HCSS Extracorporeal Membrane Oxygenation (ECMO) RN

JOB SUMMARY:

The ECMO Specialist (ES) is a licensed allied health care professional with a strong clinical background in neonatal, pediatric and/or adult critical care and advanced cardiopulmonary support. The ES has ≥ 2 years ICU experience or completion of an accredited cardiovascular perfusion training program. The ES is responsible for the coordination of clinical care for patients requiring the support of extracorporeal life support (ECLS) & mechanical circulatory support (MCS) devices under the direction & supervision of credentialed ECMO and advanced heart failure physicians. The ES has successfully completed advanced training to operate ECLS & MCS devices, in accordance with guidelines established by the Extracorporeal Life Support Organization (ELSO) & the American Society of ExtraCorporeal Technology (AmSECT). The ES adheres to the policies, guidelines & best practices set forth by the director, manager & coordinator of the ECMO department. The ES plays a key role in device management, patient monitoring, emergency response, and quality improvement initiatives.

Clinical Level Detail

The ECMO Specialist (ES) is a competent technical specialist, preceptor & ECMO primer. The ES is a proficient clinician in two high acuity clinical environments where care of an ECLS or MCS patient is provided (2 ICU's or Any ICU + OR, CVL, Transport etc.) & in two patient populations (Adult, Pediatric &/or Neonatal).

Clinical Level Minimal Experience

The required experience to qualify as an ES is ≥ 2 years’ experience as an ES; or completion of an accredited program in cardiovascular perfusion, advanced practice registered nurse, physician assistant or medical school. Completed the annually required ELSO & AmSECT based didactic education, hands on drills, simulations & passed annual competency examination(s) for an ES. Completed clinical ECMO orientations in two patient populations (Adult, Pediatric &/or Neonatal).

Clinical Level Responsibilities

The ES is trained to independently prime, operate, troubleshoot & manage ECLS & MCS devices. The ES can independently initiate support & manage advanced ECLS & MCS care plans. The ES can independently troubleshoot clinical scenarios. The ES is trained to independently manage ECLS & MCS emergencies and coordinate the allied health care team to implement major interventions. The ES is a clinical preceptor and resource for level I & II specialists. The ES has an increased responsibility for departmental needs & will assist leadership to train ES I & II specialists, balance staffing gaps, cover primer call, collect patient data & assist with supply management tasks.

MAJOR DUTIES / CRITICAL TASKS:

Communication

·       Participates in monthly interdisciplinary ECMO case reviews and in-services to share information and determine appropriateness of patient care plans.

·       Supports ECMO team research through the collection of ECMO-related data, preparation, and presentation of research abstracts and/or other documentation.

·       Utilizes the ECMO flow sheet to maintain ongoing complete and detailed documentation of patient history and the amount of blood and other fluids administered and any complications that may occur.

·       Provides family/parental education and reinforces medical counseling initiated by the ECMO physician.

·       Provides a clear and concise end of shift report for the oncoming ECMO Specialist regarding machine settings, patient status, and patient care plans.

Emergency Responses

The ECMO Specialist will master the necessary skills with repeated clinical drills until meeting the ECMO director, manager, and/or coordinators’ expected time and best practice goals to minimize interruption of therapy, follow guidelines and prevent any secondary patient injuries for all circuit emergencies, including but not limited to:

·       Power or Equipment Failure: Respond to ECMO circuit power or equipment failures by activating backup systems and hand-cranking if necessary, ensuring minimal interruption of continuous therapy.

·       Air Entrainment: Detect and eliminate air bubbles in the circuit using bubble detectors and de-airing techniques.

·       Cannula Dislodgement: Stabilize and reposition dislodged cannulas, coordinating with the team for immediate surgical intervention while maintaining patency of functioning cannula.

·       Patient Bleeding or Hypotension: Manage acute bleeding or hypotensive episodes by adjusting flow rates, administering fluids or blood products, and optimizing anticoagulation strategies.

·       Advanced Life Support (ACLS, PALS, BLS): Collaborate with the multidisciplinary team to stabilize hemodynamics of the patient and adjust ACLS & PALS algorithm to augment the support capabilities of the current ECLS or MCS strategy.

·       Circuit Exchange: Triage the need for planned or emergent circuit exchange and coordinate with the allied health care team safely complete a full circuit exchange

·       Blood Pump Failures: Rapidly triage and differentiate blood pump failures (clotted cone, decoupling) and address the failed and address blood pump failures by replacing the failed blood pump

·       Circuit Tubing Fracture or Rupture: Respond to circuit tubing fractures or ruptures by clamping affected sections, replacing tubing, and restoring circuit integrity to prevent blood loss or air entry, following ELSO circuit management and AmSECT

safety standards.

·       Circuit Tubing Kinks or Occlusions: Detect and correct circuit tubing kinks or occlusions by repositioning tubing or replacing segments, restoring optimal flow, as per ELSO bedside troubleshooting and AmSECT perfusion guidelines. 9 13 16

·       Oxygenator Failure: Manage oxygenator failure by monitoring gas exchange metrics (e.g., rising pressure drops or poor oxygenation), triaging for immediate replacement, and executing change-out procedures to maintain support, aligned with ELSO circuit guidelines and AmSECT standards. 1 9 12

·       Heat Exchanger Failure: Address heat exchanger failure by assessing temperature control issues, isolating the component, and replacing it to prevent thermal dysregulation, following ELSO and AmSECT equipment management protocols. 1 12

·       Blood Path Circuit Component Failure and Replacement: Triage blood path circuit component failures (e.g., filters, connectors), determining emergency versus planned replacement strategies, and performing replacements to sustain circuit function, per ELSO and AmSECT guidelines. 1 12 20

·       Equipment Failure Related to Any Device Connected to the ECMO Circuit: Respond to failures in connected equipment (e.g., monitors, heaters) by isolating the issue, activating backups, and coordinating repairs or replacements, ensuring patient safety as outlined in ELSO and AmSECT standards. 1 5 20 26

·       Circuit Clot Emergency Removal Techniques: Apply emergency clot removal techniques when flow through cannulas, pump, or oxygenator is compromised. Whether through aspiration, component replacement, or emergent surgical intervention.

·       Cannula Dislodgment, Malpositioning, or Impedance of Flow: Manage cannula dislodgment, malpositioning, or flow impedance by using techniques to identify the failing cannula, isolate if necessary and preserve patency of the remaining functional cannula. Coordinating patient stabilization, positioning and/or emergent surgical intervention.

·       Triaging Need to Initiate Emergency Hand Cranking: Triage the need for

emergency hand cranking, coordinating with the allied health care team to maintain goal-directed flow, and replacing failed motor, cables, or ECMO system components, ensuring minimal interruption of support.