gerekmektedir. EKMO hemşiresi
hastanın tüm yaşamsal parametrelerini, kan gazlarını, EKMO parametrelerini,
aldığı-çıkardığını ve nörolojik durumunu takip etmeli, herhangi bir
komplikasyon gelişmesi riskine yönelik dikkatli olmalı, gereken durumlarda
hekimi bilgilendirmelidir. Çocuğun günlük bakımını yapmalı ve uygun yöntemle
beslenmesini sağlamalıdır. Dünya’da ve Türkiye’de EKMO uygulamasının yoğun
bakımlarda giderek artan bir uygulama olmasına rağmen literatür incelemeleri
sonucunda ülkemizde bu konuya ilişkin yapılan çalışmaların ve yayınların azlığı
dikkat çekmiştir. Bu nedenle bu konuya ilişkin bilgilerin derlenerek
paylaşılması amaçlanmıştır.

Anahtar Kelimeler

Çocuk, hemşirelik bakımı, ekstrakorporeal membran oksijenasyonu

Kaynakça

• 1. Salvin JW, Laussen PC, Thiagarajan RR. Extracorporeal membrane oxygenation for postcardiotomy mechanical cardiovascular support in children with congenital heart disease. Paediatr Anaesth 2008;18:1157–1162.
• 2. Haines NM, Rycus PT, Zwischenberger JB, Bartlett RH, Ündar A. Extracorporeal Life Support Registry Report 2008: Neonatal and pediatric cardiac cases. ASAIO J 2009; 55(1):111–116.
• 3. Thiagarajan RR, Barbaro RP, Rycus PT, Mcmullan DM, Conrad SA, Fortenberry JD, & Paden ML. Extracorporeal life support organization registry international report 2016. ASAIO journal 2017; 63(1): 60-67.
• 4. Rajagopal SK, Almond CS, Laussen PC, Rycus PT, Wypij D, Thiagarajan RR. Extracorporeal membrane oxygenation for the support of infants, children, and young adults with acute myocarditis: A review of the Extracorporeal Life Support Organization registry. Crit Care Med 2010; 38(2): 382-387.
• 5. Costello JM, O’Brien M, Wypij D, Shubert J, Salvin JW, Newburger JW, Laussen PC, Arnold JH, Fynn-Thompson F, Thiagarajan RR. Quality of life of pediatric cardiac patients who previously required extracorporeal membrane oxygenation. Pediatr Crit Care Med 2012;13(4):428–434.
• 6. Arslantaş MK, Cinel İ, Günerli A. Sepsis ve Ekstrakorporeal Membran Oksijenizasyonu. Türk Yoğun Bakım Derneği Dergisi 2013;11: 86-92.
• 7. Lequier L. Extracorporeal Life Support in Pediatric and Neonatal Critical Care: A Review. J Intensive Care Med 2004; 19(5): 243-258.
• 8. Sasson L, Cohen I, Tamir A, Sternfeld AR, Berlowitz Y, Lenczner O, Houri S. Extracorporeal Membrane Oxygenation in Pediatric Patients: Our Experience in the Last Ten Years. IMAJ 2013; 15: 13–16.
• 9. Ravishankar C, Dominguez TE, Kreutzer J, Wernovsky G, Marino BS, Godinez R, Priestley MA, Gruber PJ, Gaynor WJ, Nicolson SC, Spray TL, Tabbutt S. Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome. Pediatr Crit Care Med 2006; 7(4): 319-26.
• 10. Alsoufi B, Al-Radi OO, Gruenwald C, Lean L, Williams WG, McCrindle BW, Caldarone CA, Van Arsdell GS. Extracorporeal life support following cardiac surgery in children: analysis of risk factors and survival in a single institution. Eur J Cardiothorac Surg 2009; 35(6):1004-11.
• 11. Kane DA, Thiagarajan RR, Wypij D, Scheurer MA, Fynn-Thompson F, Emani S, del Nido PJ, Betit P, Laussen PC. Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 2010; 122(11 suppl 1): S241-8.
• 12. Haydin S, Ündar A. Yaşam destek sistemlerinin Dünya'daki gelişmeleri ve Türkiye’deki son durum. Anadolu Kardiyol Derg 2013; 13:580-8.
• 13. Allan CK, Thiagarajan RR, del Nido PJ, Roth SJ, Almodovar MC, Laussen PC. Indication for initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 2007;133(3): 660-7.
• 14. David CH, Mirabel A, Jehanno AC, Lebreton G. Chapter 1 ECMO: Definitions and Principles. Nursing Care and ECMO. Eds. Mossadegh C. Combes A. Springer: Switzerland, 2017. Ss 3-7.
• 15. Cianchi G, Bonizzoli M, Pasquini A, Bonacchi M, Zagli G, Ciapetti M, Sani G, Batacchi S, Biondi S, Bernardo P, Lazzeri C, Giovannini V, Azzi A, Abbate R, Gensini G, Peris A. Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: Results of an Italian referral ECMO center. BMC Pulm Med 2011; 11(1): 2.
• 16. Doorenbos AZ, Starks H, Bourget E, McMullan DM, Lewis-Newby M, Rue TC, Lindhorst T, Aisenberg E, Oman N, Curtis JR, Hays R, and the Seattle Ethics in ECLS Consortium. Examining Palliative Care Team Involvement in Automatic Consultations for Children on Extracorporeal Life Support in the Pediatric Intensive Care Unit. Journal of Palliative Medicine 2013; 16(5): 492-495.
• 17. Gupta P, Gupta RD, Best D, Chu CB, Elsalloukh H. Gossett JM, Imamura M and Butt W. Delayed extracorporeal membrane oxygenation in children after cardiac surgery: two-institution experience. Cardiology in the Young 2013; 25(2): 248–254.
• 18. Frenckner B. Extracorporeal membrane oxygenation: a breakthrough for respiratory failure. J Intern Med 2015; 278(6): 586–598.
• 19. Extracorporeal Life Support Organization Guidelines, 2015 Erişim adresi: https://www.elso.org/resources/guidelines.aspx Erişim tarihi: 14. Ağustos. 2017.
• 20. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D. CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374: 1351–1363.
• 21. Barbaro RP, Odetola FO, Kidwell KM, Paden ML, Bartlett RH, Davis MM, and Annich GM. Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality. Am J Respir Crit Care Med 2015;191:894–901.
• 22. Fraser CD Jr, Jaquiss RD, Rosenthal DN, Humpl T, Canter CE, Blackstone EH, Naftel DC, Ichord RN, Bomgaars L, Tweddell JS, Massicotte MP, Turrentine MW, Cohen GA, Devaney EJ, Pearce FB, Carberry KE, Kroslowitz R, and Almond CS, for the Berlin Heart Study Investigators. Prospective trial of a pediatric ventricular assist device. N Engl J Med 2012; 367(6): 532–541.
• 23. Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 2008;372(9638):554–561.
• 24. Murphy DA, Hockings LE, Andrews RK, Aubron C, Gardiner EE, Pellegrino VA, Davis AK. Extracorporeal membrane oxygenation-hemostatic complications. Transfus Med Rev 2015; 29(2): 90–101.
• 25. Anton-Martin P, Thompson MT, Sheeran PD, Fischer AC, Taylor D, Thomas JA. Extubation During Pediatric Extracorporeal Membrane Oxygenation: A Single-Center Experience. Pediatr Crit Care Med, 2014; 15(9): 861–869.
• 26. Dipchand AI, Mahle WT, Tresler M, Naftel DC, Almond C, Kirklin JK, Pruitt E, Webber SA and the Pediatric Heart Transplant Study Investigators Extracorporeal Membrane Oxygenation as a Bridge to Pediatric Heart Transplantation. Circ Heart Fail 2015; 8(5): 960-969.
• 27. Hamrick SE, Gremmels DB, Keet CA, Leonard CH, Connell JK, Hawgood S, Piecuch RE. Neurodevelopmental outcome of infants supported with extracorporeal membrane oxygenation after cardiac surgery. Pediatrics 2003; 111(6):e671–e675.
• 28. Barrett CS, Bratton SL, Salvin JW, Laussen PC, Rycus PT, Thiagarajan RR. Neurological injury after extracorporeal membrane oxygenation use to aid pediatric cardiopulmonary resuscitation. Pediatr Crit Care Med 2009;10(4): 445–451.
• 29. Custer JR. The evolution of patient selection criteria and indications for extracorporeal life support in pediatric cardiopulmonary failure: next time, let’s not eat the bones. Organogenesis 2011; 7(1): 13-22.
• 30. Gupta M, Shanley TP, Moler FW. Extracorporeal life support for severe respiratory failure in children with immune compromised conditions. Pediatr Crit Care Med 2008; 9(4): 380-5.
• 31. Kuo KW, Barbaro RP, Gadepalli SK, Davis MM, Bartlett RH, and Odetola FO. Should Extracorporeal Membrane Oxygenation Be Offered? An International Survey. J Pediatr 2017; 182: 107-13.
• 32. Cingöz F, Tatar H. Çocuklarda ekstrakorporeal membran oksijenatör kullanımı. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2008; 16(1): 50-57.
• 33. Aharon AS, Drinkwater DC Jr, Churchwell KB, Quisling SV, Reddy VS, Taylor M, Hix S, Christian G, Pietsch JB, Deshpande JK, Kambam J, Graham TP, Chang PA. Extracorporeal membrane oxygenation in children after repair of congenital cardiac lesion. Ann Thorac Surg 2001; 72(6): 2095-102.
• 34. Ayık MF, Işık O, Akyüz M, Atay Y. Pediyatrik kalp cerrahisinde ekstrakorporeal membran oksijenasyonu kullanımı. Ege Tıp Dergisi / Ege Journal of Medicine 2014; 53(3): 173-176.
• 35. Linden V, Palmer K, Reinhard J, Westman R, Ehren H, Granholm T, Frenckner B. High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation. Intensive Care Med 2000; 26(11): 1630–7.
• 36. Mossadegh C. Nursing Care and ECMO. Eds. Mossadegh C. Combes A. Springer: Switzerland, 2017 Ss 45-69.
• 37. Brechot N. Chapter 9 Weaning Process from Venoarterial ECMO. Nursing Care and ECMO. Eds. Mossadegh C. Combes A. Springer: Switzerland, 2017. Ss 93-95.
• 38. Buscher H, Vaidiyanathan S, Al-Soufi S, Nguyen DN, Breeding J, Rycus P, Nair P. Sedation practice in veno-venous extracorporeal membrane oxygenation: an international survey. ASAIO J 2013;59(6): 636–41.
• 39. Verklan MT, Walden M. Core Curriculum for Neonatal Intensive Care Nursing-E-Book. 5th Editioni Elsevier Health Sciences. 2014;510-525.
• 40. Fowles JA. Chapter 11: Initial Training of Nurse. Nursing Care and ECMO. Eds. Mossadegh C. Combes A. Springer: Switzerland, 2017. Ss 101-107.
• 41. Sönmez Düzkaya D, Yakut T, Bozkurt G. Ekstrakorporeal Membran Oksijenasyonu Uygulanan Çocuğun Hemşirelik Bakımı (Olgu Analizi). Hemşirelikte Eğitim ve Araştırma Dergisi 2015; 12(2): 149-155.