Outside Hospital (OSH) Trauma/Burn ECMO Cannulation Process

• Define process for safely and efficiently evaluating for need of cannulation at outside hospital and transporting patient on ECMO.
• When at all possible, the patient should be transported to Jackson Memorial Hospital without ECMO and evaluated once in the facility for ECMO needs.

• Outside hospital calls Transfer center for ECMO consult (305-585-5354)
• Transfer center involves necessary teams for consult and discussion of transport for further evaluation.
• If ECMO team decides ECMO cannulation at outside hospital is necessary for safer transport than below process is initiated.

• *ECMO capabilities- ECMO provider, perfusionist, ECMO machine, canulation bag
• Rapid transport of ECMO capabilities should be initiated by Medical Transportation and Emergency Management Transportation for Jackson Health System
• Pick up from Jackson Memorial should occur at ambulance bay outside of Ryder Trauma Center

• Provide OSH with “ECMO Cannulation Readiness Form” below. A
• Adapted from Emory ECMO Transport Program
  Jackson Memorial ECMO Team will perform entirety of ECMO cannulation procedure while OSH team assists in management of hemodynamics and ventilation.

• Patient will be transported on ECMO with ECMO provider, perfusionist and transport medics.

Dear Staff,
Thank you for choosing Jackson Memorial for your patient. We are very honored to be caring for them. So that we can most efficiently place your patient on support, we would like to ask that the following be ready on our arrival.

Supplies
1L bottle of sterile NS (as for sterile irrigation)
4X sterile OR towels (multi-packs)
2x gauze packs, 4×4″ (2 multi-packs)
2x sterile drapes (same as central lines)
4× Chloraprep sticks (medium or large ones)
2x sterile gowns
2 patient tables
1 empty garbage can
Hats and masks for anyone that will be in room
Ultrasound machine, with both linear and cardiac probes (if available)
2x sterile probe covers

Medications
Norepinephrine gtt on pump and inline and ready to turn on if needed
A bag of crystalloid (NS, LR or plasmalyte) in-line (not on a pump) in case rapid volume is
needed
5000 units of heparin. drawn up and read to give IV (we will direct when to give)
Basic code drugs: 2 amps epi, 2 amps bicarb, 2 amp calcium chloride

• Please make sure that there are plenty of pressors left in the current bags and/or that there are extra bags already in the room.

Labs
An ABG within last hour prior to arrival
A type and cross for 2 units (does not necessarily need to be in room unless hemoglobin is less
than 9)

Staff
Respiratory therapist (on arrival and at end of procedure)

• Nurse required for entire procedure. will need to administer meds and manage hemodynamics.
  Another nurse or aid available to help the room nurse obtain supplies, labs etc as needed during procedure.

Family

• We will need to obtain consent from the family upon arrival, so if it is possible to have them stay close, that would be ideal. If they are unavailable, then we can obtain by phone as long as contact information is readily available.

Patient preparation
As often as possible, we prefer to cannulate the R IJ and a Femoral Vein. If there is a central line already in the RIJ, it would be preferable to have all meds moved to another line in the left IJ, subclavian, or PICC. We prefer not to have additional groin lines, but if one is already there it is not a problem.

• EKG leads should be moved such that they are on the patient’s shoulders, back or sides and do not cross over the chest.

Process
On arrival, we will talk with the family and set up for the procedure. The procedure itself takes about an hour, and then it usually takes another ½ hr to 45 min to prepare for transport. Because federal regulations do not allow us to bring medications for a patient that is not already in our hospital, we will also need to request medications for the trip back. Some of the amounts or specific medications aside from current pressors) we may not need depending on the condition, so you don’t have to have these ready before our arrival.

For trip back

• Drips: we will need at least 1 replacement bag for every drip that is currently hanging, especially vasopressors. paralytic and sedation. Our preference for sedation is midazolam and fentanyl.
• Code drugs: Depending on trip duration and stability of the patient, we are likely to request additional code drugs: 2 amps epi, 2 amps bicarb, 2 amp calcium chloride
• Blood: Also depending on the patient condition and duration of the trip, we may ask for blood.