Pressure area care

Safe pressure area care is essential during ECMO support and should be performed at usual frequencies (every 2 hours) in all ECMO patients. This can not be stressed enough given these are commonly the most severely ill patients with often a prolonged initial resuscitation time in the supine position. Patients on peripheral ECMO and temporary RVAD/LVADs can be rolled. An additional person is required to hold the ECMO lines during turns. Rotating beds are desirable for all ECMO patients. Rotating beds can be turned to a 10-15 degree tilt with head up. Turns should be completed with an additional person to hold the lines. Patients supported on peripheral ECMO can be elevated head up to 45 degrees. Patients with ECMO support with an “open sternum” may not be rolled and require alternate means of preventing pressure area injury e.g. use of KCI mattress and Jordan Frame moves. Owing to the potential for cannula dislodgement, any pressure area care, turns, Jordan framing, dressings or manipulation of the circuit require an ECMO trained consultant or senior registrar to be available in the intensive care unit including out of hours ( and made aware an ECMO intervention is planned).

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