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Evolving Technology—A Single Center Perspective


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Dorothy Lockhart, RN CCTC
Service Line Director-Thoracic Transplant/MCS
University of Kentucky
Lexington, Kentucky
dorothy.lockhart@uky.edu




"Never before in history has innovation offered promise of so much to so many in so short a time."
—Bill Gates

In late 2010 with the arrival of a new transplant leader, the University of Kentucky began to introduce cutting edge technology within lung transplantation. One example is the concept of ambulatory ECMO as a bridge to lung transplantation. Historically, ECMO was recognized as a contraindication to lung transplantation in most centers (1). At the University of Kentucky, ECMO was only used as a last resort, salvage treatment prior to this time. However, a new surgeon came with a history of using ambulatory ECMO strategies and found great success. For the people of Eastern Kentucky, riddled with lung disease from years of working in coal mines, this would give them a great chance of survival and rehabilitation until donor lungs became available. Living in an area of the country with extreme tobacco abuse, good donor lungs are hard to come by (2).

This new treatment option required extensive collaboration and planning with the ICU and multi-disciplinary team. The process began with a full-day training including didactic and wet lab for the nursing staff. Nurse champions were identified and partnered with physical therapists. links imageThe physicians worked side-by-side with the team and built trust amongst caregivers. During this time, staffing needs were addressed, and the need for more assistance was identified to implement the ambulation process. The charge nurses acted as leaders and provided an open dialogue with all team members. With the help of nurses, physical therapists, perfusionists, nursing care techs, and physicians, the process is now second nature in the ICU. The team has taken great pride in the collaboration and success seen in the last two years. Forward-thinking nurses realized early on that there would be an equipment need for walking carts and tilt tables which are used to get the most debilitated patients upright.

The multidisciplinary team established a protocol that included the following (3):

  1. All sedation off, patient fully awake
  2. Hemodynamically stable
  3. Ambulation goal of 200 feet prior to transplant
  4. Upper extremity ROM exercises and weight lifting with physical therapy
  5. Nutrition consult: allowed to eat if swallow evaluation normal

In summary, multidisciplinary planning with trust and communication is essential when implementing new technology or procedures in a highly complex patient population. It is valuable to identify champions throughout disciplines to drive forth the process to all staff members.

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Patient Sid, 55 days of ECMO

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S/P Bilateral Lung Transplant 8/9/11

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Sid—January 2012
Sid was referred to University of Kentucky in June 2011, with severe case of ARDS. When he arrived from outside hospital he was on day 25 of ECMO. After 30 days of intensive rehab using ambulatory ECMO, Sid received bi-lateral lung transplant.

Disclosure Statement: the author has no conflicts of interest to disclose.


References:

  1. Jackson, A., Cropper, J., Pye, R. et al. (2007). Use of Extracorporeal Membrane Oxygenation as a Bridge to Primary Lung Transplant: 3 Consecutive, Successful Case and a Review of the Literature. Journal for heart and lung transplantation, March, 2008.
  2. http://www.srtr.org/csr/current/Centers/centerdetailOPO.aspx?facility=KYDAOP1XX
  3. Hoopes, C., Kukreja, J., Golden, J. et al. (2013) Extracorporeal Membrane Oxygenation as a bridge to pulmonary transplantation. The Journal of Thoracic and Cardiovascular Surgery. March, 2013.



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