Hackmann Amy E, Wiggins Luke M, Grimes Glenn P, Fogel Richard M, Schenkel Felicia A, Barr Mark L, Bowdish Michael E, Cunningham Mark J, Starnes Vaughn A
Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Ann Thorac Surg. 2017 Aug;104(2):510-514. doi: 10.1016/j.athoracsur.2016.11.005. Epub 2017 Feb 10.
The use of extracorporeal life support (ECLS) worldwide has increased exponentially since 2009. The patient requiring ECLS demands an investment of hospital resources, including personnel. Educating bedside nurses to manage ECLS circuits broadens the availability of trained providers.
Experienced cardiothoracic intensive care unit (CTICU) nurses underwent training to manage ECLS circuits, including volume assessment, treatment of arterial blood gas values, the physiology of ECLS, and recognition of common emergencies. In addition to lectures and a written examination, simulation using water circuits and an ICU model allowed assessment of skills and understanding of concepts. Performance assessments were completed regularly at the bedside, and skills revalidation occurred every 6 months. A sequential cohort of 40 patients was tracked over 1 year.
Despite doubling the census of ECLS patients in 1 year, management by specially trained CTICU nurses has positively affected patient care and outcomes. At a single institution, 40 patients had a median of 6 days (interquartile range, 2 to 226 days) of support in 2014, leading to 767 patient-days of support. Survival to hospital discharge increased to 45% in 2014. Most survivors were weaned from support. Neurologic injury was the most common cause of death, followed by failure to qualify for advanced therapies.
With on-going education and assessment, including crisis training, physiology, and cannulation strategies, CTICU nurses can safely operate ECLS circuits and can increase the availability of appropriately trained providers to accommodate the exponential increase in ECLS occurrences without negatively affecting outcomes and generally at a lower cost.
自2009年以来，体外生命支持（ECLS）在全球的使用呈指数级增长。需要ECLS的患者需要投入包括人力在内的医院资源。对床边护士进行ECLS回路管理培训可增加经过培训的专业人员数量。
经验丰富的心胸重症监护病房（CTICU）护士接受了ECLS回路管理培训，包括容量评估、动脉血气值处理、ECLS生理学以及常见紧急情况的识别。除讲座和书面考试外，使用水回路和ICU模型进行模拟可评估技能和对概念的理解。在床边定期完成绩效评估，每6个月进行一次技能重新验证。对连续的40例患者进行了为期1年的跟踪。
尽管1年内ECLS患者数量增加了一倍，但经过专门培训的CTICU护士进行管理对患者护理和结局产生了积极影响。在一家机构中，2014年40例患者接受支持的中位时间为6天（四分位间距为2至226天），支持天数达767个患者日。2014年出院生存率提高到45%。大多数幸存者成功脱机。神经损伤是最常见的死亡原因，其次是不符合高级治疗条件。
通过持续的教育和评估，包括危机培训、生理学和插管策略，CTICU护士可以安全操作ECLS回路，并能增加经过适当培训的专业人员数量，以适应ECLS使用的指数级增长，而不会对结局产生负面影响，且成本通常更低。
