ECMO Specialists' Day

The ECMO specialists are the lifeblood of the ECMO program. They maintain the pump and the circuit and monitor the interaction between circuit and patient for the duration of a patient’s course on ECMO. They hail from intensive care Nursing, Respiratory Care or Cardiac Perfusion backgrounds and represent the most accomplished and respected members of their profession. They are also the hardest working, because they debut on the ECMO Specialist team working overtime hours, only after they have satisfied their bedside (or OR) shift requirements.

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To become ECMO specialists, professionals undergo a rigorous, multi-week training program that involves classroom didactics, demonstrations, “wet labs” (practical sessions managing the circuit and possible complications), an exacting written exam and a series of monitored shifts caring for actual patients under the watchful eye of more experienced specialists before they are allowed to “sit the pump” alone. In addition to sitting a minimum number of shifts to maintain their credentials as ECMO specialists, they also participate in a minimum of 6 continuing education sessions per year to keep their emergency response skills sharp and to pick up new skills (such as learning how to work a next-generation pump).

A subgroup of specialists undergoes even further training to achieve qualification as a “primer.” Primers must learn how to build an ECMO circuit from its component parts (pump head, oxygenator, tubing, stopcocks, sensors). They must also learn to prime these circuits, first with a clear liquid like saline, and ultimately with blood products (principally, blood, plasma and albumin) prior to putting a patient on ECMO. They are also responsible for changing circuits and pumps (or components such as an oxygenator, hemofilter, or pump head) on ECMO patients, when these devices cease working according to specifications. The circuit or component changes involve separating the patient from the circuit, a moment in which a patient may start to die, so they must be performed quickly. All primers must be able to change a circuit in a maximum time of 1 minute. Many are capable of doing so in less than 30 seconds.

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“That’s a lot of responsibility for one person to shoulder,” you might say to yourself. It is, but for some reason, outside of and ICU setting, no one knows what an ECMO specialist is or what they do. For that reason, we decided to start a tradition of celebrating these amazing professionals and the remarkable work they do.

Organized by the specialists themselves, on July 20, 2022, we held the first annual ECMO Specialists’ Day at Texas Children’s Hospital. The inaugural event included 2 guest speakers, the gifting of some ECMO “swag” and lunch for the specialists (both day and night shifts). Our first guest speaker was Dr. Dean McKenzie, a revered congenital heart disease surgeon who has endured a medical odyssey of his own and been on “both sides” of an ECMO circuit. In a talk he entitled “Life,” he shared his experiences, but also spoke of the importance of engaging in meaningful work and that being an ECMO specialist was indeed meaningful work that he could attest to.