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Table 1. Suggested modifications in the ECMO room.
Category Space
ECMO related equipment
Suggested details
Room space of at least 30-square meter( sqm) with 200 centimeters( cm) clearance around the bed each side.
-- ECMO machine( console) + heater / cooler unit, and backup machine.-- ECMO trolley( clamps, dressing, etc).-- ECPR back up supply.
Other machines-- Mechanical ventilator.-- Impella.-- Dialysis or hemofilters.
Monitoring & support equipment
-- Patient monitor.-- Blood gas analyzer.
-- Point of care coagulation testing like ACT, ROTEM.
-- Noninvasive brain oxymetery.
Figure 1. Suggested ECMO room design. Abbreviations: A: patient monitor, B: mechanical, ventilation, C: Impella, D: extra cannula, E: ultrasound, F: Near infrared spectroscopy, H: Intravenous, G: echocardiography, I: medication trolley, J ECMO trolley, m; meters.
ICU design and their actual implementation. They suggested optimizing lighting and reducing noise levels to improve patient sleep and overall outcomes. Additionally, a qualitative study underscored the issues associated with suboptimal ICU design [ 10, 11 ]. However, high visibility in the ICU was a strong recommendation in the SCCM ICU design guidelines despite the low evidence [ 2 ]. Therefore, patients on ECMO are prioritized as critically ill patients on life support and the ECMO rooms should also allow 360-degree access to the patient when needed to facilitate procedures such as cannulation, circuit changes, and emergency interventions. Other general ICU room design recommendations like access to natural light [ 2 ]. Further studies to highlight integrating patient and family perspectives into ICU design and compare different or upgraded ICU bed spaces and the environmental factors are crucial to assess different patients’ outcomes, including sleep and circadian Rhythm, delirium, and recovery post-ICU and also improve the patients’ experience [ 12, 13 ].
Equipment organization and readiness
Proper organization and readiness of equipment can significantly reduce response times during emergencies. This includes ensuring standardized placement of the ECMO machine and easy access to emergency supplies like clamps, a backup preprimed ECMO circuit, and additional cannulas. Also, the ECMO rooms should have an uninterruptible power supply( UPS), and multiple oxygen sources are essential for uninterrupted service, given ECMO’ s reliance on power-driven devices.
There are no universal guidelines for equipment layout, but some centers have developed ECMO carts or dedicated stations stocked with necessary supplies. We suggest that the ECMO machine be located at the bedside with the controller( monitor) facing the entrance, allowing visual access to the parameters, easy access to controls, and emergency stop functions [ 14 ]. Some centers integrate real-time hemodynamic monitoring with ECMO machine parameters for early complication detection. With advancements in telemedicine, remote ECMO monitoring is becoming feasible. Also, pre-primed ECMO circuits( typically with saline) should be stored in a nearby store for ECMO supply inside the unit or accessible to the team in a short time for emergencies. Other emergency equipment associated with ECMO should be readily available on a dedicated ECMO trolley at the bedside, similar to a crash cart.
New insight and potential innovations
1. Smart ICU design for ECMO patients
Emerging technologies in ICU design, such as smart alarms, non-invasive telemonitoring, and integrated and automated ECMO monitoring, would enhance patient safety.
2. ECMO-specific ICU units
Some high-volume ECMO centers have developed dedicated ECMO ICUs with high visibility, are fully equipped, and have staff trained exclusively in ECMO care. The ECMO unit should be designed in proximity to critical hospital areas and required resources, with flexible surge capacity depending on the hospital’ s infrastructure and planning of ECMO to be a multidisciplinary or ICU-based approach [ 3 ].
3. Tele-ECMO and remote monitoring
This could allow expert consultation in lower-resource settings and support decision-making in smaller ICUs that lack dedicated ECMO teams [ 14 ].
In summary, ECMO rooms and ECMO unit design require careful planning and consideration of various factors to enhance patients’ outcomes and ensure high-quality care. Standardization of practices, adherence to guidelines, and a focus on safety