Position Paper on Global Extracorporeal Membrane Oxygenation Education and Educational Agenda for the Future: A Statement From the Extracorporeal Life Support Organization ECMOed Taskforce*

Abstract

Objectives: The purpose of this position paper is two-fold: first, to describe the state of extracorporeal membrane oxygenation education worldwide, noting current limitations and challenges; and second, to put forth an educational agenda regarding opportunities for an international collaborative approach toward standardization. Design: Relevant medical literature was reviewed through literature search, and materials from national organizations were accessed through the Internet. Taskforce members generated a consensus statement using an iterative consensus process through teleconferences and electronic communication. Setting: In 2018, the Extracorporeal Life Support Organization convened the ECMOed Taskforce at two structured, face-to-face meetings of 40 healthcare practitioners and educators with expertise in caring for the extracorporeal membrane oxygenation patient and in extracorporeal membrane oxygenation education. Patients: None. Interventions: None. Measurements and Main Results: The ECMOed Taskforce identified seven educational domains that would benefit from international collaborative efforts. Of primary importance, the Taskforce outlined actionable items regarding 1) the creation of a standardized extracorporeal membrane oxygenation curriculum; 2) defining criteria for an extracorporeal membrane oxygenation course as a vehicle for delivering the curriculum; 3) outlining a mechanism for evaluating the quality of educational offerings; 4) utilizing validated assessment tools in the development of extracorporeal membrane oxygenation practitioner certification; and 5) promoting high-quality educational research to guide ongoing educational and competency assessment development. Conclusions: Significant variability and limitations in global extracorporeal membrane oxygenation education exist. In this position paper, we outline a road map for standardizing international extracorporeal membrane oxygenation education and practitioner certification. Ongoing high-quality educational research is needed to evaluate the impact of these initiatives.

Development and Evaluation of An Abbreviated Extracorporeal Membrane Oxygenation (ECMO) Course for Nonsurgical Physicians and Nurses

“…Expansion of ECMO training may increase the use of this lifesaving intervention; however, current ECMO training programs are limited, frequently require travel of 3 to 5 days in duration, and can be cost-prohibitive. 13,14 Within the U.S. military, some casualties have died while awaiting the arrival of the military ECMO team. 10 Expansion of this skill via an abbreviated ECMO training course may provide this lifesaving intervention to a greater number of patients in need of immediate therapy due to active or impending cardiac arrest.…”

“…Even fewer medical systems have the ability to provide immediate ECMO to prehospital, emergency department (ED), and intensive care unit cardiac arrest patients. Expansion of ECMO training may increase the use of this lifesaving intervention; however, current ECMO training programs are limited, frequently require travel of 3 to 5 days in duration, and can be cost‐prohibitive 13,14 . Within the U.S. military, some casualties have died while awaiting the arrival of the military ECMO team 10 .…”

Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

“…This outbreak is occurring at a time when worldwide ECMO infrastructure and resources for education 9 and research 10 are considerably more evolved and organised than they were a decade ago. Most importantly, there is now substantially more evidence to support the efficacy and safety of ECMO in patients with ARDS than during previous outbreaks.…”

Nursing care for patients with COVID-19 on extracorporeal membrane oxygenation (ECMO) support

“…The effectiveness of ECMO as a therapy for COVID-19 has not yet been established, but there are reports of it saving lives in severe cases (5)(6)(7), and emergency guidelines have been promulgated (8,9). Treatment of respiratory failure via ECMO requires specialized knowledge and training for not only doctors but also nurses, clinical engineers, and several other staff members (10,11). ECMO is known to improve the prognosis for patients in facilities that have used it in more cases (4); this therapy requires considerable experience and skill on the part of the medical team administering it.…”