Objective:To construct a nursing norm for extracorporeal membrane oxygenation in adults, so as to provide a reference for improving the nursing care of adult extracorporeal membrane oxygenation.Methods:The first draft was developed through literature search and expert discussion. From September to October 2023, 16 experts were selected using the Delphi method to conduct two rounds of expert consultation on the first draft, and the final draft was revised with reference to the experts' comments. The expert positivity coefficient was expressed as the effective recovery rate of the questionnaire, and the degree of expert authority was evaluated with the authority coefficient, and the degree of harmonization of expert opinions was assessed with the Kendall's harmony coefficient.Results:Literature search screened a total of four guidelines and five expert consensus. In the two rounds of consultation, the effective recovery rates of the questionnaires were all 100% (16/16), and the expert authority coefficients were all 0.900, and the Kendall's harmony coefficients of the overall indicators were 0.581 and 0.666, respectively (both P<0.01). The final constructed nursing norm for extracorporeal membrane oxygenation in adults included five primary indicators, 27 secondary indicators, and 17 tertiary indicators. Conclusions:The constructed nursing norm for extracorporeal membrane oxygenation in adults is scientific, reliable and feasible, and can guide clinical nursing staff to carry out nursing care for extracorporeal membrane oxygenation.

Objective:To optimize the anticoagulation monitoring process for extracorporeal membrane oxygenation (ECMO) patients by constructing an informatization module and evaluate its application effect.Methods:An informatization team was established, and based on literature review, an anticoagulation monitoring information sheet for ECMO patients was developed. Using a data-sharing architecture, existing hospital information management system, laboratory information management system, picture archiving and communication system, and ICU monitoring system were integrated to construct an ECMO anticoagulation monitoring informatization module with data sharing, real-time alerts, and information support functions. Clinical applications were observed for effect. A convenience sampling method was employed to select 60 ECMO patients treated in the ICU of the Affiliated Hospital of Qingdao University from October 2022 to September 2023. The patients admitted from October 2022 to March 2023 were designated as the control group ( n=30), using the conventional anticoagulation monitoring method; those admitted from April to September 2023 were designated as the experimental group ( n=30), using the anticoagulation monitoring informatization module. The anticoagulation monitoring timeliness rate, anticoagulant drug adjustment timeliness rate, and the incidence rates of thrombosis and bleeding were compared between the two groups. Results:The timeliness rate of anticoagulation monitoring and the timeliness rate of anticoagulant drug adjustment in the experimental group were (93.38±6.31) % and (91.90±4.71) %, respectively, which were higher than those in the control group (83.01±9.94) % and (83.49±12.83) %, with statistically significant differences (both P<0.01). The incidence rates of thrombosis and bleeding in the experimental group were 16.67% (5/30) and 26.67% (8/30), respectively, which were lower than those in the control group 40.00% (12/30) and 53.33% (16/30), with statistically significant differences (both P<0.05) . Conclusions:The optimized anticoagulation monitoring informatization process based on the anticoagulation monitoring informatization module demonstrates a good clinical application effect and can reduce the incidence of bleeding and thrombosis in ECMO patients.

Objective:To construct a nursing norm for extracorporeal membrane oxygenation in adults, so as to provide a reference for improving the nursing care of adult extracorporeal membrane oxygenation.Methods:The first draft was developed through literature search and expert discussion. From September to October 2023, 16 experts were selected using the Delphi method to conduct two rounds of expert consultation on the first draft, and the final draft was revised with reference to the experts' comments. The expert positivity coefficient was expressed as the effective recovery rate of the questionnaire, and the degree of expert authority was evaluated with the authority coefficient, and the degree of harmonization of expert opinions was assessed with the Kendall's harmony coefficient.Results:Literature search screened a total of four guidelines and five expert consensus. In the two rounds of consultation, the effective recovery rates of the questionnaires were all 100% (16/16), and the expert authority coefficients were all 0.900, and the Kendall's harmony coefficients of the overall indicators were 0.581 and 0.666, respectively (both P<0.01). The final constructed nursing norm for extracorporeal membrane oxygenation in adults included five primary indicators, 27 secondary indicators, and 17 tertiary indicators. Conclusions:The constructed nursing norm for extracorporeal membrane oxygenation in adults is scientific, reliable and feasible, and can guide clinical nursing staff to carry out nursing care for extracorporeal membrane oxygenation.

Objective:To optimize the anticoagulation monitoring process for extracorporeal membrane oxygenation (ECMO) patients by constructing an informatization module and evaluate its application effect.Methods:An informatization team was established, and based on literature review, an anticoagulation monitoring information sheet for ECMO patients was developed. Using a data-sharing architecture, existing hospital information management system, laboratory information management system, picture archiving and communication system, and ICU monitoring system were integrated to construct an ECMO anticoagulation monitoring informatization module with data sharing, real-time alerts, and information support functions. Clinical applications were observed for effect. A convenience sampling method was employed to select 60 ECMO patients treated in the ICU of the Affiliated Hospital of Qingdao University from October 2022 to September 2023. The patients admitted from October 2022 to March 2023 were designated as the control group ( n=30), using the conventional anticoagulation monitoring method; those admitted from April to September 2023 were designated as the experimental group ( n=30), using the anticoagulation monitoring informatization module. The anticoagulation monitoring timeliness rate, anticoagulant drug adjustment timeliness rate, and the incidence rates of thrombosis and bleeding were compared between the two groups. Results:The timeliness rate of anticoagulation monitoring and the timeliness rate of anticoagulant drug adjustment in the experimental group were (93.38±6.31) % and (91.90±4.71) %, respectively, which were higher than those in the control group (83.01±9.94) % and (83.49±12.83) %, with statistically significant differences (both P<0.01). The incidence rates of thrombosis and bleeding in the experimental group were 16.67% (5/30) and 26.67% (8/30), respectively, which were lower than those in the control group 40.00% (12/30) and 53.33% (16/30), with statistically significant differences (both P<0.05) . Conclusions:The optimized anticoagulation monitoring informatization process based on the anticoagulation monitoring informatization module demonstrates a good clinical application effect and can reduce the incidence of bleeding and thrombosis in ECMO patients.

Acute skin failure is a common condition of skin damage in critically ill patients, which seriously affects the prognosis of patients. This article summarizes the evaluation indicators, techniques, and comparison of evaluation indicators and techniques for acute skin failure, in order to provide references for the development of acute skin failure evaluation tools and the formulation of nursing measures.

OBJECTIVE: To evaluate and summarize the relevant evidence of anticoagulation and bleeding risk management in patients with extracorporeal membrane oxygenation (ECMO), and provide the evidence-based basis for the management of anticoagulation and bleeding during ECMO treatment. METHODS: According to the evidence "6S" pyramid model, all evidence on ECMO anticoagulation management and bleeding risk was searched in relevant databases, organizations and guideline websites at home and abroad. Evidence types included guidelines, expert consensus, systematic evaluation, Meta-analysis and original study. The search time limit was from May 31, 2012 to May 31, 2022. Two researchers with evidence-based research background conducted independent literature quality evaluation of the retrieved evidence, and the evidence that met the quality standards was extracted and summarized based on the opinions of industry experts. RESULTS: A total of 315 articles were retrieved, and 13 articles were included, including 3 guidelines, 6 expert consensus, and 4 Meta-analysis. A total of 27 best evidences were summarized from 7 aspects, including the selection of ECMO anticoagulation, anticoagulation in priming, anticoagulation in operation, anticoagulation monitoring, bleeding and treatment, thrombosis and treatment, and prevention and management of terminal limb ischemia. CONCLUSIONS This study provides evidence-based basis for bleeding prevention and anticoagulant management in ECMO patients. It is recommended to selectively apply the best evidence after evaluating the clinical environmental conditions of medical institutions, so as to improve the prognosis of ECMO patients.
Humans ; Extracorporeal Membrane Oxygenation/adverse effects* ; Blood Coagulation ; Hemorrhage/etiology* ; Anticoagulants/adverse effects* ; Thrombosis/prevention & control* ; Retrospective Studies

Objective:To evaluate and summarize the best evidence for early rehabilitation of adults with veno-venous extracorporeal membrane oxygenation (VV-ECMO).Methods:Evidence on early rehabilitation of adult VV-ECMO patients was searched by computer from 7 English literature databases [PubMed database, cumulative index to nursing and allied health literature (CINAHL), Embase database, Cochrane library database, UpToDate clinical consultant, BMJ best clinical practice, JBI database], 5 Chinese literature databases (China biomedical literature database, China Yimai Tong, China national knowledge infrastructure, Wanfang data, VIP database), 5 guideline networks [National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), China Guide Network] and 2 professional association websites [Extracorporeal Life Support Organization (ELSO), Chinese Association of Rehabilitation Medicine]. The search period is from January 2011 to December 2021. The appraisal of guidelines for research and evaluation Ⅱ (AGREE ) and JBI 2014 quality assessment tools were used to evaluate the quality of inclusion guidelines, systematic reviews, expert consensus and original studies, respectively, and to extract and summarize the best evidence for early rehabilitation of adults with VV-ECMO.Results:A total of 2 guidelines, 2 expert consensuses, 2 systematic reviews and 8 original studies [including 1 randomized controlled trial (RCT), 1 non-randomized controlled study, 3 cohort studies and 3 case reports] were included. The evidence was summarized from 9 aspects including the necessity of early rehabilitation, rehabilitation initiation time, rehabilitation location, pre-rehabilitation preparation, pre-rehabilitation assessment, rehabilitation method, rehabilitation frequency and duration, rehabilitation process monitoring and effect evaluation,and finally 24 pieces of the best evidence were summarized.Conclusion:Early rehabilitation of adults with VV-ECMO is safe and feasible. The summary of the best evidence can provide evidence-based guidance for clinical medical staff to reasonably carry out early rehabilitation.

Objective:To summarize the establishment and management experience of extracorporeal membrane oxygenation (ECMO) rapid response team, and explore a more efficient rescue mode.Methods:From January 2015 to September 2020, 85 patients treated with ECMO in Affiliated Hospital of Qingdao University were selected as the research objects. Thirty-eight patients treated with conventional ECMO from January 2015 to December 2019 were selected as the control group, and 47 patients treated with ECMO rapid response team from January 2020 to September 2020 were selected as the experimental group. The differences in team preparation time, catheterization time, treatment success rate, incidence of complications and equipment failure frequency between the two groups were compared.Results:There were no significant differences in gender, age or disease types between the two groups. The team preparation time and catheterization time of the experimental group were significantly shorter than those of the control group [team preparation time (minutes): 31.79±6.10 vs. 67.16±30.49, catheterization time (minutes): 40.62±7.13 vs. 84.89±19.29], and the incidence of complications was significantly lower than that of the control group [4.3% (2/47) vs. 21.1% (8/38)], and the differences were statistically significant (all P < 0.05). Conclusion:ECMO rapid response team can shorten the rescue preparation time, reduce the occurrence of complications, improve the team treatment efficiency, and provide ideas for emergency and critical patients.