What is the ECMO Specialist Model

An ECMO program can be structured in various ways depending on the type of facility, finances, and needs of the institution. During my time as a nurse, I have worked at four different medical centers that offer extracorporeal life support. Three locations have been in the United States, and one in the United Arab Emirates. I specialized in cardio-thoracic ICU care at each facility, have precepted new and experienced nurses, provided education on all CVICU therapy and MCS devices, helped implement new protocols for cardiac surgery recovery, and set up a new ECMO program.

At each location, the model of ECMO care varied from perfusion-led model, to bedside ECMO nurse/specialist combo model, to the ECMO Specialist model. Interestingly enough, the exact same therapy is offered in so many centers around the world, with differing models of care. Although I have identified many reasons for this phenomena, each institution must determine the best model of care for their patient population and long term goals.

Many people have asked me to describe the ECMO Specialist model of care, what it means, and what is required. This model can be labor intensive up front, but in the long run is efficient, cost effective, and beneficial to the long term goals of the organization. Take note that some medical centers place different criteria on the ECMO Specialist than what is listed. Each facility must determine what is best for safe practice and care at that institution.

• ECMO Specialist (ES) Model
  One specialized registered nurse or respiratory therapist with at least 2 years of critical care experience is selected and put through rigorous training in order to become a designated ECMO Specialist.

  Each specialist oversees and cares for up to 4 ECLS circuits. Responsibilities within the ECMO Specialist role includes all pump priming, initiation, emergency procedures, circuit exchanges, documentation of pressure readings, intra-hospital and out of hospital transport, cannula management and site dressings, safety checks, upkeep of emergency carts, oversight of care to ensure protocols for ECMO therapy are upheld, overall management with the team, evaluation of new patient consults and determination with the team when to cannulate, assistance with physical therapy/ambulation, daily rounds, and patient safety while on pump.

  Initial training includes 16 hours of didactic following ELSO guidelines, 2 weeks of ECMO wet labs and simulations which validate that the specialist is competent in 25 different skills, 2 weeks of precepted bedside ECMO Specialist training by a seasoned ES, a passing score on the ECMO Specialist exam, quarterly wet lab and simulations, and an annual revalidation exam. This model institutes a 1:1 bedside ECMO nurse ratio for primary ICU care of the patient.
  
  Implementation of the ECMO Specialist Model helps reduce cost from employing a perfusionist in house 24/7, encourages staff tenure by new skill sets and advanced training being offered, ensures staff competency to care for and manage ECMO patients appropriately, and improves patient safety with continuity and consistency in care.