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ECMO retrieval - preparation for referring centre prior to arrival

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Introduction

The ECMO service is considered to be a single service delivered in 2 locations (Starship PICU and Auckland CVICU).

Generally patients who require ECMO will have surgically placed cannulae under 20kg and percutaneous (seldinger) cannulae over 20kg. The checklist below is for children under 20kg. If preparing for ECMO retrieval of a child over 20kg, please have a look at the CVICU referring hospital checklist.

Referring centre to ensure the following is available / has been completed:

  • Echo excluding congenital heart defects. Including anomalous pulmonary venous drainage and double or left sided SVC
  • Family member available for discussion with ECMO team and consent
  • Equipment for surgeon (usually sourced from theatre)
    • Light source for fibre optic headlight - (surgeon will bring their own headlamp):
    • Diathermy
      ECMO retrieval 1
  • Blood product for ECMO circuit - as recently donated as available
    • 1 x unit of cross-matched fresh packed red cells
    • 1 x 100ml bottle of 20% albumin
    • 1 x unit of cross-matched fresh whole blood (by preference). If unavailable, a second unit of fresh packed cells.
  • Anaesthesia - 100 microgram vial of fentanyl
  • Patient orientation
    • head out from both wall and overhead heating stanchion
      ECMO retrieval 2
    • head and ETT facing left, so that neck vessels on the right are exposed
  • Assistants
    • Circulating theatre nurse
    • Possibly a scrubbed assistant - check with Starship team

Optional but useful

Local echocardiography trained neonatologist & echo machine to verify cannula position once inserted.

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Document Control

  • Date last published: 11 August 2017
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Owner: Brent McSharry
  • Editor: John Beca
  • Review frequency: 2 years