Authors (including presenting author) :
Leung KW, Chiu SH, Chan YM, Yu KL, Hui YC, Wong LY
Affiliation :
Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong
Introduction :
CentiMag ventricular assist device (VAD) is a mechanical circulatory support (MCS) device for advanced heart failure patients allowing full support of heart function. During the implantation period, acute respiratory failure is one of the most prevalent life-threatening conditions which require prompt action. As CentriMag only allows total takeover of heart function instead of lung function, life-saving emergency oxygenator insertion into CentriMag circuit changing to CentriMag-Extracorporeal Membrane Oxygenation (CentriMag-ECMO) configuration was used to support the frail respiratory system of patients. Being the only center offering CentriMag VAD service in Hong Kong, our department is required to cater the increased service demand of CentriMag-ECMO.
Objectives :
1. To enhance workflow efficiency and patient safety during emergency oxygenator insertion in respiratory compromised CentriMag patients. 2. To facilitate the logistics of equipment and materials agglomeration between ICU and Operation Theatre during emergency oxygenator insertion.
Methodology :
A pilot programme of emergency oxygenator insertion was promoted in CTSD ICU since January 2018. 16 designated staff were recruited to form a team specialized in CentriMag-ECMO. The team members were required to complete comprehensive trainings, including assistance of CentriMag-ECMO therapy initiation and emergency troubleshooting. Moreover, the intervention protocols, emergency role assignments and safety checklists were reengineered from the feedback of the team members and physicians. Furthermore, a tailor-made CentriMag-ECMO trolley was established for immediate provision of various equipment for CentriMag-ECMO initiation, time gap between the need and implementation of the therapy was therefore narrowed.
Result & Outcome :
From January to December 2018, three CentriMag cases complicated with acute respiratory failure required oxygenator insertion. The average duration from decision making, material preparation to therapy initiation was reduced by 45%, from 40 minutes by three staffs to 22 minutes by only one staff. The frequency of equipment transportation between Operation Theater and ICU was reduced by 75% from 4 times to 1 time per case. Positive feedbacks with 94% staff satisfaction were obtained from the evaluation. To conclude, the efficiency of emergency oxygenator insertion was significantly improved through a structuralized programme. The programme is proved to achieve the goals of manpower reduction, expedite the resources preparation and fluency of a complicated oxygenator insertion procedure.
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