Adult ECMO Specialist

Course Curriculum

 

Day 1—Monday

 

CONTENT

TIME FRAME

PRESENTER

TEACHING METHODS/LEARNER ENGAGEMENT STRATEGIES

Welcome & Introductions

  • Introductions
  • Course expectations
  • Housekeeping –where restrooms are located, etc.
  • +/D evaluation
  • Disclosures/COI
  • Overview of agenda

08:00 – 08:30

 

30 minutes

Q&A

Introduction to ECMO

  • Terminology
  • History of ECMO
  • Extracorporeal Life Support Organization (ELSO) & the data Registry
  • Addressing the growing need for ECMO Specialists
  • Compare/contrast ECMO and cardiopulmonary bypass
  • Indications for and contraindications of ECMO

08:30 – 09:15

 

45 minutes

Teaching methods:

Lecture

AV

Support

Handout

Other:  _______________

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 
BREAK
09:15 – 09:30
15 minutes

ECMO Staffing Models

  • Blended programs à perfusion and ECMO specialists working together
  • Respiratory therapist model
  • RN model
  • Perfusion model
  • Telemedicine
  • Telemonitoring

09:30 – 11:00

 

90 minutes

 

 

 

 

 

 

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 

Native Gas Exchange – Circulatory Physiology

  • Oxygen content and hemoglobin
  • Oxygen delivery and consumption
  • Respiratory exchange ratio à hemoglobin-dissociation curve
  • Normal circulation and flow
  • Antegrade vs. retrograde flow
  • Lymphatic system doesn’t drain when not moving

11:00 – 11:45

 

45 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 
LUNCH
11:45 – 12:15
30 minutes
 

ECMO Physiology

  • Hemodynamics: pressure, flow, resistance and compliance
  • Physiology of ECLS
  • Oxygen delivery during ECLS

12:15 – 13:00

 

45 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 

Venous-Arterial ECMO

  • Indications & contraindications to VA ECMO
  • Cannulation sites & confirming placement
  • Goals of therapy
  • Assessment and patient management
  • SAVE score

 

13:00 – 14:15

 

75 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 
BREAK
14:15 – 14:30
15 minutes
 

Veno-Venous ECMO

  • Respiratory ECMO indications
  • Cannulation sites/confirming placement
  • Contraindications
  • Goals of therapy
  • Assessment and patient management
  • Recirculation
  • RESP Score

 

14:30 – 15:45

 

75 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 

Cannulation & Initiation of ECMO

  • ECMO system components –blood pumps, oxygenators, heat exchangers, pump consoles, circuit design
  • Difference between polypropylene and PMP fibers
  • Consideration for cannula selection
  • Patient preparation
  • ECMO initiation
  • Non-ambulatory patient transportation

15:45 – 1700

 

75 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 

Day 2—Tuesday

 

CONTENT

TIME FRAME

PRESENTER

TEACHING METHODS/LEARNER ENGAGEMENT STRATEGIES

Daily Review #1—Jeopardy!

  • Distinguish between indications for VA vs. VV ECMO
  • Interpret DO2:VO2 ratio
  • Explain the RN/ECMO specialist role in patient transport

 

08:00 – 08:30

 

30 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

 

Physiology of Coagulation

  • ECLS antiocoagulation
  • Anticoagulation monitoring – aPTT, ACT & TEG
  • Clot formation in the ECMO circuit and determining clot burden (Transonic) & ETCO2 from exhalation from oxygenator
  • Alternative anticoagulation therapies and ECMO
  • Treatment of DIC & HIT

08:30 – 10:30

 

120 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 
BREAK
10:30 – 10:45
15 minutes
 

Laboratory and Transfusion Management

  • Blood transfusion protocols and ECMO
  • Laboratory analysis -ABG, electrolytes, metabolites, lactate, and recognizing refractory acidosis

 

10:45 – 11:45

 

60 minutes

 

 

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 
LUNCH
11:45 – 12:15
30 minutes
 

Medication & Fluid Management During ECMO

  • Titrating inotropes, chronotropes, beta blockers, etc.
  • Fluid management—crystalloid vs. colloid fluids
  • CRRT during ECLS
  • ! How CRRT can mask a problem

12:15 – 13:15

 

60 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 

ECMO Specialist Bedside Skills

  • Roles of the ECMO specialist vs. the bedside RN
  • Teamwork and collaborative communication
  • Performing circuit checks
  • Circuit related monitoring
  • Patient monitoring and RN/ECMO Specialist Assessment
  • Documentation

 

13:15 – 14:00

 

45 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 
BREAK
14:00 – 14:15
15 minutes
 

Patient Management While On ECMO

  • Management of the patient with respiratory failure
  • Management of the patient with cardiac failure
  • Adding additional cannulas
  • Ventilatory management while of VA ECMO patient & VV ECMO patient
  • Use of proning during ECMO

14:15 – 15:45

 

90 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 

Weaning Off ECMO To Decannulation

  • Patient indicators to initiate weaning
  • How to wean VV ECMO
  • How to wean VA ECMO
  • Trial off VV ECMO
  • Trial off VA ECMO
  • Decannulation

15:45 – 17:00

 

75 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

 

 

Day 3—Wednesday

 

CONTENT

TIME FRAME

PRESENTER

TEACHING METHODS/LEARNER ENGAGEMENT STRATEGIES

Daily Review #2 –Jeopardy!

Patient Assessment

Ethical Considerations

  1. o   Informed consent
  2. o   Advanced directives
  3. o   Futile treatment
  4. o   Palliative care
  5. o   Moral distress & resilience
  6. o   Compassion fatigue

08:00 – 08:30

 

30 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

Handling Complications

  • Cardiac stun
  • Cardiac arrhythmias
  • Compromised distal perfusion
  • Harlequin syndrome
  • Pneumothorax/hemothorax
  • Bleeding
  • Agitated patients
  • Left ventricular distention
  • Left ventricular thrombus

08:30 – 10:00

 

90 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________
BREAK
10:00 – 10:15
 
 

ECMO Case Studies

  • Appropriateness of ECMO (#7)
  • VA ECMO with cardiac balloon pump (#1)

VV ECMO With Persistent Hypoxemia (#4)

   

Complex Cases

  1. o   Post-surgical bleeding
  2. o   Non-surgical bleeding
  3. o   Air emboli
  4. o   Acute decompensation
  5. o   CPR on ECMO
  6. o   Accidental decannulation
  7. o   Exotic cannulation and circuits

10:15 – 11:15

 

60 minutes

  

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________
EXAM
11:15 – 12:15
60 minutes
 
LUNCH
12:15 – 12:45
30 minutes
 

Introduction to Simulations

  • Adult learning theory
  • Rationale for simulation-based learning
  • Ground rules
  • Simulation set up and scenarios
  • Importance of debriefing

12:45 – 13:00

 

 15 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _______________

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _________________

Stable Run Simulations—Easy

  • VA ECMO Initiation run & weaning to decannulation –Stable patient
  1. o   90-minute simulation
  2. o   30-minute group debrief
  • VV ECMO Initiation run & weaning to decannulation –Stable patient
  1. o   90-minute simulation
  2. o   30-minute group debrief

13:00 – 17:00

 

240 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _High fidelity simulation

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _debriefing

 

Day 4—Thursday

 

CONTENT

TIME FRAME

PRESENTER

TEACHING METHODS/LEARNER ENGAGEMENT STRATEGIES
For simulations, students will be split into 3 groups of 4 students.  Each group will have 30 minutes to perform the high-fidelity simulation.  Students will observe peers completing simulations.   After priming the circuit, instructors may give hints but will not give direct instructions to students on their actions.  Simulations will be as real-to-life as possible.  The entire group will debrief and identify lessons learned at the end of each category of simulations.  

Advanced Simulations Group A –Moderate Difficulty

  • Recognizing catheter malposition d/t inadvertent patient movement (Ch 18)
  1. o   90-minute simulation
  2. o   30-minute group debrief
  • Recognizing oxygenator failure 
  1. o   90-minute simulation
  2. o   30-minute group debrief

 

08:00 – 12:00

 

240 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _High fidelity simulation

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _debriefing
LUNCH
12:00 – 13:00
60 minutes
 

Advanced Simulations Group B –Moderate Difficulty to Difficult

  • Recognizing Harlequin Syndrome (Ch 23)
  1. o   90-minute simulation
  2. o   30-minute group debrief
  • Recognize insufficient drainage for a patient on VV ECMO therapy and discuss how to correct  (Ch 7)
  1. o   90-minute simulation
  2. o   30-minute group debrief

13:00 – 17:00

 

240 minutes

  

 

Day 5—Friday

 

CONTENT

TIME FRAME

PRESENTER

TEACHING METHODS/LEARNER ENGAGEMENT STRATEGIES
For simulations, students will be split into 3 groups of 4 students.  Each group will have 30 minutes to perform the high-fidelity simulation.  Students will observe peers completing simulations.   After priming the circuit, instructors may give hints but will not give direct instructions to students on their actions.  Simulations will be as real-to-life as possible.  The entire group will debrief and identify lessons learned at the end of each category of simulations. 

Advanced Simulations Group C—Very Difficult

  • Recognizing complications associated with peripherally cannulated VA ECMO (LV distension) (Ch 12)
  1. o   180-minute simulation
  2. o   60-minute group debrief

08:00 – 12:00

 

240 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _High fidelity simulation

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _debriefing
LUNCH
12:00 – 13:00
60 minutes
 

Advanced Simulations Group D –Very Difficult (Ch 2)

  • Recognizing hypoxia secondary to ARDS
  • Describe the most appropriate therapy
  • Test students’ knowledge
  1. o   180-minute simulation
  2. o   50-minute group debrief

13:00 – 16:50

 

 

230 minutes

Teaching Methods:

Lecture

AV Support

Handout

Other:  _High fidelity simulation

 

Learner Engagement Strategies:

Q&A

Dialogue/discussion

Self-check/Reflection

Case studies/scenarios

Problem-based learning

Group project

Other: _debriefing