Nursing care for patients with COVID- 19 on extracorporeal membrane oxygenation ( ECMO) support

In Japan, four medical facilities including our own - the National Center for Global health and Medicine (NCGM) - have been designated for the treatment of specified infectious diseases by the Minister of Health, Labour, and Welfare. Here, we report our nursing care for patients with severe COVID-19 on extracorporeal membrane oxygenation (ECMO) support. In addition to infection control measures in the form of an N95 mask, a water-repellent isolation gown, a cap, a shielded mask on top of the N95, and double-layered gloves, nurses were required to wear onepiece suits (DuPontT Tyvek (R)) and use powered air-purifying respirators (PAPRs). While closed system catheters are normally changed once a day to limit aerosol exposure, they are now changed once every 4 days. Nursing care included equipment checks, monitoring of hemodynamics and respiratory status, management of anticoagulants, observation of the patient's general condition, management of sedatives and analgesics, prevention of medical device-related pressure ulcers and bedsores, and maintenance of hygiene. Fundamentally sound nursing remains the best practice for patient treatment and management. During nursing care for patients with COVID-19 on ECMO, infection control measures should be faithfully and properly followed.