Portable rapid response extracorporeal life support: a center's 20-year experience with a registered nurse-run program.

摘要

If advanced cardiac life support therapy fails to revive a patient, extracorporeal life support (ECLS) becomes a critical bridge that maintains total systemic circulation and oxygenation during cardiac arrest or severe respiratory failure and allows time to establish a treatment plan. Improved patient outcomes depend on a shorter time period from the start of advanced cardiac life support to the initiation of ECLS. An in-house critical care nurse response team facilitates rapid initiation of ECLS, often in less than 20 minutes, at any time in any area of the hospital. Since 1986, Sharp Memorial Hospital has placed 176 patients on ECLS, using a registered nurse team with a survival rate greater than 30 days of 27.7%. The system used for rapid and mobile initiation of ECLS maintains perfusion to the vital organs via a centrifugal flow pump, using a hollow-fiber membrane oxygenator and percutaneous cannulas. Team members prime the system while the ECLS-trained first-response physicians place cannulae. Allelements of program development, team education, and ongoing program maintenance are critical to successful outcomes for patients.