HCSS Extracorporeal Membrane Oxygenation (ECMO) specialist/Perfusionist

Programmatic Responsibilities

• Collaborates with ECMO team leadership and contributes to education, training, precepting & mentoring of all ES I & II team members.
• Aids leadership with equipment maintenance, cleaning & troubleshooting of ECMO, MCS & ECMO monitoring equipment.
• Ensures backup ECMO circuit is primed & ready for use each shift.

Technical Specialist Responsibilities

• Patient Identification: Collaborates with multidisciplinary physician teams to identify patients indicated for ECLS or MCS therapies and in concordance with ECMO physician care team to adhere to indications and contraindications as found in program guidelines and policies.
• Initiation of Support: Coordinates & collaborates with multidisciplinary care team to prepare patient and environment for the timely and safe initiation of ECLS or MCS support.
• Patient Management & Monitoring on Support: Assess and manage patient clinical needs, including but not limited to patient assessment, hemodynamic monitoring, NIRS, blood gas interpretation, laboratory results, fluid balance, nutrition, respiratory support, neurologic status, infection control, sedation, pain management, hematology, and cardiac function.
• Documentation: In collaboration with bedside clinician, follows department guidelines for EMR documentation. Utilizes the ECMO flow sheet & EMR to maintain ongoing detailed documentation of the ECMO case. This includes hourly charting in flowsheet, progress & procedure notes, events, complications, physician communication, input & output, medication, blood administration & physical assessment documentation associated with monitoring the delivery of ECMO therapy.
• Evaluation of Chest X-Rays: Evaluates chest x-rays for endotracheal tube, ECMO cannula, or MCS device position & placement.

Extracorporeal VAD Management

• Assist the physician during insertion of extracorporeal VAD devices; manage and troubleshoot equipment issues such as pump failures or circuit occlusions; monitor and optimize patient hemodynamics (e.g., flow rates, pressure support) and anticoagulation strategies to prevent thrombosis or bleeding; coordinate discontinuation and removal processes, ensuring safe weaning and device explanation.

Percutaneously Inserted VAD Management

• Assist the physician during percutaneous insertion; manage and troubleshoot device-specific issues like position migration or suction events; assess patient hemodynamics and anticoagulation protocols; oversee discontinuation, including safe removal and post-removal monitoring.

Implanted VAD Management

• Assist the physician & VAD coordinator during surgical implantation; manage and troubleshoot equipment such as driveline issues or pump thrombosis; evaluate and fine-tune patient hemodynamics and long-term anticoagulation strategies; facilitate discontinuation through explanation or transition to other therapies, following the guidance of the VAD coordinator.

ECLS Circuit Priming and Initiation

• Prepare and prime ECLS circuits, including pumps, oxygenators, heat exchangers, shunt lines and associated components, ensuring sterility and functionality prior to patient connection.

ECLS Circuit Blood Priming

• Safely blood primes ECMO circuits for patients as indicated by department guidelines, policies or as requested by cannulating ECMO physician.

ECMO Circuit Maintenance

• Continuously monitor and maintain ECMO circuit integrity, including adjusting blood flow rates, monitoring pressure gradients, to prevent complications like hemolysis or clot formation.

ECMO Circuit Evaluation

• Using in-line tools and blood gas analyses to calculate metrics such as oxygen consumption (VO2), oxygen delivery (DO2), oxygen transfer rate, recirculation & sweep gas adjustment rate.

ECMO Circuit Troubleshooting

• Identify and resolve issues such as circuit leaks, component failures, or suboptimal performance, including elective or emergent component changes when indicated.

Anticoagulation Management on ECMO

• Maintain competency in strategies to anticoagulate, buffer, correct electrolytes, wash, hemoconcentrate & interpret ECMO circuit blood gases.

Cytokine and Inflammatory Marker Removal

• Safely crystalloid prime & insert cytokine absorbers into the ECMO circuit for removal of cytokines, endotoxins, and inflammatory markers as ordered by ECMO physician; monitor adsorption efficiency, absorber performance, and patient inflammatory biomarkers; manage and troubleshoot blood flow rate, adsorber saturation & circuit integration issues.

Medication Administration to ECMO Circuit

• Following physician guidance and orders, administer patient-required medications directly into the ECMO circuit, collaborate with ECMO physician and reports concerning circuit sequestration & drug efficacy. Maintains up to date knowledge & understanding of the pharmacokinetic effects of all drugs and treatments given to the patient via the ECMO circuit.

Emergency Responses

• Master the necessary skills with repeated clinical drills until meeting the ECMO director, manager, and/or coordinators’ expected time and best practice goals in response to ECMO emergencies. These guidelines & goals are set to minimize loss of flow & reduce risk of secondary harm that may occur during the interruption of extracorporeal life support therapy.