Deirdre Murphy is Deputy Director, Intensive Care and Head of the Cardio-thoracic ICU at The Alfred Hospital. One of her talks at smaccGOLD was titled ‘ECMO: What could go wrong?’. It was one of my personal favourites at the conference because the talk was ostensibly about a highly specialised area of intensive care, yet provided insights for everyone. Deirdre uses the hard won lessons from the development of the ECMO programme at The Alfred ICU to show what it takes to ‘beat Murphy’s law’. This is essential listening for anyone interested in ECMO, and for anyone who wants to learn how to excel at a complex task.
Key lessons include:
- the importance of getting the indications, inclusions and exclusions right
- the utility of clinical support aids
- the need to work as a team and share knowledge – including our mistakes
- we can always learn from our colleagues and key expertise can be found across specialties and professionals
- ECMO cannulation requires technical excellence, any deficiencies in technique will be exposed…
- the backflow cannula is the embodiment of Murphy’s law!
- use of ultrasound is a ‘no brainer’
- cannulation is best as a 2 person technique – one person ensures that the guidewire moves freely when the cannula is advanced
- never underestimate the amount of damage you can do with a needle and a guidewire!
- rewiring lines is fraught with danger, a fresh puncture is preferable
- you can’t cut corners, attention to detail is critical, there are some things that we don’t have time not to do
- the 3 major problems with ECMO are bleeding, bleeding and more bleeding… and then sometimes clotting while bleeding can be a problem too!
- why we don’t suture in ECMO cannulae at The Alfred ICU and why we don’t have access ports on the venous (low pressure) side of the ECMO circuit
- why we need to always think a few steps ahead and learn to love the checklist
- … what can go wrong, will go wrong!
The talk covers many of the key complications of ECMO and how to prevent them. Listen to it now!
Here is the audio (download mp3):
Here are the slides: