**7.3 Order sets**

Order sets provide a rapid, standardized, initiation for ECMO. The order set should include guidance for the perfusion team and nursing team to appropriately care for the patient in a variety of settings, as well as give parameters for physician notification to address changes in patient status quickly.

Order set elements should include:

	- AP abdomen post-cannulation
	- AP chest post-cannulation
	- Echocardiogram for symptoms
	- Daily and routine laboratory studies

**41**

*Clinical and Administrative Steps to the ECMO Program Development*

Critically ill patients requiring ECMO can be transported by ground, helicopter,

Per the 2015 ELSO guidelines, team members will vary depending on the need to cannulate the patient [19]. An ECMO specialist physician is required in either case, as is an ECMO specialist and a transport RN/RT. If cannulation is required, and the ECMO specialist physician is unable to perform this, there may be the need to add a cannulating physician and a surgical assistant to the team. Each team member has specific roles that should be delineated and understood prior to deployment to the outlying facility. A checklist, should include all the needed equipment for the return trip with the

3.Device(s) for heating and regulating circuit blood temperature (less critical for

4.Medical gas tanks, regulators, hoses, connectors, flow meters, and blenders for

6.Point-of-care anticoagulation monitoring equipment (e.g., activated clotting time)

7.Emergency pump or manual control mechanism in the event of primary pump

8.Uninterruptible power source(s) capable of meeting the electrical power needs of all equipment during transfer between vehicles and in the event of vehicle

9.Portable ultrasound machine, if not provided by the referring facility

provision and adjustment of blended sweep gas to the oxygenator

5.Venous and arterial pressure monitoring device(s), according to center-

and fixed wing aircraft. Considerations in choice of transport include distance, number of team members required, equipment, electrical and oxygen needs, and cost. Ideally, patients can be identified and transported prior to initiation of ECMO therapy, however there are models of care with good results in which the team goes to the patient and initiates ECMO, and then the patient is transported to the ECMO center.

*DOI: http://dx.doi.org/10.5772/intechopen.84838*

• Physical therapy

**8. ECMO transports**

◦ Occupational therapy

◦ Routine ICU parameters

**8.1 Team members for transport**

adult transports)

specific practices

failure or power failure

power source failure.

patient, and should be verified prior to departure.

1.Suitable blood pump, centrifugal, or roller

The equipment recommended by ELSO includes [20]:

2.Membrane oxygenator, appropriate for the patient size

◦ Case management

	- Nursing care
	- Sedation medications

*Clinical and Administrative Steps to the ECMO Program Development DOI: http://dx.doi.org/10.5772/intechopen.84838*

• Physical therapy

*Advances in Extracorporeal Membrane Oxygenation - Volume 3*

notification to address changes in patient status quickly.

Order set elements should include:

• ECMO circuit settings

• ECMO daily parameters

• Ventilatory settings

• Radiology ◦studies

• Instructions for ECMO machine priming

• Blood products and transfusion parameters

• Massive transfusion protocol parameters

• Post-cannulation radiology studies

◦ AP abdomen post-cannulation

◦ Echocardiogram for symptoms

◦ Daily and routine laboratory studies

◦ AP chest post-cannulation

safely anywhere needed.

**7.3 Order sets**

cases would be to the scheduling and allocation of OR/Cath lab resources, and often "how comfortable" the team is with the procedures. For example, Cath lab teams who are more comfortable with the catheter and wire-base procedures than surgical team might be a better option for peripheral cannulation of ECMO (arterial and venous)—while operating room teams might be better skilled at assisting with central cannulation (especially if the chest is already open). Nevertheless, a core "ECMO team" of providers beyond physicians and perfusions must be identified and included in all communications so that therapy can be initiated efficiently and

Order sets provide a rapid, standardized, initiation for ECMO. The order set should include guidance for the perfusion team and nursing team to appropriately care for the patient in a variety of settings, as well as give parameters for physician

• Instructions for the perfusionist/nurse in charge of the machine

• Instructions to leave all catheters in if not functioning and notify physician

• Anticoagulation and associated laboratory monitoring and adjustments

• Triggers for notification of the ECMO physician/nurse practitioner

**40**

• Other

◦ Nursing care

◦ Sedation medications

