The curriculum is designed to flex to the needs of each fellow. An example curriculum with objectives is included below.
Objectives to Master and Functions to Execute
Be familiar with the indications for, as well as, benefits and risks of ECMO for various physiologic indications.
- Respiratory ECMO
- Post-cardiotomy ECMO
- ECMO for refractory shock
Perform consultations in the ICU to help determine the appropriate candidacy of patients for ECMO therapy.
- VV ECMO candidates
- VA ECMO candidates
Round on cannulated ECMO and VAD patients in all critical care units.
Be capable of constructing and priming an ECMO circuit.
- Understand tubing size selection
- Be familiar with the different types of oxygenators available
- Be able to choose an appropriate cannula size for a given patient
- Dual-lumen cannula
- Single-lumen cannula
- Be familiar with both the standard ECMO circuit and the transport ECMO circuit.
Understand the anticoagulation strategies for patients requiring ECMO.
- Be able to initiate and manage anticoagulation for patients on ECMO.
- Understand coagulation assays used for patients on ECMO.
- Become familiar with special situations that may require changes in anticoagulation management (e.g., surgery, bleeding, thrombosis, DIC, elevations in plasma-free Hgb, etc.).
- Have the opportunity to work closely with the transfusion medicine team.
Acquire the ability to cannulate patients onto VV ECMO with a dual-lumen cannula using ultrasound and fluoroscopy guidance.
- To be done in conjunction with pediatric surgery.
Understand and be able to construct, prime and initiate ultrafiltration and/or dialysis via the ECMO circuit.
- Basic ultrafiltration
- Dialysis using the ECMO circuit
- CRRT in tandem with ECMO
Become familiar with ECMO transport
- Manage patients during transport.
- Be capable of cannulating a patient at an outside institution.
Create practice guidelines to assist with management of ECMO patients at Texas Children's Hospital.
Complete project/manuscript related to ECMO by the end of instructor year.
Become involved in simulation.
- Help run ECMO simulation scenarios for Fellows and Advanced Practice Providers.
- Attend Lectures for ECMO orientation sessions.
- Help create additional scenarios for senior fellows and junior faculty.
- Will help give lectures for ECMO RN group.
Take ownership of the consult log, keep it updated and follow up on curbside consults.
Be a member of the ECMO journal club and present at least one article every 6 months..
Lead Thursday ECMO/VAD meetings.
- Running the list of current patients on mechanical devices.
- Help maintain didactic schedule and speakers each week.
- Present 5-6 topics during the year (One per month).
Attend high-impact national ECMO meetings to gain insight into current trends and future directions of mechanical support (e.g., ELSO international or regional (Euro oro LATAM) meeting, Keystone or SCCM).
Expected Rotations and Time Allotment
PICU Service Attending (8 weeks)
ECMO Call (24 weeks)
- Will be on-call with the ECMO attending 24/7 during 2 month critical care blocks except for designated vacation time.
- Will be on all ECMO transport..
- Will attend ECMO rounds in all units as able (PICU, CICU, NICU)
CVOR Perfusionist (1 week)
- Will spend 1 week in the CV OR shadowing perfusion teams/ sit pump with the perfusionists and log hours/patients.
Transfusion Medicine (1 week)
- Will spend 1 weeks with blood bank team performing consults, rounding on patients and listening to didactic lectures given.
Interventional Cardiology (1 week)
Echocardiography (1 week)
Renal-CRRT/TPE/MARS (4 weeks)
Round with adult ECMO program(s) in Texas Medical Center (up to 8 weeks).
- Collaborating Hospitals: Houston Methodist Hospital, St. Luke’s Texas Heart Institute
Round with Ethics Team (1-2 weeks)
Vacation (4 weeks)
Total Weeks: 52 weeks