52 C. Nemeh et al.: J Extra Corpor Technol 2026, 58, 51--56
Abbreviations
ECMO ICU AV VIPER ECPR ELSO
Introduction
Extracorporeal membrane oxygenation Intensive care unit Arteriovenous Variable Input Patient Electronic Records Extracorporeal cardiopulmonary resuscitation Extracorporeal Life Support Organization
Pediatric ECMO is challenging and requires extensive resources and trained professionals for optimal safety and efficacy [ 1, 2 ]. In many pediatric ECMO centers, ECMO specialists with extensive training provide the day-to-day monitoring of ECMO patients and are typically staffed at the bedside of each ECMO patient [ 3 ]. Most ECMO specialists are respiratory therapists or nurses who have completed additional ECMO training and are stationed at the bedside to monitor ECMO patients in a 1:1 ratio [ 3, 4 ]. The practice variability of ECMO monitoring and staffing across pediatric centers is mainly due to resource utilization and availability of personnel. Although perfusionists are advanced practitioners with ECMO experience, most centers use trained ECMO specialists due to multiple factors, including potentially reducing costs, perfusionist shortage, and greater availability and flexibility of nurses and respiratory therapists [ 3, 4 ]. We use remote monitoring for ECMO patients, which is a novel concept that has been described with adequate response time to troubleshoot circuitry issues in adults [ 5, 6 ]. The goal of our staffing model is to develop an effective and safe system for monitoring ECMO patients that uses hospital resources, technology, education, and personnel to its advantage [ 3, 4 ]. We present a bedside model of ECMO staffing that leverages the combination of expertise by perfusionists and advanced technology to remotely monitor multiple pediatric ECMO patients simultaneously.
Materials and methods
Our institution is a pediatric quaternary care high-volume ECMO center in an urban environment. There are, on average, 48 pediatric ECMO cannulations per year since this model was implemented. Our staffing model uses one perfusionist per 12-hour shift to monitor all ECMO patients on a single floor( Figure 1). In our model, there are 12 perfusionists who cover ECMO. ECMO care is provided in three intensive care units( ICUs)-- a pediatric cardiac ICU( 14 beds), a neonatal cardiac ICU( 17 beds), and a pediatric med / surg ICU( 13 beds), which are all located on the same floor. ECMO cannulation may occur in various areas across our hospital due to the availability of mobile ECMO carts. Cannulations are performed by pediatric cardiothoracic surgeons or pediatric general surgeons. If a patient is cannulated outside of the three ECMO ICUs, they are moved to one of the three ECMO units and monitored by a bedside perfusionist for the first 24 h post-cannulation, followed by remote monitoring and an hourly rounding model by the perfusionist team.
All neonatal and pediatric ECMO patients are supported using the Cardiohelp System TM and either an HLS 5.0 disposable and 1 / 4 00 AV loop with a shunt in order to meet the minimum flow rate through the oxygenator or an HLS 7.0 disposable and 3 / 8 00 AV loop. The Cardiohelp HLS system is manufactured by Getinge USA Sales, LLC, located at 1 Geoffrey Way, Wayne, NJ 07470, USA. Of note, the 1 / 4 00 AV loop circuits allow for a manifold to assist with access, especially for neonates. Each ECMO circuit is connected to a Spectrum Medical Quantum Elite Workstation, which uses Variable Input Patient Electronic Records( VIPER) software and Livevue( Spectrum Medical’ s web-based near real-time remote access tool) that remotely delivers ECMO circuit parameters [ 6 ]. The Quantum Elite Workstation with VIPER software and Livevue is manufactured by Spectrum Medical, whose USA headquarters are located at 481 Munn Road, Suite 180, Fort Mill, SC 29715, USA. The workstation integrates parameters directly from the Cardiohelp System TM, such as revolutions per minute, circuit pressures, and temperature, while directly measuring parameters such as flows, saturations, PaO2, and PCO2. The workstation also integrates with the Phillips Intellivue monitor to access patient parameters such as temperatures, blood pressures, pulse oximeter readings, and near-infrared tissue saturations. These variables are sent to a hospital-based server where they can be accessed for remote viewing facilitated by VIPER and LiveVue. Patients’ vital signs, ECMO circuit parameters, and alarms are remotely monitored using Philips Ó technology and Livevue, which delivers critical notifications to a computer screen in the perfusionists’ workroom and their mobile devices via push notifications. LiveVue pulls its information from the Spectrum Medical monitoring system, whose data comes from a variety of probes on the ECMO circuit.
The perfusionist rounds hourly on each circuit, performs a checklist of tasks, and is readily available to troubleshoot and assist in patient-related tasks( i. e., daily rounding, patient turning, physical therapy, etc.). The checklists broadly include, but are not limited to verification of patient, medical record number, evaluating the pump, zeroing the pump, alarm parameters set, hand crank being available, electrical connections being intact, pump tubing with no kinks and banded where appropriate, checking for clots and air in tubing, oxygenator evaluation with packing intact and no defects, gas being on, bubble detector being operational, and shunt closed( if applicable), cleaning all touch and control surfaces, ECMO settings verified( sweep, flow, etc.), VIPER alarms set appropriately, temperature alarms, and handoff updated.
Pediatric ECMO fellows are available 24 / 7 and are the first contact for ECMO consults, standbys, and extracorporeal cardiopulmonary resuscitation( ECPR). ECPR simulations are performed bimonthly, consisting of all the multidisciplinary teams involved during a live cannulation. ECPR simulations are immediately followed by a debriefing session that enhances collaboration among all the participants during cannulation.
A designated ECMO program coordinator provides training to the frontline ICU nurses through ECMO simulations, didactic education days, and workshops. The ECMO program coordinator at our institution is a nurse practitioner. A one-time ECMO didactics course is required for all ICU nurses who work on the ECMO floors. Didactics consist of lectures,