Foundation Course in ECLS/ECMO

Pathway directors:

• Daniel DE BACKER MD, PHD Head of Intensive Care and Emergency Departments, CHIREC Hospitals, Belgium, Professor of Intensive Care Medicine, Université Libre de Bruxelles, Brussels, Belgium
• Leen VERCAEMST RN, ECCP, University Hospital Leuven, Belgium, EBCP-EuroELSO Liaison, Member of the EBCP Scientific Committee & EuroELSO Steering Committee

Directors:

• Lisa CARSON-PRICE BSc Senior Clinical Perfusionist, UHL NHS Trust, Nottinghamshire, United Kingdom; Scientific Committee, EuroELSO
• Jordi RIERA MD PhD Critical Care Department, Adult ECMO program Director,Vall d’Hebron University Hospital, Barcelona, Spain. EuroELSO Steering Committee, ELSO Scientific Oversight Committee

By the end of this course the participant will be able to:

• What is ECMO/ECLS – Historical growth
• Define what is ECLS/ECMO
• Describe the different modes of ECMO support
• List the key milestones in the development of ECMO
• Define and briefly describe the different types of ECLS; based on support mode (cardiac &/or respiratory support) or canulation site (VV/VA/AV)
• Describe the ECMO results and growth
• Describe the value of ELSO and an international ELSO Data Registry
• The ECMO circuit
• Describe the main components and composition of an ECMO circuit
• Explain the physics and working principles of a centrifugal pump
• Explain the features and working principles of the membrane lung, heater and gas blender
• Explain how to prepare an ECMO circuit for ECMO initiation
• Describe the ECMO circuit monitoring (pressures, flow, rpms, O2 saturations, bubbles) and rationale for this
• Touch on component complications (clinical case)
• Canulation for adult cardiac & respiratory ECMO
• Describe the differences in ECMO canula design
• Explain the considerations in selecting a specific ECMO cannula design
• Explain the choice of canulation site and site of blood drainage/return for VA and VV ECMO
• Describe the different techniques used for canula placement and rationale for the choice of technique
• Explain complications of ECMO cannulation
• Explain optional canulation sites in ECMO supported patients (limb perfusion, direct LV vent)
• Anticoagulation on ECMO
• Explain the need for anticoagulation in ECMO supported patients
• Explain the choices of anticoagulation drugs for patients on ECMO
• Explain the different modes of anticoagulation monitoring for patients on ECMO
• Explain the difficult balance between bleeding and clotting, and the possible ways to keep an optimal balance
• Describe the most common causes of clotting and bleeding complications, and how to prevent or detect
• Discuss thrombotic complications after ECMO explant
• ECMO for adult respiratory failure
• Explain the normal physiology of O2 uptake and delivery
• Provide an overview of respiratory failure
• Explain the rationale for ECMO support in adults with respiratory failure– what to expect from VV ECMO
• List the most important indications/contraindications for ECMO in adult respiratory failure and the outcome
• Describe how ECMO support can compensate for the failing lungs and allow them to recover
• Explain the determinants of oxygenation during ECMO (role of ratio ECMOBF/CO)
• Describe the management of patients on ECMO, including lung protective ventilation, hemodynamic management, sedation, fluid management, infection control
• Describe some typical VV ECMO related phenomena:
  • Recirculation; causes, how to detect and to solve
• Describe how to assess wearability and how to wean a patient from VV ECMO
• ECMO for adult cardiac failure
• Provide an overview of cardiac failure
• Explain the rationale for ECMO support in adults with cardiac failure – what to expect from VA ECMO
• List the most important indications for ECMO in adult cardiac failure and their outcome
• Describe the effects of VA ECMO on left and right ventricles
• Describe how ECMO support can compensate for the failing heart and allow the heart to recover
• Describe the management of patients on ECMO, including LV unloading, hemodynamic & ventilation management, sedation, fluid management, infection control
• Describe some typical VA ECMO related phenomena:
  • Harlequin syndrome; causes, how to detect and to solve
  • Left ventricular distention; causes, how to detect and prevent
• Describe how to assess weanability and how to wean a patient from VA ECMO

Clinical case session will be based on the content of the given talks related to the clinical case. It is the goal for the participant to recognize phenomena and direct the therapy into the optimal direction

• What is ECMO/ECLS?
• Historical growth
• The ECMO circuit
• Canulation for adult cardiac & respiratory ECMO
• Anticoagulation on ECMO
• ECMO for Adult Respiratory Failure
• ECMO for Adult Cardiac Failure

A total of 5 fellowships will be conducted in centres around Europe, giving fellows the opportunity to experience ECLS/ECMO in real-life settings and learn directly from experts. Fellowship-related costs (accommodation and travel) up to 1000 EUR/fellow will be reimbursed by ESICM.

Eligibility for fellowships:

• Must be a member of the ESICM (so join us now if not already a member!)
• Must attend at least 2 levels of the ECLS/ECMO pathway within 1 year
• Fellowships will be awarded on basis of attendance at the course and highest performance in the post-course evaluation.

Fellowship centre and mentor:

• Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom – Nicholas BARRETT and the local team (February 24-28, 2025)

Note! Priority will be given to those participants who haven’t benefitted from a fellowship on this topic before.

• Physicians involved or interested in ECMO
• Perfusionists and Nurses involved in ECMO or interested in respiratory vs circulatory support

IMPORTANT! A total of 10 places will be offered for FREE to participants coming from Low and Middle-Income Countries (LMIC), as per the World Bank classification. If you are interested to apply for an LMIC place, send us your letter of interest and CV to education@esicm.org. Applicants from LMIC may be selected for a maximum of 3 ESICM eCourses for FREE every year. Applicants who have participated in 1 eCourse as a free LMIC applicant need to have an active ESICM membership for the current year before applying again. 

Applications close 1 month before the Live Event.

An application will be made to the UEMS EACCME® for CME accreditation of this event.

The second edition of this educational collaboration with EuroELSO provided basic training in extracorporeal techniques to 83 participants from 20 countries by leveraging 2D Virtual Reality and other interactive formats! Here’s what participants liked most about it:

• Great speakers with a huge experience to share.
• It was very interactive and the clinical cases were very interesting and useful for clinical practitioners.
• Completeness! Every aspect has been addressed in detail.
• Interaction with experts and among themselves. Getting to know the practice around the world.
• High-quality slide presentations.

We are proud of this joint educational action with EuroELSO, which provided specialised training in extracorporeal techniques to 101 participants from 29 countries by leveraging 2D Virtual Reality and other interactive formats! See what participants liked most about the first edition of this innovative e-Master Class:

• Terrific two days. Wonderful interaction. See you in Madrid and/or London!
• This masterclass should be mandatory for everyone, who takes care ECMO patients, holistic, it was awesome.
• Thanks a lot for sharing knowledge and experience. Looking forward to seeing you in London!
• I am very glad to learn so much from such a great team. I am already enrolled in the hands-on workshop in Madrid next May. Thank you so much!
• Thank you all for this spectacular course