BACKGROUND

In a center with a perfusionist department, the perfusionist are the goalkeepers in maintaining, preparing, resourcing and initiation of extracorporeal membrane oxygenation (ECMO) units in the catheterization laboratory (CL) and hybrid operating room (HOR) for providing extracorporeal life support (ECLS) systems. However, their working area might not be nearby the CL / HOR or the perfusionist is on call and not present at all. This results in a relevant delay for establishing the cardiac support system. Often, the ECMO unit must be physically transferred to the CL / HOR. "The Jena Method" prevents these circumstances and allows rapid establishment of the extracorporeal circuit without the presence of the perfusionist by providing a wet - primed ECMO.

METHODS

Our goal was to avoid a time delay between arrival of patients requiring ECLS and ECMO initiation with uncompromised safety for patients, as if the perfusionist would be directly present. Other aspects were ensuring that the system meets all hygienic requirements, safe primed storage of the circuit, training of the staff and easy to understand picture - based step – by - step instructions for the ECMO unit.

RESULTS 

In 2015, the newly built CL / HOR was put in operation and we started with the establishment of the “The Jena Method”. Since then, 212 patients received VA – ECMO treatment in our unit (Table 1). The requirements of the ECMO unit “parking” area were diverse: The place must ensure the integrity of the ECMO unit, both CL and the HOR should be easily accessible and a power socket should be nearby. Bacterial tests for long - term sterility of the primed ECMO circuits during a 14 - day period showed no germ growth (Table 2). To shield the circuit, the ECMO unit is covered with a big plastic bag. The functionality of all components of the primed ECMO circuit after 14 days, especially the pump and oxygenator, were thoroughly checked and no malfunction has been found to this day.  As a first step to train the staff with the aim that they can start the ECMO without perfusionist support on site, a step-by - step system involved bringing the ECMO unit safely to the place of intervention and establishing all connections such as power, O₂ and compressed air. The next step required how to start the console, recirculation, de - airing of the system after a long stand - by period and making the system ready for connection to the cannulas. This process is assisted by a self - developed picture - based step – by - step instruction guide. New members to the staff learn and train from colleagues of the CL / HOR. Training sessions by the perfusionists take place once a quarter. After arrival at the intensive care unit (ICU), the perfusionist checks the system and coordinates the settings of the circuit with the ICU staff before leaving the ICU. After the deployment of one ECMO unit, the perfusionist directly provides a new primed system and brings it to the “parking area”.

CONCLUSION

It is possible, feasible and save to establish a permanently wet – primed on demand ECLS circuit (ECMO) without direct perfusionist support. “The Jena Method” prevents the lack of a ready system and perfusionist. It allows rapid, undelayed deployment of the extracorporeal circuit without the presence of the perfusionist. It is conceivable that this could also be established in emergency departments.