Who is truly qualified to be an ECMO SPECIALIST? The answer to that question seems to vary widely across the United States. Some believe ONLY perfusionists can really be the Specialist. Some believe Nurses and Respiratory Therapists might be trained to be technicians with Perfusion back up. Some believe Perfusion involvement isn’t a necessity.
There seems to be two primary camps. One camp has foundation in ELSO (ExtraCorporeal Life Support Organization) background where Nurses, Respiratory Therapists, and Perfusionists all have the same track to becoming an ECMO Specialist. And the second camp seems to be oblivious to the fact that Nurses and Respiratory Therapists have been providing high-quality ECMO support for over 30 years, sometimes with and sometimes without Perfusion support.
Historically, Nurses and Respiratory Therapists have been following ELSO Guidelines as far back as the early 1990s to provide high-quality ECMO support. My personal journey in the ECMO community started as a Respiratory Therapist back in the early ’90s. I worked in a RN/RRT ECMO program. It was and still is a well respected ECMO program with good patient outcomes. I continued my ECMO career at another ECMO program in Tennessee which was also an RN/RRT ECMO program. Also a very high-quality well-respected program. There are actually quite a few high-quality ECMO programs that operate without Perfusion involvement and have done so for many years.
Since starting ECMO Advantage in 2007, we have assisted many new ECMO programs start-up or realign to new equipment or different staffing models. We have utilized our RN/RRT ECMO Advantage Specialists to provide high-quality ECMO support to many patients with and without perfusion assistance. Some of our most successful high-quality ECMO program clients operate with RN/RRT ECMO Specialists with no involvement from perfusion.
So what really makes someone qualified to be an ECMO Specialist? I would argue, from experience, it’s not whether or not they have RN, RRT, or CCP behind their name. It’s whether or not they have been properly educated and trained to function in the role of ECMO Specialist. Over the last 12 years that ECMO Advantage has been training, educating, and working side by side with ECMO Specialists across the U.S., I would put some of the RN/RRT ECMO Specialists at the top of the list of highly qualified and skilled professionals supporting ECMO patients.
I might argue that the RN/RRT ECMO Specialist MIGHT even be the better candidate to provide the highest level of ECMO Specialist support. I have experienced the training process where Perfusionists, Nurses, and Respiratory Therapists can all be taught to function equally in the technical aspects of managing the ECMO circuit, equipment, and response to emergent procedures. But the advantage to the ECMO patient may actually fall on the side of the competently trained ECMO Specialist who also is a highly skilled and experienced ICU healthcare provider. The RN/RRT who has spent years working in the ICU caring for the critically ill patient may have a better understanding of the overall patient disease process as well as a better handle on the ICU environment in general.
The ECMO SPECIALIST should be a well trained, highly experienced RN, RRT, or CCP that has full command and understanding of not only the ECMO equipment, ECMO support processes, and emergent ECMO procedures (including how to AVOID the need for the emergent procedures), but should also understand the disease process, ICU care of that disease process, and how the ECMO support process can best be utilized to provide the most benefit to the patient. The ECMO SPECIALIST can provide the greatest ECMO Advantage if they are able to recognize how the ECMO support process impacts the ECMO patient as well as how the PATIENT and disease process impacts the ECMO system. Simply being an RN, RRT, or CCP does NOT automatically make you an ECMO SPECIALIST. All professions need to experience additional education and training to provide patients the greatest ECMO Advantage.
The following is a post from a few years ago discussing the difference between ECMO Specialist and ECMO tech.
ECMO tech vs ECMO Specialist…Does it really matter?
ECMO tech vs ECMO SPECIALIST…Does it really matter?
Let me answer that before you read on. YES!! It matters greatly!
ECMO Advantage has the opportunity to work with many institutions across the United States. We are also able to communicate and associate with other providers of extracorporeal support. One striking thing that I have noticed over the years is the wide range of expectations of the professional sitting behind the ECMO pump. These expectations range from simply having a bedside RN write down numbers and call someone if there is a problem…to a well trained, highly experienced ECMO Specialist (RN, RRT, or CCP) that has full command and understanding of not only the ECMO equipment, but also the disease process, ICU care of that disease process, and how the ECMO support process can best be utilized to provide the most benefit to the patient.
There are several ways to provide ECMO support and there are several devices and configurations of an ECMO system that can be used to support ECMO patients. There are many ways to manage the patient on ECMO. But I believe one aspect of quality care that is often overlooked is the ability of the ECMO Specialist to make all those things work together for the benefit of the patient. That is what we strive for at ECMO Advantage. All of our ECMO Specialists are RN’s, RRT’s, or CCP’s who have ICU backgrounds in addition to their many years as an ECMO Specialist. They all know what it’s like to provide long term care for a critically ill patient in the ICU. They understand the ICU environment and what is involved in the care of a patient on ECMO from the perspective of the ICU healthcare provider. In addition, they have full command and understanding of the ECMO process (that is not to say we are not all still learning!). The combined knowledge, skills, and experiences definitely provide an ECMO Advantage to the clients and patients we serve whether that be in the role of consultant, educator, preceptor, primer, coordinator, or the ECMO Specialist sitting at the pump.