Interdisciplinary Management of Healthcare Technology – Extracorporeal Membrane Oxygenation

Interdisciplinary Management of Healthcare Technology – Extracorporeal Membrane Oxygenation

Introduction

One of the latest healthcare technologies introduced at the bedside in the care of patients with complex conditions is Extracorporeal Membrane Oxygenation (EMO). The technology is used to save the lives of many patients with cardiovascular and respiratory conditions. The technology ensures that there is improved gaseous exchange by supplying body tissues with oxygen. Patients with heart and lung problems or infections may have a reduced supply of oxygen to body tissues. Therefore, Extracorporeal Membrane Oxygenation is used in critically ill patients with respiratory and cardiac problems to improve gaseous exchange (Brodie, 2018). Extracorporeal Membrane Oxygenation technology has been used during the Covid-19 pandemic. COVID-19, in combination with other infections such as pneumonia, destroys the lungs, leading to poor oxygen circulation. Thus, with Extracorporeal Membrane Oxygenation, the patients’ tissues are able to get enough oxygen supply, which supports the patients’ lives (Brodie, 2018). The complexity of the technique requires specialized and well-trained professionals to start, maintain and stop it. The technology involves fixing a device on the patient’s membrane; therefore, specialized professionals dealing with the technology should be highly trained, experienced, and skilled (Brodie, 2018). Interdisciplinary collaboration improves the outcomes of the patients using the technology since there will be training and coordination of care among the team.

In Maya Hospital, A patient by the name of Jane is in ICU bed 2. Jane was a 65-year-old female White American diagnosed with Covid-19 a month ago. Recently, she has been diagnosed with pneumonia. The two conditions seem to have affected Jane’s respiration and blood circulation due to damage to the respiratory system. An image of his lungs shows destroyed lungs. The patient is on artificial ventilation and requires a lung transplant. After thorough consultations with each other, the interdisciplinary team recommended Extracorporeal Membrane Oxygenation for Jane to support her before surgery and during the lung transplant. The technology was to help in gaseous exchange until the patient recovers after lung transplant.

Explanation and Background

Extracorporeal Membrane Oxygenation is a technology that supports respiratory and cardiac function. The technology is also called extracorporeal life support (Brodie, 2018). Patients with cardiac and respiratory conditions have a reduced supply of oxygen to tissues and cells. The cells may die due to lack of oxygen, hence the need for action to be taken. Extracorporeal Membrane Oxygenation technology works by bypassing the cardiopulmonary system to support the lungs and the heart in gaseous exchange and improving tissue perfusion (Brodie, 2018). Extracorporeal Membrane Oxygenation device, which bypasses the cardiopulmonary systems, acts as an artificial lung membrane oxygenator. The Extracorporeal Membrane Oxygenation device bypasses the lungs and the heart, drawing blood for gaseous exchange (Brodie, 2018). Blood is drawn from the heart to the Extracorporeal Membrane Oxygenation device, which removes carbon dioxide and oxygenates it, and then taken back to the body for tissue perfusion.

Some critically ill patients may have damaged lungs that cannot oxygenate their blood and remove carbon dioxide, while some have cardiac conditions. With Extracorporeal Membrane Oxygenation technology, critically ill patients with cardiac and respiratory failure can be managed successfully to improve their health outcomes. Serious respiratory conditions that may require the use of the technology include severe Covid-19, acute respiratory distress syndrome, and people severe pneumonia in combination with Covid-19. Conditions such as congenital heart diseases in children and myocardial infarction may require the use of technology. Extracorporeal Membrane Oxygenation technology may also be used during and after lung and heart transplants to support the patients’ gaseous exchange until they recover.

There are risks associated with the technology, and therefore, safety concerns should be considered during the initiation, maintenance, and termination of the technology. The patient may interfere with the device and the procedure during initiation due to movements. Therefore, the patients should be immobilized or sedated during the process. The technology works as an artificial lung where the device draws blood from the lungs. Hence, the blood may clot in the device. Administering heparin in the device’s circuit prevents blood from clotting. Antibiotics like ceftriaxone are also administered to prevent infections. There should be close monitoring of the patient to avoid device failure and bleeding, and therefore, the patient should never be left alone. Since it is a new technology, Extracorporeal Membrane Oxygenation is very expensive, and only rich patients can afford it; the government may make it affordable to all patients by funding companies making the devices and affordable health insurance.

Benefits of Extracorporeal Membrane Oxygenation and Risks

The technology helps in the reduction of mortality and morbidity related to respiratory and cardiovascular conditions (Sanaiha et al., 2019). The technology prevents death by supporting the life of patients with heart and lung failure till they receive an organ transplant (Huesch, Foy & Brehm, 2018). The technology improves the outcomes of patients with conditions like Covid-19. The technology can also be used in heart and lung surgeries to help patients recover. Innovation of the technology has also given light to other innovations that can help manage respiratory and cardiac conditions. Ideally, with the technology, there are improved patient outcomes and quality of managing critically ill patients.

Ensuring positive outcomes for patients using Extracorporeal Membrane Oxygenation technology should be a priority in health. The technology is complex and risky to use; hence certain rules should be formulated to guide its use so as to bring positive outcomes. Policies and standards should allow only specialized and highly experienced professionals to start, maintain, and terminate the process (Huesch, Foy & Brehm, 2018). There should be close monitoring of the patient. A patient on Extracorporeal Membrane Oxygenation should never be left alone. The device should be checked to avoid device failure. The multidisciplinary team should observe high levels of hygiene to prevent infections (Huesch, Foy & Brehm, 2018). Multidisciplinary team collaboration, when using the technology, will reduce errors and improve outcomes.

Risks associated with the technology include the risk of bleeding, blood clotting, and infection. Since the blood is drawn from the heart, device failure may lead to bleeding, which may lead to anemia. Blood in the device may clot, which may, in turn, lead to embolism. Embolism may lead to death (Huesch, Foy & Brehm, 2018). Bacterial infection may affect the person during the insertion of the device and when levels of hygiene are low. Some parts of the body, such as the legs, may not receive enough blood, leading to the death of cells (Huesch, Foy & Brehm, 2018). Seizures and strokes may occur in some patients using the technology.

Using highly trained, specialized, and skilled professionals to start, maintain, and stop the technology reduces the risk of bleeding. Close monitoring of the devices and the patient reduces the risk of bleeding. Performing initiation, maintenance, and termination procedure aseptically reduce the risk of infections (Huesch, Foy & Brehm, 2018). The use of antibiotics like ceftriaxone prevents bacterial infections. Low doses of heparin prevent blood in the device from clotting. A check of the devices before being installed prevents complications.

The Roles and Responsibilities of Interdisciplinary Team

Health professionals should work as a team to successfully implement the use of the technology and improve patient outcomes. Different professionals are required at different levels, and therefore, they should coordinate with each other. Professionals involved in caring for patients on the technology include respiratory therapists, registered nurses, ICU nurses, cardiothoracic surgeons, physicians, pharmacists, psychologists, and social workers (Ratnani, Tuazon, Zainab, & Uddin, 2018). Psychologists help to counsel patients using the technology and their family members before and after the procedure. Surgeons insert the device while respiratory therapists, registered nurses, ICU nurses, and physicians care for the patients. Pharmacists supply relevant drugs needed. Social workers deal with financial issues related to the use of technology on the part of the patient. The major roles will be played by registered nurses and ICU nurses monitor the patient, ensure infection prevention, and educate the patient (Ratnani, Tuazon, Zainab, & Uddin, 2018). The major challenge with the multidisciplinary team approach is the confusion of roles and miscommunication. One professional may perform the role of the other or may assume his or her role will be done by another professional; hence, a gap is created. Communication of ideas, strategies, and instructions may be a challenge since the professionals are trained differently.

Nursing Scope of Practice

Based on the nursing scope of practice, all nurses caring for patients using Extracorporeal Membrane Oxygenation technology should be licensed with a specialization in the area of Extracorporeal Membrane Oxygenation. The nurses should be knowledgeable and have information and skills on both respiratory and cardiac function. Specialized nurses should be aware of how the technology works, the medications to use, and how to monitor patients on the circuit (Abrams et al., 2020). Nurses using the new technology should consider ethical principles such as confidentiality, justice, and doing no harm to patients (Abrams et al., 2020). The scope requires nurses to assess patients on the technology and implement interventions such as turning patients, educating patients, monitoring patients, and identifying any risk factors or complications. Effective communication skills and patient assessment skills are essential in managing patients on Extracorporeal Membrane Oxygenation (Abrams et al., 2020). Nurses should have a positive attitude to encourage the patient and ensure the success of the team caring for the patient.

Patient Education 

It is essential to educate conscious patients who decide to use the technology. Their family members should also be educated. Education should focus on explaining the technology, its benefits based on the patient’s conditions, and the risks or complications associated with the technology. Teaching should also be done on how to identify complications and deal with their complications (Abrams et al., 2020). Education should also include infection prevention practices such as maintaining high standards of hygiene. The verbal and audiovisual presentations will be used in teaching to improve understanding. Certain cultural considerations should be considered during education, such as religious practices and differences in language. Literacy levels of the patient and family members and the patient’s level of consciousness should also be considered during education (Abrams et al., 2020). To evaluate the effectiveness of teaching, the outcomes of the patient will be used. Asking questions will also help in the evaluation of the education sessions.

Conclusion 

Extracorporeal Membrane Oxygenation is one of the latest technologies in health that has improved the outcomes of critically ill patients suffering from cardiac and respiratory conditions. The technology works as an artificial lung where a device is placed in the membrane to bypass the lungs and the heart. Blood is drawn into the device for gaseous exchange, where carbon dioxide is removed and oxygen added, hence improving tissue perfusion. The technology supports the lives of patients with conditions such as severe Covid-19 and pneumonia. Patients with heart and lung conditions, such as those undergoing lung and heart transplants, may also use the technology. Risk for infection, bleeding, and blood clotting are the complications of the technology, and therefore, highly trained and specialized professionals should initiate, maintain, and terminate the technology. There should be interdisciplinary collaboration when managing patients on Extracorporeal Membrane Oxygenation to improve patient outcomes. Ethical standards such as autonomy, confidentiality, and patient safety should be maintained based on nursing standards.

References

Abrams, D. C., Prager, K., Blinderman, C. D., Burkart, K. M., & Brodie, D. (2020). Ethical dilemmas encountered with the use of extracorporeal membrane oxygenation in adults. In The Ethical Challenges of Emerging Medical Technologies (pp. 327-333). Routledge.

Brodie, D. (2018). The evolution of extracorporeal membrane oxygenation for adult respiratory failure. Annals of the American Thoracic Society, 15(Supplement 1), S57-S60. https://doi.org/10.1513/AnnalsATS.201705-386KV 

Huesch, M. D., Foy, A., & Brehm, C. (2018). Survival outcomes following the use of extracorporeal membrane oxygenation as a rescue technology in critically ill patients: results from Pennsylvania 2007–2015. Critical care medicine, 46(1), e87-e90. https://doi.org/10.1097/CCM.0000000000002801

Ratnani, I., Tuazon, D., Zainab, A., & Uddin, F. (2018). The role and impact of extracorporeal membrane oxygenation in critical care. Methodist DeBakey Cardiovascular Journal, 14(2), 110. doi: 10.14797/mdcj-14-2-110

Sanaiha, Y., Bailey, K., Downey, P., Seo, Y. J., Aguayo, E., Dobaria, V., … & Benharash, P. (2019). Trends in mortality and resource utilization for extracorporeal membrane oxygenation in the United States: 2008–2014. Surgery, 165(2), 381-388. https://doi.org/10.1016/j.surg.2018.08.012

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Interdisciplinary Management of Healthcare Technology – Extracorporeal Membrane Oxygenation

Extracorporeal Membrane Oxygenation