RESUMEN
Objectives: The nursing care is more complex in relation to new technologies, new diseases, new globally emergencies. In relation to technology, nurses acquired more competences in relation to advanced therapy, in respiratory, circulatory, and renal support. The nursing workload increases in complexity and in responsibilities, without a staff increasing in relation to nursing activities. ECMO was widely applied to manage acute respiratory distress syndrome and circulatory failure, in case of cardiac arrest or cardiogenic shock, configuring as a therapy bridge to decision, to restore, to transplant or to nowhere. During the last years, nurses were involved to a rapid and continuous changing, to respond adequately to new health challenges, understanding or not their role and responsibilities in globally health care system. Nurse manages different variables, well represented by nursing activities score, but in nursing ECMO care, these variables are more complicated, in relation to ECMO device and to ECMO patient. What is the globally perception of nurses involved in ECMO care? Methods: A literature review was applied on PubMed. The inclusion criteria were all articles about ECMO, including pediatric and/or adult population, with a publication less than ten years. Result(s): A total of sixteen articles were found, with reduction to ten for relevance. The excluded articles talked about non ECMO care or patient;s perceptions. Articles included in the research talk about nursing perceptions (40%), education (30%), ethics in ECMO care (20%), professional experience in ECMO Covid (10%). Conclusion(s): The nursing perception on ECMO nursing care are different. They recognize the central role in ECMO care, but over workload, without staff increasing, less peer support, a low teamwork and personal differences in technical and non-technical skills increase some barriers to nursing perception of themselves. Nurses allocate their competence on experience and continuous training, but also a good teamwork and a professional recognition by other health care professions or by nursing supervisors can increase nursing perception and reduce the abandonment of nursing profession.
RESUMEN
Objective: ECMO can provide respiratory (VV) or circulatory (VA) support. During mobilization, specially during transport, nursing care on manoeuvres as proning, decannulation can be one of the worst complication during ECMO support: in relation to aetiology of ECLS, type of configuration, site of decannulation (i.e. drainage or return cannula), specific management has to be done. Methods: Two case reports are presented about ECMO decannulation in VA and in VV support. The patient was undergoing to VA ECMO support due to out of hospital cardiac arrest (OHCA);in the second case VV ECMO was applied due to acute respiratory distress syndrome in Sars-Cov2. A retrospective analysis was done on medical reports to identify what, where and why decannulation was occurred with focus on decision making process and survival outcome. Results: In both, decannulation was on return cannula and patients were survived. In VA case neurological negative outcome was attributable to OHCA damage, while in VV ECMO is currently ongoing. In VA decannulation, displacement occurred before nursing hygiene care, discovering of continuous bleeding: during medication dressing, return cannula was displaced. Perfusionist was present in ICU, clamping circuit, while one nurse compressed the site, one called for help, one increased catecholamines support to manage the acute cardiogenic shock. Return cannula were repositioned into the same vessel. In VV decannulation, in femoral-femoral approach, decannulation occur before a fourth proning cycle. Bleeding was recognized increasing quickly, with discover of integrity lesion on the return cannula: ventilation upgrade, circuit clamping and compression were applied, with replacement of return cannula in right external vein. Conclusions: Decannulation is a teamwork management. Return cannula can product hypovolemic shock in case of VV support, with acute respiratory failure and emergency airways management, especially in case of awaked and extubated patient, while in VA support cardiogenic and hypovolemic shock can occur with increased mortality.