title: The Utility of Nurse-Managed Extracorporeal Life Support in an Adult Cardiac Intensive Care Unit.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California. Electronic address: amy.hackmann@surgery.usc.edu.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Hackmann
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Luke M
authors.initials: LM
authors.lastname: Wiggins
authors.affiliation: Keck Medical Center of the University of Southern California, Los Angeles, California.
authors.forename: Glenn P
authors.initials: GP
authors.lastname: Grimes
authors.affiliation: Keck Medical Center of the University of Southern California, Los Angeles, California.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Fogel
authors.affiliation: Keck Medical Center of the University of Southern California, Los Angeles, California.
authors.forename: Felicia A
authors.initials: FA
authors.lastname: Schenkel
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Barr
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Bowdish
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Cunningham
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Vaughn A
authors.initials: VA
authors.lastname: Starnes
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000451:nursing* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D057184:Practice Patterns, Nurses'; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000628:therapy*; D000078329:Workforce