TRANSPORTATION OF THE ECMO-PATIENT

Transcription

1 TRANSPORTATION OF THE ECMO-PATIENT Ann Alexanderson ECMO Center Karolinska Karolinska University Hospital SWEDEN

2 ECMO Center Karolinska 1986 Animal experiments 1987 First patient newborn 1995 First adult patient 1996 ECMO transport

3 ECMO Center Karolinska 6 beds (3-4) Newborn, children and adults

4 ECMO Center Karolinska Doctors, nurses and assistant nurses (no perfussionists) Individual training 2 weeks ECMO course (ELSO-standard) Waterdrills every 5:th week

5 ECMO where from?

6 The mobile ECMO-team ECMO doctor* ECMO nurse* Cannulating surgeon OR nurse *) ELSO accredited course/s + 2 years of full-time at an ELSO-ECMO-ICU

7 The mobile ECMO-team 7 nurses included in the mobile team On call hours per week Weekdays on the ward evening, nights and weekends at home. 30 minutes to get to the center

8 Surgery Intrahospital transports CT-scan Transport to Thorax ICU Patients in need of ECMO in the ER or in other ICU:s Need to see the sun

9 Intrahospital transports Responsable for the ECMO during transport Bring the right extra equipment (enough oxygen, extra oxygenator etc)

10 Intrahospital transport Before going anywhere TIME OUT Do we have everything? (volume, drugs etc) Any problems that we can expect? (clots in the system, problem with cannula?) If something happens everyone knows what to do?

11 Intrahospital transport The intrahospital transport is the right place to let other nurses do my job!

12 Why mobile ECMO? Sweden SàN: 1570 km (976 miles) 9,9 Million 60% forest, 15% above the Polar circle This calls for a effective transport organization

13 Interhospital ECMO transports /31 July Team launched No indication 110 ECMO Centre Karolinska 574 DoT Primary transports 734 Transports to other center 160 Transports on ECMO 813 Secondary transports 74 Lack of beds 27 Medical indication 52

14 Transports outside Sweden Denmark England Finland Germany Iceland Ireland Norway Scottland Spain/France Egypt Australia United Arab Emirates

15 Interhospital transportations On call 24 hours year around minutes then we are on our way

16 Neo Ped Adult Checklists Pre-packed systems and equipment

17 Interhospital transportations Equipment for mobile ECMO 250 kg We want to be independent Everything we need, we bring with us Anything can happen

18 Interhospital transportations Time-out before setting off double check - no equipment missing

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20 Interhospital transportations Before leaving with the patient eliminate things that can become a problem Loading the patient is always the most dangerous part. Be prepared for loading problems Help from a lot of people

21 After transfer from bed/reloading between vehicles/aircraft etc Check Electricity Gas Heat Rpm s Pressure Flow Color/temp of tubing

22 Climate issues In sub-zero ( C) ambient temperatures tubings and IV lines freeze within seconds! Newborns reach moderate hypothermia within a few minutes if heater on maximum if -10 C outdoors.

23 Always plan for trouble! Always have a back-up plan!

24 Adverse events in a six years follow-up of Interhospital ECMO transports n % Total number of transports 474 Identified transport journals ,4 n % Transports with incidents ,8 Equipment/technical 25 5,5 > 1 incident 27 6,0 Clotting of ECMO-system 2 total no of incidents 165 Canulla clot 1 Probability for incident on transport Ox clot 2 Broken lab device 9 Patient related ,5 Syringe pump failure 2 Accidental extubation 2 Broken heater/hose 4 Loss of tidal volume 44 Broken oxygen hose 1 Flooding of lung 5 Broken ventilator/hose 2 Bleedings 12 Powers supply roller pump 1 cannulation site 6 Iv pump line/air into system 1 lung 4 Staff flaw 4 nose 1 ECMO-system forgotten 1 Haematoma at cannulation site 1 ECMO-pump head forgotten 1 Hypoglycemia 2 Communication 2 Hyper/hypokalemia 3 Vehicle/transportation 19 4,2 Tachy/bradycardia 3 Wrong ambulance/equipment/late 3 Hypothermia 3 Ambulance utility malfunction 2 Thrombocytosis 1 Ambulance traffic accident 2 Arousal 2 colliding w wildlife 2 Cardiac stun 6 Ambulance; no electricity 1 Leg ischemia 3 Change in destination 1 Vagal reflex/secretions 2 No transport after delivery 1 Hypovolemia 8 Airport logoistics/delay 4 Circulatory instability/high-low BP 7 Environment 5 Recirculation (VV ECMO) 1 Reload in low ambient temp 2 Loss of arterial line 1 Freezing of iv lines/stop-cock 2 Inadequate ECMO (VV conv VA) 2 Not classified 6

25 Limited space

26 Keep training for safety Simulations outdoors with the Ambulance service Wet labs Equipment need to be part customized for transports Know your equipment

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