ECMO in Latin America

October 2019, Buenos Aires, Argentina (Clínica y Maternidad Suizo Argentina)

Building ECMO Capacity in Latin America: Teaching and Modeling Teamwork to Maximize Successful Program Initiation

Developing a successful ECMO program is a complex, resource-intensive undertaking, requiring distinct but overlapping clinical and administrative expertise. If tackled in a piecemeal fashion, early patients may die and the program may be deemed a failure and shuttered. Successful initiation of an ECMO program requires the identification, support, training and ongoing practice of an expert team. Team members must learn to identify good candidate patients, cannulate them safely, manage complications and emergencies that arise while on ECMO, and remove them from ECMO when they have improved sufficiently to be supported by more conventional means.

For new teams starting an ECMO program at their institutions, members of the Texas Children’s ECMO team, together with colleagues from Colombia and Costa Rica, have developed a training course designed to teach new teams in Latin America basic and intermediate concepts of ECMO physiology, patient selection and management, and program administration, using lectures, problem-based learning, high-fidelity simulation with pre- and post-testing. The course aims to break down traditional barriers between physicians, nurses, respiratory therapists and perfusionists, emphasizing and modeling mutual respect and teamwork.

Our program is unique for 4 reasons.

  • First, it focuses on teams. Other courses focus on physicians, but exclude nurses, respiratory therapists or perfusionists, each of whom is required for successful operation of an ECMO program. Our instructors come from medical, surgical, nursing and perfusion backgrounds and have helped build successful ECMO programs in their respective institutions.
  • Second, the entire course is taught in Spanish. All instructors are either native or near-native Spanish speakers and remain available to all learners throughout the course, in lectures, problem-based learning sessions, simulations and even during breaks. Moreover, all have been involved in setting up ECMO programs in Latin American institutions and have faced – and solved – many of the obstacles our learners will encounter when setting up their own programs.
  • Third, this course is significantly less expensive than other available ECMO training courses, with average per-person inscription of $500 USD, as opposed to $2,500 USD. This allows institutions to sponsor more learners and makes learning ECMO more accessible to nonphysician team members.
  • Fourth, instructors remain available for consultation after the course is over, maintaining contact and providing advice via chat, email, telephone or videoconferencing

In addition to the full 4-day courses, members of this same team have conducted shorter, 1-day ECMO workshops at different subspecialty conferences in Latin America or with large Latin American audiences, including ones in San Miguel de Allende, Puebla, and Mexico City (Mexico), as well as in Houston when the Latin American Society for Pediatric Intensive Care held its 15th Annual Congress here in 2019.

The Faculty

Course Co-Directors

  • James A. Thomas, MD, Medical Director, ECMO Program, Texas Children’s Hospital
  • Gabriel Cassalett-Bustillo, MD, Chief of Pediatric Intensive Care at the Fundación Clínica Shaio in Bogotá, Colombia.
  • Patricia Bastero, MD, Medical Director Critical Care Simulation, Texas Children’s Hospital

Instructors

  • Javier Brenes-Gonzalez, MD, Pediatric Thoracic and Cardiovascular Surgery at National Children’s Hospital and the CIMA Hospital, San José, Costa Rica
  • Estefanía Giraldo-Bejarano, RN, MSN, Coordinator Adult ICU, ECMO Specialist, Fundación Clínica Shaio, Bogotá
  • Otto Gonzalez-Pardo, MD, Pediatric Intensivist at Fundación Clínica Shaio and Fundación Cardioinfantil in Bogotá
  • Tatiana Jaramillo, RN, Pediatric Critical Care Nurse, ECMO Specialist, Fundación Clínica Shaio, Bogotá
  • Federico Núñez-Ricardo, MD, Chief of Cardiovascular Surgery, Fundación Clínica Shaio, Bogotá
  • Renan Orellana, MD, Associate Professor Pediatrics, Baylor College of Medicine
  • María Lucía Pava, RN, Perfusionist, Fundación Clínica Shaio, Bogotá
  • Leonardo Salazar, MD, MSc, Medical Director, ECMO and VAD Group, Fundación Cardiovascular, Bucaramanga, Colombia
  • Patricia Salcedo, RN, Perfusionist, Fundación Clínica Shaio, Bogotá
  • Tony Sarquis, MD, Cardiovascular Anesthesia, Fundación Clínica Shaio, Bogotá
  • Paul Sheeran, MD, Associate Professor Pediatric Anesthesiology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
  • Marita T. Thompson, MD, Medical Director Pediatric ECMO program, Children’s Mercy Hospital, Kansas City, Missouri

Course Organization

  • 4 days long
  • 21-25 didactic lectures
  • 2 workshops to familiarize learners with the equipment and practice priming
  • 4-6 problem-based learning scenarios
  • 4-5 high-fidelity simulation scenarios, including intrahospital transport on ECMO
  • Final Examination and Certificate Distribution

Courses Offered

  • May 2013: Bogota, Colombia (Insimed)
  • October 2013: Santiago, Chile (Hospital Roberto del Río)
  • April 2014: Bogotá, Colombia (Insimed)
  • April 2015: Bogotá, Colombia (Hospital Militar)
  • August 2016: Bogotá, Colombia (Insimed)
  • April 2017: Mexico City, Mexico (Hospital ABC)
  • October 2017: Medellín, Colombia (Hospital CardioVid)
  • April 2018: San José, Costa Rica (Hospital Nacional de Niños Carlos Sáenz Herrera)
  • March 2019: Neuquén, Argentina (Hospital Provincial Neuquén, Dr. Eduardo Castro Rendón)
  • October 2019, Buenos Aires, Argentina (Clínica y Maternidad Suizo Argentina)

Results

  • Courses filled within days of announcement
  • More than 300 learners taught
  • Teams from 10 countries: Colombia, Mexico, Chile, Peru, Ecuador, Costa Rica, Argentina, Uruguay, Venezuela, Panama
  • Favorable evaluations from participants (overall >4.7/5 on Likert scale)
  • Successful implementation of programs in ≥5 centers (Colombia (2), Chile, Peru, Mexico, Costa Rica)

Video

ECMO course taught in Medellín, Colombia at the Clínica Cardiovid