Development of an Electronic Medical Record for Extracorporeal Membrane Oxygenation and Its Role in a Multidisciplinary Team.

As the extracorporeal membrane oxygenation (ECMO) program at our institution has grown and our staffing model has evolved into a multidisciplinary team, our method of ECMO charting has also evolved, using an electronic medical record (EMR) with electronic checklists, progress notes, and remote access. Using our EPIC charting platform, version 1 of our EMR was implemented in 2015. It has been revised three times, and remote access deemed necessary to properly support our staff and patients. Our current, yet still evolving, remotely accessible, ECMO EMR incorporates hourly charting and protocol-based checklists for procedures such as initiation of support, shift handoffs, circuit checks, and patient transport. Perfusionists are required to fill out thrice daily progress notes, notes for bedside/operating room procedures, and patient transport. We present a format for centers looking to implement a comprehensive EMR for ECMO patients. An expanding ECMO program required a change to our staffing model, and an EMR with electronic checklists and remote access facilitated the transition to a multidisciplinary team. Protocol-based checklists ensure consistency during procedures, transports, and shift changes. The remote access and required progress notes create a safer team approach and keep our perfusionists engaged when specialists are sitting ECMO.

Successful management of a left ventricular assist device malfunction in an outpatient setting.

Heart disease kills as many people as nearly all other causes of death combined. Chronic, progressive, end-stage heart failure results in substantial health care costs and immeasurable suffering for both individuals in particular and society in general. Ventricular assist devices are having an increasing role in supporting patients with severe circulatory compromise. These devices provide support and make it possible for patients to be discharged from the hospital and returned to their communities. System failures and device malfunctions do occur and are the most common cause of death for patients on device support. We present a device malfunction involving a HeartMate XVE Bridge to Transplant that occurred while the patient was at his home, > 100 mi. from our center. The patient was placed on a HeartMate after a re-operative coronary artery bypass surgery. He was discharged to his home on day 43 after device implant. On the 447th post-operative day, two "Red Heart" alarms occurred. After initiating hand pumping of the device, the patient's companion contacted our center, and the local Emergency Medical Service was activated. The patient was transported by helicopter to the Maine Medical Center, where he was placed on a backup pneumatic console and subsequently transferred to a Boston transplant center. The patient subsequently underwent cardiac transplantation. It is imperative to have a definitive strategy and clear support plan to address device malfunctions and system failures. Considering the growing number of ventricular assist device patients discharged home, these occurrences will be more common outside of the hospital setting. Education of clinicians, patients, and their companions, as well as local rescue teams and community hospitals, is essential for successful outcomes and continued quality of life.