The purpose of this document is to standardise management of patients receiving extracorporeal membrane oxygenation (ECMO) in the intensive care unit (ICU). It is meant to provide a guide for the safe practice of ECMO at The Alfred ICU. It contains references to current equipment and staffing practices at The Alfred ICU and is tailored to local system requirements that may not apply to alternate contexts.
This guideline is freely available to assist our own staff and others in the care of ECMO patients. It is used at The Alfred Hospital in the context of local experience and the established processes of ECMO care. It relies heavily on individual patient assessment and institutional ECMO expertise.
The guideline is provided to the wider community as an educational resource and does not replace individual clinician judgment and responsibility. External users should always rely on their own expertise in evaluating and using any information or methods described and accept full responsibility for their actions. ECMO expertise and safe ECMO care can not be inferred by following this guideline.
An overview of the staffing roles, responsibilities and training requirements are contained in the
- ECMO Clinical Service Structure and Scope of Practice
The current initial credentialing process for consultant intensivists includes completion of the ECMO course, ECMO Competency Course Presentations, individual introduction and assessment of knowledge and practical skills. In addition, the ARV retrieval competency package is required.
For ongoing credentialing, the following targets are set and reviewed on an annual basis:
- 5 ECMO cannulations (include ECMO cannulation course)
- Distal perfusion cannulation
- Cannulator 3/ PLS console training
- ECPR participation
- ECPR simulation
- Teaching activities – ECMO course / SR teaching or external course
- Circuit priming HLS / PLS
- Circuit change
- ARV (Adult Retrieval Victoria) credentialing – as required
- ARV retrieval
ECMO activities are recorded by each individual consultant online via the ECMO activities link on the daily ICU consultant roster.
There are multiple arms to ECMO education that can be either attended as a learner or instructor to refresh current material beyond the content of this guideline.
- ECMO course biannually
- Senior Registrar (SR) teaching sessions at the bedside
- ECMO certificate currently includes (link to ECMO certificate page)
- ECMO practical teaching session (5 sections taught biannually)
- Write one ECMO blog
- Perform one circuit prime
- Observe on VA ECMO weaning study
- Intensiveblog.com – ECMO section on this educational Alfred ICU website
- Participating in the specialised ECMO patients ward round (V-round)