ECMO in Latin America

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

Developing a successful ECMO program in other countries is a complex, resource-intensive undertaking, requiring distinct but overlapping clinical and administrative expertise. If tackled in a piece-meal fashion, early patients may die and the program may be deemed a failure. 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 patients from ECMO when they have improved sufficiently to be supported by more conventional means.

For new teams starting an ECMO program at their institutions, Texas Children's has developed a training course designed to teach  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. This course aims to break down traditional barriers between physicians, nurses, respiratory therapists and perfusionists, emphasizing and modeling mutual respect and teamwork.

This program is unique for four reasons:

  • First, it focuses on teams. Other courses focus on physicians and exclude nurses, respiratory therapists or perfusionists. This is not our approach. We believe all of these disciplines are 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. Many instructors have been involved in setting up ECMO programs in their 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 non-physician team members.
  • Fourth, instructors remain available for consultation after the course is over, maintaining contact and providing advice via chat, email, telephone or videoconferencing.

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, Associate Medical Director, ECMO Program, 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

  • Four days long
  • 21-25 didactic lectures
  • Two workshops to familiarize learners with the equipment and practice priming
  • Four-six problem-based learning scenarios
  • Four-five high-fidelity simulation scenarios, including intra-hospital 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)
  • March 2017: Mexico City, Mexico (Hospital ABC)
  • October 2017: Medellín, Colombia (Clínica Cardiovid).
  • April 17-20, 2018: San José, Costa Rica (Critical Care Medical, Pediatric Cardiovascular Surgical, PICU Nursing, Perfusion and Respiratory Care staff at the Hospital Nacional de Niños Carlos Sáenz Herrera (National Children’s Hospital))
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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 on 5-point Likert scale)
  • Successful implementation of programs in ≥4 centers (Colombia, Chile, Peru, Mexico)

Video

ECMO course taught in Medellín, Colombia at the Clínica Cardiovid