Ethics-Driven Cannulation Protocol of ECMO Candidates

Purpose: This project sought to improve patient and staff outcomes through the implementation of an ethics-driven protocol of patients considered for and placed on extracorporeal membrane oxygenation (ECMO) in a Cardiovascular Intensive Care Unit (CVICU). The aim was to improve 30-day post-cannulation survival outcomes, reduce pain, improve quality of life, and reduce inappropriate cannulations. Background: Patients in the CVICU suffering from cardiac or pulmonary failure may require ECMO support. However, ECMO utilization is associated with significant risks, especially in cases of poor prognosis or multiple comorbidities. Before protocol implementation, facility decisions were clinician-dependent, rather than standardized. This protocol aimed to bring structure and consistency to clinical decision-making and improve outcomes. Methodology: The protocol was developed based on literature and evidence-based practice, implemented, reinforced and refined through the use of 3 distinct PDSA (Plan-Do-Study-Act) cycles focusing on development, education, and data collection. Data was collected on measures pre- and post- implementation. Outcomes included protocol adherence, pain scores, quality-of-life data, 30-day survival rates, and staff certification rates. Results: Patient pain scores in verbal, awake patients increased, but resolved with medication administration. Quality-of-life scores improved after protocol implementation. Venovenous survival rates rose from 61.5% to 76.9%, and Venoarterial from 55.2% to 57.5%. Protocol adherence and nurse ECMO certification rates improved. Implications: Protocol implementation helped structure and streamline decision-making, improved patient outcomes, and increased staff satisfaction. Ongoing evaluation of how the protocol is utilized on the unit may help support long-term sustainability, strengthen communication, and bring greater consistency to unit practice.