Updated 26 June 2023
ECMO is extracorporeal membrane oxygenation, also known as ECLS (extracorporeal life support).
The Alfred ICU has provided ECMO care since 1990 and now provides ECMO support for more than 100 patients per year.
An ECMO Clinical Service, independent from Perfusion Services, was established in 2003 to improve ECMO delivery and bedside care. The philosophy of the ECMO Clinical Service is that ECMO is best provided as an integrated Intensive Care patient support modality. Training programs, competency maintenance, credentialing requirements, protocols, preventative strategies and consultative Perfusion Service input are components of our integrated ECMO Service. The ECMO service is actively involved in ongoing research as well. The development of this service has led to the Alfred ICU becoming, at that time, one of only five recipients of the ELSO Platinum level Centre of Excellence designation and the only such centre outside of the United States.
Alfred ICU ECMO Guidelines
ECMO.ICU – Alfred ICU ECMO guidelines available as a free-to-access website.
ECMO Education at the Alfred ICU
Twice a year, the Alfred ICU runs the Alfred ICU and Perfusion Adult ECMO Course as well as a Cannulation course, both of which are open to external participants.
Senior Registrars and Fellows at the Alfred ICU have the opportunity to complete the ‘Alfred ICU ECMO Certificate‘, which requires sufficient clinical exposure, attendance at didactic and simulation-based teaching sessions, contribution to the education programme and completion of the Alfred ICU and Perfusion Adult ECMO Course.
ECMO cases, issues and developments are discussed at the monthly ECMO Special Interest Group meeting and regular inter-professional, inter-departmental ECPR simulations are performed.
Introduction to ECMO for New ICU Staff
- Intro to ECMO for New ICU Staff by Ken Hoffman is the best place to start if you are new to ECMO. It includes for 4 short videos: Part 1 is on nomenclature and components of ECMO, Part 2 is on V-V (veno-venous) ECMO, Part 3 is on V-A (veno-arterial) ECMO and the final video, Part 4 addresses ECPR (ECMO-CPR during cardiac arrest).
ECMO on the INTENSIVE Podcast
The ‘Everything ECMO’ series
This is a developing series of peer-reviewed case-based Q&A blog posts published on INTENSIVE covering all aspects of ECMO management in critically ill patients.
- 001 — Persistent hypoxaemia on V-V ECMO
- 002 — V-V ECMO ventilation and weaning
- 003 — An ECMO earthquake? (access insufficiency)
- 004 — Why is the bag turning red? (haemolysis)
- 005 — Cardiac arrest on V-V ECMO
- 006 — Access insufficiency is just the beginning… (complications of VV ECMO and necrotizing pneumonia)
- 007 — What is different about hypoxia on V-A ECMO? (differential hypoxia aka Harlequin Syndrome)
- 008 — Weaning from V-A ECMO
- 009 — Differential hypoxia in reverse?! (pseudo-differential hypoxia and reverse differential hypoxia)
- 010 — Keep calm and cannulate! (ECMO cannulation)
- 011 — Go with the flow (High-flow V-V ECMO configuration)
- 012 — Turn and face the circuit… ch-ch-change it! (ECMO circuit change)
- 013 — Pump it! (Ventricular Assist Device (VAD) concepts)
- 014 — Not just little adults… ECMO and paediatric lung transplantation
- 015 — Cardiac arrest on ECMO… Does it still count? (ECMO cardiac arrest)
- 016 — Holy HITTS! (Oxygenator thrombosis, HITTS)
- 017 — ECMO Circuit Rupture!
- 018 — ECMO Cannula Rupture!
- 019 — Bad bubbles and V-V ECMO (Air embolus on V-V ECMO)
- 020 — “Pink fluid coming up the tube”.. ECMO, LV distention, and more! (left ventricular distention and acute pulmonary oedema)
- 021 — How to “Ace the Avalon”! (Dual Lumen Cannula for V-V ECMO)
- 022 — The V-A ECMO Ward Round
- 023 — The V-V ECMO Ward Round
- 024 — On the move: ECMO transport
- 025 — Staying Alive: Timing and Indications for ECPR
- 026 — Making ECPR happen
- 027 — Subclavian ECMO cannulation
- 028 — Not just heart and lungs: ECMO, kidneys, and renal replacement therapy
- 029 — Everything ECMO: Cannula and Cardiac Curveballs (hepatic vein positioning and tamponade)
- 030 — ‘sounds like ECMO trouble… (ECMO, echocardiography, and ultrasound)
- 031 — Saving life and limb: Distal perfusion cannula and V-A ECMO
- 032 — Flow, and where did the fibrin go? (anticoagulation, oxygenator thrombosis, and hyperfibrinolysis)
- 033 — Dying on ECMO – How do we care for the dying patient on mechanical support? (palliation)
- 034 — Understanding the Impella ella ella eh eh eh…… Part I!(Impella® principles, indications, insertion and positioning)
- 035 — Understanding the Impella ella ella eh eh eh…… Part II! (Impella® contraindications, anticoagulation management, complications and evidence)
- 036 — The History of ECMO (broad strokes history of ECMO starting with William Harvey!)
- 037 — ECMO and blood on the brain (intracranial haemorrhage and ECMO)
- 038 — Hyperoxia and VA-ECMO for cardiac arrest: is less, more?
- 039 — V-V ECMO: Who is it good for? (V-V ECMO indications, triggers, and patient selection)
- 040 — Oh no, low flow! (Low flow alarm)
- 041 — ECMO but no pulse (Loss of arterial pulsatility)
- 042 — What the SIG!? (SIG alarm)
- 043 — What to do when the SpO2 stays low on VV-ECMO? (Persistent and refractory hypoxaemia on VV-ECMO, Part 1)
- 044 — What to do when the SpO2 still stays low on VV-ECMO? (Persistent and refractory hypoxaemia on VV-ECMO, Part 2: recirculation, oxygenator failure)
- 045 — ECPella… what is it good for? (ECPella and left ventricular unloading)
ECPR on INTENSIVE
The Alfred ECMO Service is among the pioneers of ECPR. ECPR content on INTENSIVE includes:
Other ECMO resources
- A Primer on Priming the PLS circuit (video)
- Echo-guided bicaval dual lumen ECMO catheter insertion (Avalon Elite)
- ECMO in San Diego
- ECMO: What could go wrong? (podcast by Dr Deirdre Murphy)
- No mistakes with ECMO
- Quick tips from the Alfred ICU ECMO course
- Weaning VA ECMO on ECMO.org (podcast with Dr Deirdre Murphy)