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Key competences of a nurse in extracorporeal membrane oxygenation
HOLKUPOVÁ, Klára
The aim of this thesis is to map the specifics of work in intensive care of a critically ill patient on extracorporeal membrane oxygenation and to find out what knowledge and skills an intensive care nurse caring for a critically ill patient connected to extracorporeal membrane oxygenation must have. Three research questions were established to meet the objectives: What are the key competencies of a critical care nurse in caring for a critically ill patient on extracorporeal membrane oxygenation? What activities does a critical care nurse perform in intensive care when caring for a critically ill patient on extracorporeal membrane oxygenation? What is a critical care nurse's role in a multidisciplinary team when caring for a critically ill patient on extracorporeal membrane oxygenation? The theoretical part of the thesis focuses on the ECMO device itself, its history and components. It also describes the risks and complications that may occur as a result of this method. Last but not least, the necessary education and competence of nurses who can provide care for a critically ill patient on ECMO is described. A part of the thesis is also dedicated to the nursing management of care for such a patient. Qualitative research was used to achieve the objectives. The empirical part of the thesis was drawn up on the basis of semi-structured interviews with nine informants providing highly specialised nursing care for patients on extracorporeal membrane oxygenation working throughout the Czech Republic. The open coding method was used to analyse the data. Analysis of the data gave us a comprehensive view of care for patients on extracorporeal membrane oxygenation. Intensive care nurses provide comprehensive highly specialised nursing care, and it is essential that they have sufficient knowledge of the matter and the ability to work collaboratively in a team. The output of the thesis is a manual with basic information for nurses who encounter extracorporeal membrane oxygenation for the first time.
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Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery
Mlejnský, František ; Lindner, Jaroslav (advisor) ; Lonský, Vladimír (referee) ; Vaněk, Tomáš (referee)
Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...
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Pulmonary pathophysiology during circulatory support.
Popková, Michaela ; Mlček, Mikuláš (advisor) ; Rohn, Vilém (referee) ; Otáhal, Michal (referee)
Introduction: Left-ventricular (LV) distension and consequent pulmonary congestion are complications frequently discussed in patients with severe LV dysfunction treated with veno- arterial extracorporeal membrane oxygenation (VA ECMO). The goal of this study was to describe the influence of high VA ECMO flows to LV distension, lung hemodynamics, and lung fluid accumulation. Methods of LV decompression were studied to prevent lung edema. Methods: In all experiments porcine models under general anesthesia were used. The effects of high extracorporeal blood flow (EBF) on LV heart work were assessed in a chronic heart failure model. The effects of LV afterload on lung fluid accumulation were evaluated by electrical impedance tomography (EIT) on acute heart failure models. Phase and frequency filtration and mathematical analysis were applied to the raw EIT data. Subsequently, mini- invasive techniques of LV decompression were evaluated for LV work. Results: The stepwise increases of VA ECMO flow improved both hemodynamic and oxygenation parameters. Nevertheless, it also caused distension and increased work of LV. The rise in EBF led to increased pulmonary capillary wedge pressure and lung fluid accumulation assessed by EIT in heart failure. The methods for LV decompression (Impella pump, atrial...
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Hemodynamic adaptation mechanisms of heart failure to percutaneous venoarterial extracorporeal circulatory support
Hála, Pavel ; Kittnar, Otomar (advisor) ; Szárszoi, Ondrej (referee) ; Havránek, Štěpán (referee)
Introduction: Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in the treatment of circulatory failure, but repeatedly, its negative effects on the left ventricle (LV) have been observed. The purpose of this study is to assess the influence of ex- tracorporeal blood flow (EBF) on systemic hemodynamic changes and LV performance parameters during VA ECMO therapy of decompensated heart failure. Methods: Porcine models of low-output chronic and acute heart failure were developed by long-term fast cardiac pacing and coronary hypoxemia, respectively. Profound signs of circulatory decompensation were defined by reduced cardiac output and tissue hypoperfusion. Sub- sequently, under total anesthesia and artificial ventilation, VA ECMO was introduced. LV performance and organ specific parameters were recorded at different levels of EBF using an LV pressure-volume loop analysis, arterial flow probes on carotid and subclavian arteries, and transcutaneous probes positioned to measure cerebral and forelimb regional tissue oxygen saturations. Results: Conditions of severely decompensated heart failure led to systemic hypotension, low tissue and mixed venous oxygen saturations, and increase in LV end-diastolic pressure. By increasing the EBF from minimal flow to 5 L/min, we observed a...
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Regional flow and number of microembolisms in the common carotid artery at different levels of hemodynamics controlled by VA-ECMO.
Janák, David ; Kittnar, Otomar (advisor) ; Danzig, Vilém (referee) ; Bešík, Josef (referee)
Extracorporeal membrane oxygenation (ECMO) is a method that allows extracorporeal life support in potentially reversible life-threatening conditions affecting the heart or lungs which are refractory to conventional treatment. Depending on the parameters of its setting, this method affects the haemodynamics of the cardiovascular system and the perfusion of the target organ. From the point of view of its character, the necessity for invasive application, and the function thereof in the conditions of the cardiovascular system, ECMO is regarded as a risky method accompanied by a number of complications. Among the critical complications are thromboembolic complications affecting the central nervous system (CNS) and haemorrhagic complications. The goal of this paper is to present and verify the prerequisites for the formation of periprocedural embolisms affecting the CNS and to evaluate the regional haemodynamics of the CNS. This is done by analysing the presence of embolisms and by analysing the parameters of blood flow rates in the right common carotid artery (arteria carotis communis-ACC) and the corresponding oxygenation of the brain tissue during various flow rate parameters generated by the ECMO support on induced heart failure in a biological porcine model. In the first section of the paper, 8...
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Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery
Mlejnský, František ; Lindner, Jaroslav (advisor) ; Lonský, Vladimír (referee) ; Vaněk, Tomáš (referee)
Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...
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