An exploration of staff experiences of extracorporeal membrane oxygenation (ECMO)

Intensive care unit (ICU) staff are exposed to a broad range of professional, ethical and clinical practice issues such as when to offer and withdraw potentially life-saving care, which are most apparent when working with hyper-advanced technologies such as extracorporeal membrane oxygenation (ECMO). Despite the rapid increase in use of ECMO to support adults with critical heart and lung conditions, few studies have documented staff experiences of working with this technology. This study aimed to explore ICU doctors and nurses conceptualisations of key professional, ethical and clinical practice issues relating to ECMO, and the psychological impact of managing them.
A qualitative design was utilised, in which semi-structured interviews were conducted with 10 ICU staff (five doctors and five nurses), working in a specialist ECMO centre in the United Kingdom
(UK). Data were analysed using thematic analysis, underpinned by a critical realist epistemological stance. Three key themes were identified. 1) Embodying the ECMO Specialist: Staff experienced a sense of mastery when managing technical aspects of the work, but felt inept when dealing with abstract ethical issues. Specialists sought to drive forward clinical practice, and learning was considered important for developing clinical abilities. 2) Team dynamics: Staff came together as a team to address the technical, professional and ethical challenges associated with their work with ECMO, however ECMO was also described as a divisive force in the ICU. 3) Riding the Emotional Rollercoaster: Life or death outcomes were associated with intense emotions and staff reported various ways of managing them.
These findings add a new dimension to the professional and ethical discussions in the academic literature and have several implications for clinical practice, which are discussed. Further research may wish to focus on more specific aspects of ECMO care, such as the processes involved in decision-making.