Physicians

*Advances in Extracorporeal Membrane Oxygenation - Volume 3*

understand and learn about many of these topics.

discussed by Dr. Constantino.

One area that is particularly challenging is incorporating ECMO into the management of patients who develop acute cardiopulmonary collapse. ECMO-assisted CPR (eCPR) is one of the fastest growing uses of ECMO, and many rapid

response/code teams are increasingly using ECMO in the management of patients who develop cardiac arrest. The data, experiences, and outcomes in this very complex area are rapidly evolving, and the controversies are substantial. The chapter by Dr. Lakshmi illustrates the current state of the art in this area and how patients can be selected and managed, with a focus on illustrating the improved outcomes in a patient population that was historically considered unsalvageable. Other similar unique applications for ECMO discussed in this text include a chapter on carbon dioxide removal by Dr. Morales-Quinteros. The very unusual role of normothermic regional perfusion in the setting of solid organ transplantation is

A major focus of this volume is the specific management challenges that complicate the use of ECMO, especially in high-risk patient populations. Despite a greater awareness, peripheral cannulation techniques that are often used are associated with high rates of limb complications including amputation. Such concerns are discussed in the chapter by Dr. Prashant. Imaging of patients on ECMO, with an emphasis on assessing for cardiac recovery and prognosis, is especially important and discussed by Dr. Luigi, while the actual techniques, concepts, and applications of various weaning strategies are the focus of another chapter. Meanwhile, Dr. Weller's chapter on anticoagulation in the pediatric patient and Dr. Pinto's chapter on neurologic complications and monitoring revisit some of the difficult topics addressed in the previous editions and emphasize the growing experiences and literature in these complex topics [4, 5]. As some aspects of these topics have been addressed in the earlier books in this series, the contemporary experiences highlight that there remains much to

Again, it is also clear that to successfully offer ECMO as a viable therapy and especially to strive for reasonable outcomes—there must be alignment of all key stakeholders. Without a doubt, ECMO requires an extensive team of providers at all levels working together in a manner that respects professionalism, competencies, compassion, and strict attention to details. The substantial and tireless efforts of the entire team must be recognized and appreciated by all and

A frequently asked question is "how do we start an ECMO program?" Offering ECMO as a therapy involves so much more than just purchasing capital equipment and some disposable supplies. The chapter on program development emphasizes the many administrative aspects that must be considered within an appropriate framework to establish a program. This chapter considers the importance of physician, nursing, and administrative leadership and collaboration as a foundation for a successful program. While a great deal has been written on the extensive medical and surgical aspects of the management of a patient on ECMO, the chapter by Mr. Botsch and colleagues reviews the many aspects of the nursing bedside care. Of course, these topics continue to illustrate the importance of teamwork which cannot

As discussed in the previous editions, a highly functioning "ECMO team" is a cornerstone in building a successful program. The ability to initiate therapy at any time and place is increasingly considered an important component of a well-organized team. While the makeup of an ECMO team can vary across institutions; each requires a champion to provide leadership and help with structure and organization. A fundamental principle is effective communication and a multidisciplinary approach to all aspects of management. Just as importantly, all

**4**

at all levels [6].

be overemphasized.

