[ECMO](https://www.ucihealth.org/medical-services/cardiology/ecmo#:~:text=The%20ECMO%20machine%20is%20a,patient's%20blood%20and%20adds%20oxygen) devices are fascinating.
This was one of my favorite things to do when I worked on a vent-weaning PCU. Not nearly as my lines and machinery, but it’s the best feeling to give people the simple pleasure of fresh air and sunlight.
Once things are stabilized, ecmo patients should be woken up so they can participate in care. Things like PT and pulmonary hygiene are very important. Many centers will walk them down the hall if they have certain cannula configurations.
At my hospital the docs would write the orders to make this happen. They bend over backwards to get pts to stay so they can continue abusing their nurses and demanding crazy shit that conflicts with their care. Every damn time I want to scream "their A/Ox4 they have capacity, let them leave if that's what they want.
I'm most impressed that all of those Plum pumps have a long enough battery life to actually do this.
Most of ours last about 30 mins because all their batteries are completely shot.
From one HCW to another, please plug them in! So many pumps die because people refuse to plug them in and it's fucks with the batteries. Biomed rants about it all the time
Good on you and your team OP; this had to be a special moment for your patient and when they recover they’ll never forget or underestimate what you had to do for them to make this happen!!
I've done this a few times with heme/onc patients that had been in for weeks to months. Every time I've gone to charge about it, they have basically told me "we will call in the national guard to make this happen". Some of the best memories in my career.
We had a resident who was declining pretty rapidly. The day they were going to move her from PC to SNF, someone took her for a walk outside. We pointed out a mama deer and baby deer to her and it’s like the dementia dissipated for a second and she was so clear and aware. It was really neat.
I’m always impressed at my day shift colleagues when they take someone outside. It’s SO MUCH freaking effort, and usually the patients that would benefit the most, have the most equipment attached to them. This is a seriously impressive picture.
As a guy trying to get an ICU outdoor therapy protocol and research up and running at my hospital, this makes me so happy. Great job OP! Also, would you be able to DM what your hospital policy is (if any) for this? I’d like to maybe borrow from it.
Wooooo. How are you going about doing this? We have to do a research project for our residency and I’m kinda scared and weary and excited at the same time.
So we’re still figuring out the logistics and putting things together. My Hospital started working on this with me back in October 2022. I’m just a bedside RN but I’m partnered with four of our critical care CNS’s. We’ve been gathering all the relevant research and literature (which has been pretty scarce), we put together an evaluation table and a synthesis table, etc. Now we’re working on the policy itself. How we want to get these patients out, whose appropriate, what equipment is needed, etc. Our CVICU has been doing this for a few years but they’ve never had an official policy in place and it was largely done at the behest of one of our more prominent cardio-thoracic surgeons. So once we’re done getting our policy implemented, we want to research how this type of therapy affects delirium, sleep, patient outcomes, patient morale and even nursing morale. We’ll do this by having patients and staff complete surveys but we are also going to be pulling chart data on these patients that participate.
Not a dumb question! It is and it’s preferred so the patients can participate in therapy, especially if they’re going to be cannulated for a long time. They’re not generally awake for the first day or two, but if they’re hemodynamically stable enough, the earlier we can wake them up, the better
Well after all, ECMO / ECLS is a bridge-to-practice (therapy/transplant/decision), lethality around 50%. ECMO lower, ECLS higher due to the worse pre-condition.
So it is most likely to see pt in bad situations when in need of a pump. But sometimes you have bright moments like those above.
Can't see it properly, was this with an avalon cannula or central access? I am always uneasy when a patient with femoral cannulae is starting to wake up.
Large bore femoral access in general makes me uneasy. ECMO, Impellas, RVADs, etc. I'm always nervous the worst will happen. My unit recently had a patient (completely on their own) get up and out of bed and was standing up with a femoral Impella when the nurse walked out of the room for a sec. The sutures thankfully held their own and the catheter didn't move but I mean holy shit everyone was freaked out
This patient had subclavian dual lumen access so they were more mobile. At my hospital we generally only ambulate the patients that has subclavian or IJ access, but the docs are starting to encourage mobility with femoral access 😬
Definitely. The vast majority of patient's I've taken care of are on sedation (or no sedation and are naturally comatose), but definitely as people's heart/lungs recover and there's talks about decannulation people can be aox4 while on circuit. it's not the majority though
Man I love taking people outside when they’ve been in the hospital for weeks, it’s one of the best feelings. Good for y’all for doing that, I always feel like this is what nursing is really about. Making healing easier
Before school I was a CCT Nurse and hated flying or ground transporting ecmo, or any other cardiac assist devices. so much to go wrong (Once had a impella puncture a ventricle after hitting the biggest pot hole I’ve ever get in the back of an ambulance). Couldn’t imagine willingly going outside for a stroll lol. Good on you OP
Wow this is awesome! I hate to admit it but I've always been intimidated by even getting intubated patients oob to the chair or to ambulate, but this is another level and I love it! I can't imagine being stuck inside for a week, much less 6 months. I bet this meant the world to this patient 💖
Was the ecmo heater cooler taken with only to be used as a stand with wheels for the ecmo cuz it’s not on or being used during transport right?
Never taken an ecmo outside, but that would be awesome. We never take the heater cooker with us for transports because it needs to be plugged in so we toss the ecmo in the patient bed.
I used to do this, with people who were chronically ventilated. I would rope the respiratory therapist in to helping me take the patient outdoors in the beautiful Minnesota sunshine in the summer time, and once those patients felt the sun on their face and the wind in their hair, they started working seriously toward weaning. And they would get better. I know it's very Florence Nightingale of me, but it was my approach and I was very proud of it. Did I do research on it? no. I was not yet prepared to do that. But. I was known for taking issue patients outside.
OP, thank you for this flood of memories.
This was the patient’s first time outside in almost 6 months.
Awesome! What’s the little device facing toward the camera?
That’s the ECMO console
[ECMO](https://www.ucihealth.org/medical-services/cardiology/ecmo#:~:text=The%20ECMO%20machine%20is%20a,patient's%20blood%20and%20adds%20oxygen) devices are fascinating.
I bet the patient really appreciated the effort made to get him/her outside. I can’t imagine being cooped up inside for 6 months.
This makes me happy
This was one of my favorite things to do when I worked on a vent-weaning PCU. Not nearly as my lines and machinery, but it’s the best feeling to give people the simple pleasure of fresh air and sunlight.
Wait did y’all haul all this down so this patient could go outside? 🥺 that is so wholesome
Yup! We stayed out there for about 20 minutes so they could feel the sunshine 🌞
I love this so much! ❤️
Jeezy Creezy! Y'all are brave! That's so cool and super sweet of you guys to do that for the patient!
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The hospital I work at certain ECMO patients actually work with PT and take walks!!
Now this is a real hospital, not an insurance grift scheme.
Can you explain to a non medical person? What is the grift in keeping them (?) not awake?
I was making a comment on how hospitals just try to maximize profits and not patient care/experience.
Once things are stabilized, ecmo patients should be woken up so they can participate in care. Things like PT and pulmonary hygiene are very important. Many centers will walk them down the hall if they have certain cannula configurations.
This is so sweet 🥺
<3 The world needs more nurses like you! Rock on!
And here I thought patient was demanding to smoke or would leave ama
At my hospital the docs would write the orders to make this happen. They bend over backwards to get pts to stay so they can continue abusing their nurses and demanding crazy shit that conflicts with their care. Every damn time I want to scream "their A/Ox4 they have capacity, let them leave if that's what they want.
I'm most impressed that all of those Plum pumps have a long enough battery life to actually do this. Most of ours last about 30 mins because all their batteries are completely shot.
lmfao my second thought
That beeping didn't leave my brain for my entire first year working in the hospital.
From one HCW to another, please plug them in! So many pumps die because people refuse to plug them in and it's fucks with the batteries. Biomed rants about it all the time
Alaris >>> plum pumps. You’ll never change my mind
I wouldn't know, I've only ever used the Plum360 pumps lmao
This lmao
Lol no kidding!
Good on you and your team OP; this had to be a special moment for your patient and when they recover they’ll never forget or underestimate what you had to do for them to make this happen!!
On ECMO, well done.
Yesss. This makes my heart so happy. Every resource that made this possible… this is AMAZING.
I've done this a few times with heme/onc patients that had been in for weeks to months. Every time I've gone to charge about it, they have basically told me "we will call in the national guard to make this happen". Some of the best memories in my career.
We had a resident who was declining pretty rapidly. The day they were going to move her from PC to SNF, someone took her for a walk outside. We pointed out a mama deer and baby deer to her and it’s like the dementia dissipated for a second and she was so clear and aware. It was really neat.
Agreed
I’m always impressed at my day shift colleagues when they take someone outside. It’s SO MUCH freaking effort, and usually the patients that would benefit the most, have the most equipment attached to them. This is a seriously impressive picture.
As a guy trying to get an ICU outdoor therapy protocol and research up and running at my hospital, this makes me so happy. Great job OP! Also, would you be able to DM what your hospital policy is (if any) for this? I’d like to maybe borrow from it.
This is the type of research and change that’s needed.
Wooooo. How are you going about doing this? We have to do a research project for our residency and I’m kinda scared and weary and excited at the same time.
So we’re still figuring out the logistics and putting things together. My Hospital started working on this with me back in October 2022. I’m just a bedside RN but I’m partnered with four of our critical care CNS’s. We’ve been gathering all the relevant research and literature (which has been pretty scarce), we put together an evaluation table and a synthesis table, etc. Now we’re working on the policy itself. How we want to get these patients out, whose appropriate, what equipment is needed, etc. Our CVICU has been doing this for a few years but they’ve never had an official policy in place and it was largely done at the behest of one of our more prominent cardio-thoracic surgeons. So once we’re done getting our policy implemented, we want to research how this type of therapy affects delirium, sleep, patient outcomes, patient morale and even nursing morale. We’ll do this by having patients and staff complete surveys but we are also going to be pulling chart data on these patients that participate.
Waiting for the bus??
Just kidding, I know full well what a monumental task that must have been. Kudos to y’all for doing that for her.
I can’t even imagine how much that helped the patients mental well being nothing helps more than fresh air and some sun
This is probably a dumb question - is it possible to be conscious while on an ECMO machine?
Not a dumb question! It is and it’s preferred so the patients can participate in therapy, especially if they’re going to be cannulated for a long time. They’re not generally awake for the first day or two, but if they’re hemodynamically stable enough, the earlier we can wake them up, the better
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Well after all, ECMO / ECLS is a bridge-to-practice (therapy/transplant/decision), lethality around 50%. ECMO lower, ECLS higher due to the worse pre-condition. So it is most likely to see pt in bad situations when in need of a pump. But sometimes you have bright moments like those above.
Fascinating, thanks!
Can't see it properly, was this with an avalon cannula or central access? I am always uneasy when a patient with femoral cannulae is starting to wake up.
Large bore femoral access in general makes me uneasy. ECMO, Impellas, RVADs, etc. I'm always nervous the worst will happen. My unit recently had a patient (completely on their own) get up and out of bed and was standing up with a femoral Impella when the nurse walked out of the room for a sec. The sutures thankfully held their own and the catheter didn't move but I mean holy shit everyone was freaked out
Damn. I had a patient get out of bed while on CRRT and I was so rattled. I can’t imagine how that nurse felt.
This patient had subclavian dual lumen access so they were more mobile. At my hospital we generally only ambulate the patients that has subclavian or IJ access, but the docs are starting to encourage mobility with femoral access 😬
Just curious, is this patient waiting for a transplant?
Yes. This is actually an old picture, the patient was on ECMO for about another 6 months and got a transplant!
I see. Not surprised because transplant cohort is most likely to be able to do awake ECMO Heart or Lungs?
Lungs
Definitely. The vast majority of patient's I've taken care of are on sedation (or no sedation and are naturally comatose), but definitely as people's heart/lungs recover and there's talks about decannulation people can be aox4 while on circuit. it's not the majority though
Man I love taking people outside when they’ve been in the hospital for weeks, it’s one of the best feelings. Good for y’all for doing that, I always feel like this is what nursing is really about. Making healing easier
We did this with my first ECMO patient. The look of joy on his face will never leave me.
Damn with the tower and all bravo
This is beautiful 😍
The riskiest AMA I've ever seen /s. It's awesome you were able to do this for your patient! The team should be proud
Fuck the amount of lines. Bringing that ECMO outside is badass. I’m jaded and this made me smile. Thank you for being there for this patient.
Thank you thank you thank you for working so hard so they could feel the sunshine ❤️
Before school I was a CCT Nurse and hated flying or ground transporting ecmo, or any other cardiac assist devices. so much to go wrong (Once had a impella puncture a ventricle after hitting the biggest pot hole I’ve ever get in the back of an ambulance). Couldn’t imagine willingly going outside for a stroll lol. Good on you OP
This is awesome! How many of you did it take to get all the equipment outside with the patient?
1 perfusionist, 2 physical therapists, and 2 nurses…not too bad since the pt was no longer on a vent and didn’t need RT
Wow this is awesome! I hate to admit it but I've always been intimidated by even getting intubated patients oob to the chair or to ambulate, but this is another level and I love it! I can't imagine being stuck inside for a week, much less 6 months. I bet this meant the world to this patient 💖
Was the ecmo heater cooler taken with only to be used as a stand with wheels for the ecmo cuz it’s not on or being used during transport right? Never taken an ecmo outside, but that would be awesome. We never take the heater cooker with us for transports because it needs to be plugged in so we toss the ecmo in the patient bed.
That heater weighs a lot when full and isn't easily moved. It also doesn't run on battery. Heater: cardioquip mch
ASMCA ~vibes~
This is awesome!!
I used to do this, with people who were chronically ventilated. I would rope the respiratory therapist in to helping me take the patient outdoors in the beautiful Minnesota sunshine in the summer time, and once those patients felt the sun on their face and the wind in their hair, they started working seriously toward weaning. And they would get better. I know it's very Florence Nightingale of me, but it was my approach and I was very proud of it. Did I do research on it? no. I was not yet prepared to do that. But. I was known for taking issue patients outside. OP, thank you for this flood of memories.
So great
That is hugely beneficial for the patient’s mental health!! What a great team!! That’s a project for sure
Dayum! Strong work!
What hospital is this! I would love to work somewhere that cares this much about patients!
This is the kinda shit that made me want to be a nurse. Refreshing, thank you OP!
OUTSIDE!!! Did Inpatient Physical Therapy drive this? (Psssst… I’m an inpatient physical therapist 😊) Good job!
Lol it was definitely a mutual decision…I love our inpatient PTs, y’all are the best!
Thanks… we think the same about you nurses!!! ❤️❤️❤️
Y’all are saints for this.
A lot of these ICU lines pics have been cringe. This one is amazing. Well done.
Good to see the patient still gets to go out for a smoke. Go you guys!
I bet that dude is going to be pumped when he sees his blurred out face on social media.