A multicenter survey of 83 ECMO-trained nurses in four Israeli pediatric intensive care units found that perceived knowledge, autonomy, and aspects of teamwork were associated with how frequently nurses reported performing ECMO-related activities. For perfusion teams, the study raises useful questions about education and shared responsibilities. It does not establish causation, assess observed competence, or demonstrate effects on patient outcomes.
Who Does What in Pediatric ECMO Care?
Pediatric ECMO depends on coordinated work across nursing, perfusion, and medical teams. Yet the frequency with which any one professional performs a task can reflect several things: preparation, confidence, local policy, staffing, patient needs, and the way responsibilities are divided. Melnikov and colleagues examined these relationships through a cross-sectional questionnaire study published in Nursing in Critical Care.
The distinction between participation and performance is central to interpreting the paper. A nurse reporting fewer circuit interventions is not necessarily less capable or less engaged. Another team member may routinely perform those activities. Similarly, more frequent activity is not automatically evidence of better or safer care.
Study Design and Participants
The investigators recruited a convenience sample from Hadassah, Rambam, Schneider, and Sheba medical centers. Of 100 questionnaires distributed, 83 were returned. All participants had completed standardized ECMO training and practiced in the ECMO specialist nurse role. Their median experience was 11 years in nursing, eight years in intensive care, and five years working with ECMO.
Questionnaires assessed perceived ECMO knowledge, nursing autonomy, collaboration and support, RN–perfusionist teamwork, and the reported frequency of activities across four domains. These included device calibration and monitoring, medication and blood administration through the circuit, emergency ECMO activities, and general nursing care of ECMO-supported patients.
The investigators used correlations and exploratory multivariable linear regression. Several instruments were developed or adapted for this study and evaluated in the same sample. The knowledge measure captured perceived knowledge, confidence, and skills; it was not an objective examination or a direct observation of clinical competence.
Reported Activity Varied by Domain
| Activity domain | Median reported score | Interquartile range |
|---|---|---|
| General nursing care not directly related to the ECMO device | 100.00 | 84.52–100.00 |
| ECMO calibration and monitoring | 62.50 | 50.00–68.75 |
| Medication and blood administration through ECMO | 31.25 | 12.50–48.44 |
| Emergency ECMO activities | 30.00 | 15.94–45.00 |
General bedside nursing care had the highest reported frequency, followed by circuit calibration and monitoring. Circuit medication/blood administration and emergency activities were less frequent. These patterns require clinical context: emergency tasks depend partly on whether emergencies occur, while circuit access may be assigned to particular professional groups.
Knowledge, Autonomy, and Team Relationships
In bivariate analyses, total ECMO nursing activity scores correlated positively with nursing autonomy (Spearman’s rs = 0.34) and overall interprofessional collaboration (rs = 0.32). Both associations had p values below 0.01.
In the multivariable analysis, perceived knowledge was associated with calibration and monitoring activity (B = 0.39; 95% CI, 0.13–0.64; p = 0.004). Nursing autonomy was associated with medication and blood administration through the circuit (B = 0.50; 95% CI, 0.21–0.80). These coefficients describe relationships between questionnaire measures, not clinical effect sizes or changes in patient risk.
Interpreting the RN–Perfusionist Finding
Higher RN–perfusionist teamwork scores were associated with less frequent nurse-reported medication and blood administration through the circuit (B = −0.29; 95% CI, −0.50 to −0.08; p = 0.008). This finding should not be read as evidence that teamwork harms care or that perfusionists prevent nurses from contributing.
A plausible explanation discussed by the authors is task allocation: where perfusionists are available and responsibilities are clearly assigned, they may perform some shared circuit procedures more often. That explanation was not directly tested. Center practices, staffing, and other unmeasured factors could also contribute. The study did not determine which staffing model is superior.
What Perfusion Teams Can Take From the Study
The paper supports a discussion about how training, role clarity, and everyday collaboration fit together. Teams can use it as a starting point to review who monitors each aspect of the circuit, who performs shared procedures, how concerns are escalated, and how responsibilities are rehearsed during emergencies. These are educational considerations, not interventions proven effective by this survey.
Education should also distinguish confidence from demonstrated competence. Simulation, supervised practice, and local competency assessment address questions that a self-report questionnaire cannot answer. For related IPA coverage, see interdisciplinary ECMO simulation and self-reported confidence and the randomized VA-ECMO cannulation training study.
Evidence Limits
This was a modest, nonrandom sample from one national practice environment. All central variables were self-reported at one time point, creating potential recall, social-desirability, and common-method biases. The design cannot establish whether knowledge or autonomy preceded greater participation, or whether performing more activities influenced those perceptions.
The calibration/monitoring subscale had modest internal consistency (Cronbach’s α = 0.62). Stepwise model selection in a sample of 83 raises overfitting concerns, and instruments examined in the same sample need independent validation. Center-level differences were not analyzed. The paper also contains reporting inconsistencies in score transformation and some statistical details, which warrant caution when interpreting numerical magnitudes.
No patient outcomes, observed task quality, or comparative staffing safety outcomes were measured. The study’s contribution is exploratory evidence about professional participation and team organization, rather than a basis for expanding scope of practice or selecting a staffing model.
Original Article
Melnikov S, Abed Elhai R, Hijazi N, Zaid N, Furmanov A. Associations Between Perceived Knowledge, Interprofessional Collaboration, Autonomy and the Frequency of Nursing Activities in Paediatric Extracorporeal Membrane Oxygenation: A Cross-Sectional Study. Nursing in Critical Care. 2026;31:e70726. doi:10.1111/nicc.70726.
This independently written IPA educational review summarizes the uploaded open-access article. The original publication is distributed under a Creative Commons Attribution license; consult the full paper for complete methods and results.
