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Development and Evaluation of Evidence-Based Nursing Protocol for Extracorporeal Membrane Oxygenation to Critically Ill Patients

체외막산소화장치 적용 중환자를 위한 근거기반 간호 프로토콜 개발 및 효과 평가

  • Kim, Soomi (Department of Nursing, Chungbuk National University Hospital) ;
  • Kim, Chul-Gyu (Department of Nursing Science, Chungbuk National University)
  • Received : 2022.09.13
  • Accepted : 2023.04.06
  • Published : 2023.06.30

Abstract

Purpose: This study aimed to develop an evidence-based extracorporeal membrane oxygenation (ECMO) nursing protocol for critically ill patients receiving ECMO treatment by using an adaptation process, and to verify the effects of the protocol. Methods: The protocol was developed according to the adaptation guidelines. A non-randomized controlled trial was conducted to test the protocol's effects. Data were collected between April 2019 and March 2021. The differences in physiological indicators and complication rates between the two groups were investigated using a chart review to evaluate patient outcomes. The nurses' outcome variables were evaluated using a questionnaire. Results: First, after reviewing 11 guidelines by appraisal of the guidelines for research and evaluation collaboration II, 5 guidelines with a standardization grade of over 50 points were selected. An ECMO nursing protocol was developed based on these guidelines. Second, there were no statistically significant differences in physiological indicators between the two groups of patients. However, the experimental group showed a statistically significant decrease in the infection rate (p = .026) and pressure injury rates (p = .041). The levels of satisfaction with ECMO nursing care, and empowerment and performance of the nurses who used the ECMO nursing protocol were higher than those of nurses who did not (p < .001). Conclusion: This protocol may help prevent infections and pressure injuries in patients, and improve nurses' satisfaction and empowerment. The nursing protocol developed for critically ill patients receiving ECMO treatment can be utilized in evidence-based nursing practice.

Keywords

References

  1. Bear DE, Smith E, Barrett NA. Nutrition support in adult patients receiving extracorporeal membrane oxygenation. Nutrition in Clinical Practice. 2018;33(6):738-746. https://doi.org/10.1002/ncp.10211
  2. Badulak JH, Shinar Z. Extracorporeal membrane oxygenation in the emergency department. Emergency Medicine Clinics of North America. 2020;38(4):945-959. https://doi.org/10.1016/j.emc.2020.06.015
  3. Extracorporeal Life Support Organization (ELSO). Registry dashboard of ECMO supported COVID-19 patient data [Internet]. Ann Arbor (MI): ELSO; [cited 2022 Feb 28]. Available from: https://www.elso.org/
  4. The Korean Society for Thoracic & Cardiovascular Surgery (KSTCS). Korean Society of Cardiovascular and Thoracic Surgery recommendation for ECMO treatment in severe COVID-19 infected patients [Internet]. Seoul: KSTCS; 2020 [cited 2021 Dec 20]. Available from: http://www.covid19ecmo.org/
  5. Extracorporeal Life Support Organization (ELSO). General guidelines for all ECLS Cases [Internet]. Ann Arbor (MI): ELSO; 2017 [cited 2020 Oct 28]. Available from: https://www.elso.org/portals/0/elso%20guidelines%20general%20all%20ecls%20version%201_4.pdf
  6. Hackmann AE, Wiggins LM, Grimes GP, Fogel RM, Schenkel FA, Barr ML, et al. The utility of nurse-managed extracorporeal life support in an adult cardiac intensive care unit. Annals of Thoracic Surgery. 2017;104(2):510-514. https://doi.org/10.1016/j.athoracsur.2016.11.005
  7. Pokorny ME, Koldjeski D, Swanson M. Skin care intervention for patients having cardiac surgery. American Journal of Critical Care. 2003;12(6):535-544. https://doi.org/10.4037/ajcc2003.12.6.535
  8. Tam SF, Mobargha A, Tobias J, Schad CA, Okochi S, Middlesworth W, et al. Pressure ulcers in paediatric patients on extracorporeal membrane oxygenation. International Wound Journal. 2019;16(2):420-423. https://doi.org/10.1111/iwj.13049
  9. Samsung Medical Center (SMC). SMC ECMO mannual. Seoul: SMC; 2014. p. 1-77.
  10. Kim GW, Choi EY, Hong SB. The treatment of adult respiratory distress syndrome (ARDS) using extracorporeal membrane oxygenation (ECMO). Tuberculosis and Respiratory Diseases. 2012;72(1):1-7. https://doi.org/10.4046/trd.2012.72.1.1
  11. Cherian S. Trends in extracorporeal membrane oxygenation(ECMO) nursing. Paper presented at: DHA Nursing Leadership Conference; 2015 May 4; Dubai, UAE.
  12. University of Wisconsin Hospital. Extracorporeal membrane oxygenation (ECMO): Initiation and management adult inpatient clinical practice guideline. Madison (WI): University of Wisconsin Hospital; 2018. p. 1-53.
  13. Auckland City Hospital. CVICU adult ECMO manual [Internet]. Auckland: Auckland City Hospital; 2019 [cited 2019 Oct 14]. Available from: https://www.cvicu.co.nz/assets/Uploads/MP1135-CVICU-ECMO-MANUAL-2019-12.03.19eFinal.pdf
  14. Nekic P. Extra Corporeal Oxygenation (ECMO) learning package [Internet]. Liverpool: Liverpool Hospital; 2016 [cited 2019 Oct 16]. Available from: https://www.coursehero.com/file/34320827/ECMO-Learning-packagepdf/
  15. Shin NM, Ha SY, Cho YS. Comparison of the nutritional indicators of critically ill patients on extracorporeal membrane oxygen (ECMO). Journal of Nutrition and Health. 2021;54(5):489-500. https://doi.org/10.4163/jnh.2021.54.5.489
  16. Pitts B, Vaughan M, Roney J. Using an existing clinical practice guideline to develop and implement an adult ECMO program during a global pandemic [Internet]. Lubbock (TX): Texas Tech University; 2022 [cited 2023 Jan 3]. Available from: https://digitalcommons.psjhealth.org/publications/5926/
  17. Leffall B, Myers L, Holcomb JB, Drake SA. Nursing care for extracorporeal membrane oxygenation in the trauma patient. Critical Care Nursing Quarterly. 2021;44(2):140-146. https://doi.org/10.1097/CNQ.0000000000000348
  18. Peig NNA, Djen E, Garalza M, Given C, Henderson J, O'Connor T, et al. Nursing management of a patient with COVID-19 receiving ECMO: A case report. Critical Care Nurse. 2021;41(6):12-21. https://doi.org/10.4037/ccn2021929
  19. Kim SY, Choi MY, Sheen SS, Ji SM, Park SH, You JH, et al. Handbook for clinical practice guideline developer ver 1.0. Seoul: National Evidence-based Healthcare Collaborating Agency; 2015. p. 112-162. https://www.neca.re.kr/lay1/bbs/S1T11C102/F/39/view.do?article_seq=5347&cpage=1&rows=10&condition=A.TITLE&keyword=%EC%9E%84%EC%83%81%EC%A7%84%EB%A3%8C%EC%A7%80%EC%B9%A8&show=&cat=
  20. Jung JS. Extracorporeal membrane oxygenation: Past, present and future. Korean Journal of Medicine. 2015;88(6):651-657. https://doi.org/10.3904/kjm.2015.88.6.651
  21. Jeong IS, Jeong JS, Seo HJ, Lim EY, Hong EY, Park KH, et al. Development of indwelling urinary catheterization guideline by adaptation process. Journal of Korean Clinical Nursing Research. 2015;21(1):31-42. https://doi.org/10.22650/JKCNR.2015.21.1.31
  22. Park KH, Choi HJ. Adaptation and evaluation of the incontinence care protocol. Journal of Korean Academy of Nursing. 2015;45(3):357-366. https://doi.org/10.4040/jkan.2015.45.3.357
  23. Hong IH, Eun Y. Development and effectiveness of practice application program of intravenous infusion evidence-based nursing practice guideline - for small and medium sized hospitals. Journal of Korean Academy of Nursing. 2020;50(6):863-875. https://doi.org/10.4040/jkan.20196
  24. Balakrishnan N. Methods and applications of statistics in clinical trials. Volume 1, Concepts, principles, trials, and designs. Hoboken (NJ): Wiley; 2014. p. 961.
  25. Ghezeljeh TN, Nasari M, Haghani H, Rezaei Loieh H. The effect of nature sounds on physiological indicators among patients in the cardiac care unit. Complementary Therapies in Clinical Practice. 2017;29:147-152. https://doi.org/10.1016/j.ctcp.2017.09.010
  26. Doran DM. Nursing outcomes: The state of the science. 2nd ed. Sudbury (MA): Jones & Bartlett Learning; 2011. p. 241-250.
  27. Melnyk BM, Fineout-Overholt E, Mays MZ. The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments. Worldviews on Evidence-Based Nursing. 2008;5(4):208-216. https://doi.org/10.1111/j.1741-6787.2008.00126.x
  28. Park HY, Jang KS. Structural model of evidence-based practice implementation among clinical nurses. Journal of Korean Academy of Nursing. 2016;46(5):697-709. https://doi.org/10.4040/jkan.2016.46.5.697
  29. Ko MR. Development and application of standardized nursing protocol for spinal surgery patient [master's thesis]. Daejeon: Eulji University; 2018. p. 1-68.
  30. Spreitzer GM. Psychological empowerment in the workplace: Dimensions, measurement, and validation. Academy of Management Journal. 1995;38(5):1442-1465. https://doi.org/10.2307/256865
  31. Ryoo EH. Operating room of local anesthesia/sedation patient safety standards management guidelines development and evaluation [master's thesis]. Pocheon: CHA University; 2016. p. 1-98.
  32. Lee Y, Lee J. Nursing algorithm for stroke patients with sensory disorder. Korean Journal of Adult Nursing. 2018;30(3):301-313. https://doi.org/10.7475/kjan.2018.30.3.301
  33. Hartford Hospital. Extracorporeal membrane oxygenation (ECMO) guideline. Hartford (CT): Hartford Hospital; 2009. p. 1-16.
  34. Strickland R, Frantzis P. Royal Adelaide Hospital ICU ECMO guidelines. Adelaide: Royal Adelaide Hospital; 2015. p. 1-52.
  35. Chung M, Shiloh AL, Carlese A. Monitoring of the adult patient on venoarterial extracorporeal membrane oxygenation. Scientific World Journal. 2014;2014:393258. https://doi.org/10.1155/2014/393258
  36. American Association of Critical Care Nurses (AACN). AACN scope and standards for acute and critical care nursing practice. Aliso Viejo (CA): AACN; 2008. p. 1-3.
  37. Murphy DA, Hockings LE, Andrews RK, Aubron C, Gardiner EE, Pellegrino VA, et al. Extracorporeal membrane oxygenation-hemostatic complications. Transfusion Medicine Reviews. 2015;29(2):90-101. https://doi.org/10.1016/j.tmrv.2014.12.001
  38. Aissaoui N, Luyt CE, Leprince P, Trouillet JL, Leger P, Pavie A, et al. Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Medicine. 2011;37(11):1738-1745. https://doi.org/10.1007/s00134-011-2358-2
  39. Kim SW, Chang JW, Lee SJ. Clinical results of extra-corporeal membrane oxygenation for critically ill patients at Jeju National University Hospital. Journal of Medicine and Life Science. 2013;10(1):71-75. https://doi.org/10.22730/jmls.2013.10.1.71
  40. Abrams D, Agerstrand C, Fried J, Brodie D. Extracorporeal life support in adults in the intensive care unit: Overview [Internet]. Up To Date; 2021 [cited 2021 Nov 18]. Available from: https://www.uptodate.com/contents/extracorporeal-membrane-oxygenation-ecmo-in-adults/print
  41. Ryu YS, Park JS. Development and effect of evidence-based nursing practice guidelines for pain management in patients with dementia. Korean Journal of Adult Nursing. 2019;31(2):176-189. https://doi.org/10.7475/kjan.2019.31.2.176
  42. Choi AJ, Yi YH. Effects of the schematized alarm-managing manual for continuous renal replacement therapy on the alarm resolution rate and nursing competence of nurses in intensive care units. Journal of Korean Academy of Nursing Administration. 2014;20(5):535-544. https://doi.org/10.11111/jkana.2014.20.5.535
  43. Segal G, Karniel E, Mahagna A, Kaa'dan F, Levi Z, Balik C. A nurse-guided, basal-prandial insulin treatment protocol for achieving glycaemic control of hospitalized, non-critically ill diabetes patients, is non-inferior to physician-guided therapy: A pivotal, nurse-empowerment study. International Journal of Nursing Practice. 2015;21(6):790-796. https://doi.org/10.1111/ijn.12292
  44. Kim MS. Factors influencing performance confidence of multi-drug resistant organisms(MDRO)s infection control among registered nurse in intensive care unit [master's thesis]. Gimhae: Inje University; 2020. p. 1-74.
  45. Lee SJ, Yang NY. Awareness and performance of healthcare-associated infections control and psycological empowerment of intensive care unit nurses. Journal of Korean Academic Society of Home Health Care Nursing. 2017;24(3):306-315. https://doi.org/10.22705/jkashcn.2017.24.3.306
  46. Min AR, Kim IS. Relationship of perception of clinical ladder system with professional self-concept and empowerment based on nurses' clinical career stage. Journal of Korean Academy of Nursing Administration. 2013;19(2):254-264. https://doi.org/10.11111/jkana.2013.19.2.254
  47. Kim HS. Evaluation of nursing knowledge implementation level and nursing quality on the physical restraints protocol. Journal of Korean Nursing Research. 2019;3(2):37-46. https://doi.org/10.34089/jknr.2019.3.2.37
  48. Kim KS, Kim JA, Park YR. Educational needs based on analysis of importance, frequency and difficulty of ICU nursing practice for ICU nurses. Journal of Korean Academy of Fundamentals of Nursing. 2011;18(3):373-382.
  49. Park MH, Kim HJ, Lee BW, Bae SH, Lee JY. Near misses experienced at a university hospital in Korea. Quality Improvement in Health Care. 2016;22(1):41-57. https://doi.org/10.14371/QIH.2016.22.1.41
  50. Drews FA, Markewitz BA, Stoddard GJ, Samore MH. Interruptions and delivery of care in the intensive care unit. Human Factors. 2019;61(4):564-576. https://doi.org/10.1177/0018720819838090