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Nursing Management of a Patient With COVID-19 Receiving ECMO: A Case Report
Nestor Neil A Peig1, Erica Djen2, Marielle Garalza3
1Nestor Neil A. Peig is a clinical nurse in the cardiothoracic intensive care unit, Ronald Reagan UCLA Medical Center, Los Angeles, California.
Introduction:
Venovenous extracorporeal membrane oxygenation has been recommended as an effective rescue therapy for select critically ill patients with COVID-19. This case report describes a first experience caring for a patient with COVID-19 who received venovenous extracorporeal membrane oxygenation and expands the literature by discussing relevant nursing management and operational considerations.
Clinical Findings:
A 46-year-old man presented to a hospital emergency department with pleuritic chest pain, dyspnea, anorexia, and chills. The patient was intubated for pneumonia-associated acute respiratory distress syndrome.
Diagnosis:
A nasopharyngeal swab specimen was positive for SARS-CoV-2, and chest radiography confirmed a diagnosis of COVID-19 with acute respiratory distress syndrome.
Interventions:
After no improvement with mechanical ventilation and prone positioning, the patient began receiving venovenous extracorporeal membrane oxygenation and was transferred to an extracorporeal membrane oxygenation center. Frontline critical care nurses played a vital role in coordinating patient care activities, monitoring changes in the patient's condition, and detecting complications early.
Outcomes:
The patient was decannulated on day 15 and extubated on day 17. The patient was successfully discharged home on hospital day 24.
Conclusion:
Caring for a patient with COVID-19 receiving venovenous extracorporeal membrane oxygenation posed unprecedented challenges that required deviations from standards of care to optimize infection control measures and staff safety while providing quality care. This case report may inform, prepare, and guide other critical care nurses who will be caring for similar patients during this pandemic.
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