The Role of the Apheresis Tandem Safety Timeout in ECMO and Apheresis Therapy

Authors

Johanna I. Orrick, Children's Mercy HospitalFollow
Debra E. Newton, Children's Mercy HospitalFollow
Kari L. Davidson, Children's Mercy HospitalFollow
Karen Murray, Children's Mercy HospitalFollow

Publication Date

3-2025

Files

Abstract

The Apheresis Tandem Safety Timeout was implemented in 2017 at Children’s Mercy Hospital (CMH) to ensure safe, coordinated care when performing therapeutic plasma exchange (TPE) alongside Extracorporeal Membrane Oxygenation (ECMO). The first tandem procedure at CMH was performed in 2013, introducing a valuable tool for treating the sickest patients in the region. However, when patients are placed on two extracorporeal circuits simultaneously, the risk of complications increases significantly. These include electrolyte imbalances, anticoagulation challenges, hemodynamic instability, and the potential for either circuit to be compromised. The ECMO and Apheresis team recognized that even minor miscommunication could lead to life-threatening complications in these complex tandem therapies. Checklists are widely recognized in healthcare as effective tools to promote safety and identify human error before critical events occur. A checklist was developed to mitigate the increased risk of abnormalities in electrolytes, anticoagulation levels, and hemodynamics by ensuring that each team member understands the potential issues identified and addresses them before initiating apheresis on ECMO patients. The Apheresis Tandem Safety Timeout checklist facilitates closed-loop communication, defining roles, verifying system readiness, and identifying possible adverse events that may arise during the procedure. Given the high likelihood of technical challenges, such as maintaining blood flow in two circuits simultaneously, avoiding pressure differentials, and managing the risk of air emboli, the checklist ensures that the ECMO and Apheresis team are thoroughly prepared for each tandem procedure. By standardizing communication, the checklist enhances team coordination and reduces the likelihood of system failures or patient complications. The ongoing refinement of the checklist, based on quantitative and qualitative data from each procedure, has led to safer, more efficient tandem therapies. The checklist remains a vital tool in managing the complexity of these cases, allowing multiple teams to provide optimal care to critically ill patients who require simultaneous extracorporeal therapies.

Disciplines

Critical Care

Notes

Presented at the 41st Annual ECMO and the Advanced Therapies for Respiratory Failure Symposium; Keystone, Colorado; March 2-5, 2025

Recommended Citation

Orrick, Johanna I.; Newton, Debra E.; Davidson, Kari L.; and Murray, Karen, "The Role of the Apheresis Tandem Safety Timeout in ECMO and Apheresis Therapy" (2025). Posters. 468.
https://scholarlyexchange.childrensmercy.org/posters/468