C. Nemeh et al.: J Extra Corpor Technol 2026, 58, 51--56 55
specific tasks when a real ECPR occurs. Debriefings occur immediately after the session, and the goal is to familiarize the team with CPR, ECMO cannulation, and the associated problems that may arise before, during, and immediately after cannulation. ECMO education is invaluable to ensuring that staff are prepared to deal with common and rare complications that can occur during an ECMO run, which is essential in our model’ s efficiency and safety [ 2, 12, 15, 16 ].
Technology
Our technology allows ECMO circuit parameters and alarms to be sent to a workroom and mobile devices. This allows perfusionists to monitor multiple ECMO patients simultaneously. The perfusionist can set desired ranges such that if a circuit parameter falls out of range, the system will notify the perfusionist via the monitor connected to LiveVue and their mobile devices [ 6 ]. The LiveVue system is fully customizable, so perfusionists can input different parameters from the circuit and lab parameters. Having all ECMO patients on the same floor allows for a quick response time by the perfusionist to troubleshoot alarms and emergencies as they arise. We exclusively use the Cardiohelp System TM for neonatal and pediatric ECMO, which simplifies circuit components and allows for the ease of delivery of circuit parameters. VIPER records ECMO circuit parameters, enabling the perfusionist to track and identify changes when troubleshooting issues with the ECMO circuit. The VIPER system utilizes formulas and algorithms, referred to as clinical guidance, that can be customized by the ECMO team to identify specific issues and alert personnel. Examples in our practice, which combine inputs from several different systems, are recirculation on venovenous ECMO and poor distal perfusion during femoral venoarterial ECMO with distal perfusion catheters. Perfusionists are automatically alerted to the presence potential issues based on changes in the measured parameters. Automating these notifications helps to improve the consistency of care between perfusionists aiding in the ability to monitor several simultaneous ECMO patients.
Conclusions
Pediatric ECMO staffing requires multidisciplinary care to ensure patient safety and optimal outcomes. We describe an ECMO staffing model with perfusionists, in contrast to ECMO specialists who are typically used in high-volume pediatric ECMO centers. Our model involves remotely monitoring pediatric ECMO patients with one pediatric perfusionist per 12-hour shift, even when multiple patients are simultaneously on ECMO. All ECMO units are on the same floor, which allows our perfusionists to cover multiple patients simultaneously and quickly respond to issues when they arise. Our duration of ECMO with multiple patients cannulated significantly exceeds the duration of solo runs. This, combined with the low incidence of adverse events, demonstrated by having comparable numbers to ELSO rates, suggests this model’ s potential safety even with multiple patients on ECMO. Our staffing model has several factors that enable it to work efficiently, including an ECMO program coordinator, integrated technology for alerting perfusionists, and frequent ECMO education and simulation for all participating providers.
Funding The authors received no funding to complete this research.
Conflicts of interest The authors declare no conflict of interest.
Data availability statement
All data obtained are included in the manuscript, and further information is available on request.
Author contribution statement
Christopher Nemeh: Concept / design, data collection, data analysis / interpretation, drafting article, critical revision of article.
Caitlin Cain-Trivette: Concept / design, data analysis / interpretation, drafting article, critical revision of article.
Nicholas Schmoke: Concept / design, data analysis / interpretation, drafting article, critical revision of article.
Caleb Varner: Concept / design, data collection, data analysis / interpretation, drafting article, critical revision of article, approval of article.
Michael Brewer: Concept / design, data collection, data analysis / interpretation, critical revision of article, approval of article.
Eunice Clark: Data collection, data analysis / interpretation, critical revision of article.
Holly Ream: Data collection, data analysis / interpretation, critical revision of article.
Diana Vargas Chaves: Concept / design, data analysis / interpretation, approval of article.
Tarif Choudhury: Concept / design, data analysis / interpretation, approval of article.
Steven Stylianos: Concept / design, data analysis / interpretation, critical revision of article, approval of article.
William Middlesworth: Concept / design, data analysis / interpretation, critical revision of article, approval of article.
Eva W. Cheung: Concept / design, data collection, data analysis / interpretation, critical revision of article, approval of article.
Ethics approval
IRB approval was obtained for the study from Columbia University AAAR0525.
References
1. Hamilton M, Thornton SW, Tracy ET, Ozment C. Quality improvement strategies in pediatric ECMO. Semin Pediatr Surg. 2023; 32( 4): 151337.
2. Johnston L, Williams SB, Ades A. Education for ECMO providers: Using education science to bridge the gap between clinical and educational expertise. Semin Perinatol. 2018; 42( 2): 138--146.
3. Mongero LB, Beck JR, Charette KA. Managing the extracorporeal membrane oxygenation( ECMO) circuit integrity and safety utilizing the perfusionist as the“ ECMO Specialist”. Perfusion 2013; 28( 6): 552--554.