Beyond the machine
ECMO involves high-tech medicine – but not less nursing care. On the contrary, it is precisely the combination of advanced technology and individualized patient care that highlights how essential nursing competencies are. Tobias Wittler and Tobias Ochmann from Germany’s ECMO Network explain the professional, technical, and social skills nurses need to provide optimal care for ECMO patients – with a clear-eyed view of realities, challenges, and possible solutions.
Nursing at the core of ECMO
Technology alone does not define ECMO. It is the convergence of technology and human care where nursing plays its most vital role. ECMO patients still require comprehensive care: early mobilization, nutritional support, cognitive stimulation, and emotional guidance. These are not "add-ons" but essential interventions that must be delivered alongside technical management.
"Our professional identity is built on the ability to integrate complex technology into high-quality, holistic patient care," says Tobias Wittler, spokesperson of the ECMO network and deputy head nurse, intensive care unit, Marienhospital Osnabrück. "Patients must not receive less attention simply because the therapy is technical."
Clinical judgment: A critical skill
In many countries, including Germany, there are no binding standards for what ECMO nursing entails. Yet the expectations are high. Nurses must master intensive care fundamentals while also understanding underlying pathologies, ECMO mechanisms, and potential complications. Often, nurses are the first to detect clinical changes – and must respond immediately.
"If something critical changes, we can’t wait for someone else to notice. We must assess and act in real time," says Tobias Ochmann, deputy spokesperson of the ECMO network, nursing expert (APN), certified intensive care and anesthesia nurse, Catholic Marienkrankenhaus Hamburg. "That goes far beyond monitoring vitals – it requires a nuanced understanding of the patient’s mental, emotional, and physical state."
Technical expertise within a dynamic system
ECMO changes everything: circulation, respiration, metabolic load. Nurses must understand how technical adjustments impact these interconnected systems. In some hospitals, they even take on responsibilities traditionally held by perfusionists or technicians, such as equipment setup or device fleet management.
"You need to grasp more than just a number on a screen. It's about understanding how multiple changes interact – and what that means for your patient," Tobias Wittler explains.
Navigating human realities
ECMO provides time, not a cure. While clinical teams understand this, patients and families often interpret stable monitor readings as signs of recovery. When it becomes clear that there is no viable path to healing, difficult conversations must follow.
"Families need space and time to process decisions. Our job is to facilitate this – not to deliver verdicts, but to support humane, informed decision-making," says Tobias Wittler.
Some patients are conscious and aware they cannot survive without ECMO. Others are waiting for a transplant. Emotional states vary – from hope to fear to rejection of the therapy itself. Nurses must provide psychological support while maintaining therapeutic clarity and moral balance.
"Patients say things like, 'This isn't life for me anymore.' And that impacts us as caregivers too," Tobias Wittler adds. "We need to be emotionally resilient and ethically grounded."
Interdisciplinary teamwork and communication
ECMO is never a solo effort. Its success depends on interprofessional collaboration, clear communication, and mutual trust. Nurses are not just participants but integral connectors – liaising with physicians, physiotherapists, palliative teams, and ethics committees.
"The more complex the therapy, the more important it is to function as one coherent unit. ECMO thrives or fails as a team effort," Tobias Ochmann emphasizes.
One practical example: early mobilization. It prevents long-term complications, but requires careful planning and coordination. Nurses play a central role in aligning patient readiness, therapist input, and family involvement.
Structured training is key
Onboarding new staff into ECMO nursing requires more than short courses. "A course is only the beginning. Each hospital needs a structured and sustainable approach to training. We’re discussing options like VR simulations and online training tools – but there’s still a long way to go," Tobias Wittler acknowledges.
Conclusion
ECMO nursing is not just technical work. It demands the full range of clinical, ethical, emotional, and interpersonal skills. The voices of nurses like Tobias Wittler and Tobias Ochmann show how vital it is to recognize and support the true scope of ECMO care. As critical care evolves, so too must our understanding of what it means to provide it.