HCSS Extracorporeal Membrane Oxygenation (ECMO) specialist/Perfusionist

University of Texas Medical Branch•Galveston, TX

77d•$100

About The Position

The ECMO Specialist (ES) is a licensed allied health care professional with a strong clinical background in neonatal, pediatric and/or adult critical care and advanced cardiopulmonary support. The ES has ≥ 2 years ICU experience or completion of an accredited cardiovascular perfusion training program. The ES is responsible for the coordination of clinical care for patients requiring the support of extracorporeal life support (ECLS) & mechanical circulatory support (MCS) devices under the direction & supervision of credentialed ECMO and advanced heart failure physicians. The ES adheres to the policies, guidelines & best practices set forth by the director, manager & coordinator of the ECMO department. The ES plays a key role in device management, patient monitoring, emergency response, and quality improvement initiatives. Clinical Level Detail The ECMO Specialist (ES) is a competent technical specialist, preceptor & ECMO primer. The ES is a proficient clinician in two high acuity clinical environments where care of an ECLS or MCS patient is provided (2 ICU's or Any ICU + OR, CVL, Transport etc.) & in two patient populations (Adult, Pediatric &/or Neonatal). Clinical Level Minimal Experience The required experience to qualify as an ES is ≥ 2 years' experience as an ES; or completion of an accredited program in cardiovascular perfusion, nursing, or respiratory therapy. Completed annual required hands-on drills, simulations & passed annual competency examination(s) for an ES. Completed clinical ECMO orientations in two patient populations (Adult, Pediatric &/or Neonatal). Clinical Level Responsibilities The ES is trained to independently prime, operate, troubleshoot & manage ECLS & MCS devices. The ES can independently initiate support & manage advanced ECLS & MCS care plans. The ES can independently troubleshoot clinical scenarios. The ES is trained to independently manage ECLS & MCS emergencies and coordinate the allied health care team to implement major interventions. The ES is a clinical preceptor and resource for level I & II specialists.

Requirements

Licensed as Certified Clinical Perfusionist (CCP) as recognized by the American Board of Cardiovascular Perfusion (ABCP) and State of Texas Licensure as a Licensed Perfusionist
Two (2) years directly related critical care experience in adult or neonatal and/or pediatric care including patient assessment, technical skills, and psychosocial aspects of care.
Must have current BLS obtained through American Heart Association (AHA).
Satisfactory maintenance of clinical competencies: Attendance to quarterly water drills
Satisfactory completion of the annual ECMO didactic program, satisfactory score of 90% and above on annual ECMO exam
Satisfactory completion of required special procedure classes (e.g. blood administration)
Knowledge regarding quality improvement and standards of care within practice area
Experience teaching patients and families
Excellent communication skills
Knowledge of and ability to evaluate and assess arterial blood gas measurements.
Ability to respond to emergent or stressful situations appropriately, calmly, and in a timely manner
Will respond to ECMO activation within 45-60 minutes
Ability to lift up to 50 pounds maximum with frequent lifting/and or carrying objects weighing up to 25 pounds.

Nice To Haves

Graduate of Perfusion Program Preferred Baccalaureate degree and certification in care specific area

Responsibilities

Collaborates with ECMO team leadership and contributes to education, training, precepting & mentoring of all ES I & II team members.
Assists leadership with equipment maintenance, cleaning & troubleshooting of ECMO, MCS & ECMO monitoring equipment. Ensures backup ECMO circuit is primed & ready for use each shift.
Collaborates with multidisciplinary physician teams to identify patients indicated for ECLS or MCS therapies and in concordance with ECMO physician guides care team to adhere to indications and contraindications as found in program guidelines and policies.
Coordinates & collaborates with multidisciplinary care team to prepare patient and environment for the timely and safe initiation of ECLS or MCS support.
Assess and manage patient clinical needs, including but not limited to patient assessment, hemodynamic monitoring, NIRS, blood gas interpretation, laboratory results, fluid balance, nutrition, respiratory support, neurologic status, infection control, sedation, pain management, hematology, and cardiac function.
In collaboration with bedside clinician, follows department guidelines for EMR documentation. Utilizes the ECMO flow sheet & EMR to maintain ongoing detailed documentation of the ECMO case. This includes hourly charting in flowsheet, progress & procedure notes, events, complications, physician communication, input & output, medication, blood administration & physical assessment documentation associated with monitoring the delivery of ECMO therapy.
Coordinates with care team to ensure safe execution and delivery of diagnostic testing such as x-ray, ultrasound, echocardiography, EEG including safe and timely transportation to CT, invasive lab or operating room. Evaluates chest x-rays for endotracheal tube, ECMO cannula, or MCS device
Assist the physician during insertion of extracorporeal VAD devices; manage and troubleshoot equipment issues such as pump failures or circuit occlusions; monitor and optimize patient hemodynamics (e.g., flow rates, pressure support) and anticoagulation strategies to prevent thrombosis or bleeding; coordinate discontinuation and removal processes, ensuring safe weaning and device explanation.
Assist the physician during percutaneous insertion; manage and troubleshoot device-specific issues like position migration or suction events; assess patient hemodynamics and anticoagulation protocols; oversee discontinuation, including safe removal and post-removal monitoring.
Assist the physician & VAD coordinator during surgical implantation; manage and troubleshoot equipment such as driveline issues or pump thrombosis; evaluate and fine-tune patient hemodynamics and long-term anticoagulation strategies; facilitate discontinuation through explanation or transition to other therapies, following the guidance of the VAD coordinator.
Prepare and prime ECLS circuits, including pumps, oxygenators, heat exchangers, shunt lines and associated components, ensuring sterility and functionality prior to patient connection.
Safely blood primes ECMO circuits for patients as indicated by department guidelines, policies or as requested by cannulating ECMO physician. Maintains competency in strategies to anticoagulate, buffer, correct electrolytes, wash, hemoconcentrate & interpret ECMO circuit blood gases.
Continuously monitor and maintain ECMO circuit
Using in-line tools and blood gas analyses to calculate metrics such as oxygen consumption (VO2), oxygen delivery (DO2), oxygen transfer rate, recirculation & sweep gas adjustment rate.
Identify and resolve issues such as circuit leaks, component failures, or suboptimal performance, including elective or emergent component changes when indicated.
Monitor and adjust anticoagulation levels to balance the risk of circuit thrombosis and patient hemostasis.
Evaluate clot formation through staging (e.g., visual inspection, pressure monitoring), triage severity, and recommend anticoagulation adjustments to mitigate risks of major patient events such as embolism or circuit failure.
Assist in setup of continuous veno-venous hemodiafiltration (CVVHD) or hemodialysis devices integrated into the ECMO circuit; monitor therapy parameters including dialysate flow, ultrafiltration rates, electrolyte balance, and fluid removal; manage ongoing therapy by adjusting settings for optimal clearance and patient stability; troubleshoot issues such as filter clotting, pressure alarms, or access problems, following hospital guidelines for renal replacement therapy in ECMO patients.
Safely crystalloid prime & insert hemofilter into the ECMO circuit shunt line. Implement slow continuous ultrafiltration (SCUF), zero-balance ultrafiltration (ZBUF), or countercurrent hemodialysis (CVVHD) using the ECMO circuit hemoconcentrator. Monitor & document fluid input & output, ultrafiltration volumes, patient hemodynamics, and electrolyte shifts; manage and troubleshoot blood & ultrafiltration flow rates, circuit integration issues and replace or remove hemoconcentrator as indicated.
Safely crystalloid prime & insert cytokine absorbers into the ECMO circuit for removal of cytokines, endotoxins,
Following physician guidance and orders, administer patient-required medications directly into the ECMO circuit, collaborate with ECMO physician and reports concerning circuit sequestration & drug efficacy. Maintains up to date knowledge & understanding of the
Following physician guidance & orders, administer blood products (e.g., packed red blood cells, platelets, fresh frozen plasma, cryoprecipitate) via the ECMO circuit to maintain target blood count parameters and physician guided platelet & coagulation cascade functionality; monitor transfusion effects on circuit function and patient hemostasis; troubleshoot & monitor for transfusion-related complications & reactions.
Manage all ECMO circuit flows. Follow guidelines to set alarms, interpret changes in pressures, communicate concerns with ECMO physician & care team, coordinate appropriate interventions to resolve deviations greater than 10% from physician-ordered patient flow.
Interpret and troubleshoot ECMO system alarms, triaging the need for planned, staged or emergency interventions. Communicate with care team and ECMO leadership to implement component, circuit or equipment exchanges in a safe and timely manner.
Address alarms from any device connected to the ECMO circuit, triaging the need for
Safely lead and coordinate inter-facility and intra-facility ECMO transport. Ensure safe patient handling, circuit integrity, ECMO equipment functionality and ordered ECMO flows are maintained.
Assess patient readiness for weaning & follow guidelines & physician orders to safely wean ECMO flow (V-A/V-PA) or sweep gas (V-V). Coordinate patient care team to safely transition patient off ECMO and ensuring vent settings are no longer in "ECMO rest settings" and inotropic support is available. Assist ECMO physician in decannulation procedure. Compassionately support family and coordinate with ECMO physician and care team to withdraw ECMO when end of life measures are ordered.
Ensure equipment is connected to generator backed red outlet. If power failure is extended ensure backup equipment is readily available to swap consoles prior to battery depletion.
Triage the need for emergency hand cranking, coordinating with the allied health care team to start emergency ventilation & patient management strategies. Hand crank to maintain goal-directed flow using visual indicators of RPM's and patient vital signs. Coordinate the replacement of failed ECMO system components.
Rapidly triage and differentiate blood pump failures (clotted cone, decoupling), mitigate loss of flow possible, clamp circuit if not and safely & rapidly replace failed blood pump or circuit.
Detect and eliminate air bubbles in the circuit using bubble detectors and de-airing techniques, clamp ECMO circuit, isolate patient from air embolism, remove air from circuit and re-establish flow. Replace entire circuit if unable to clear air from a mass air entrainment. Investigate and identify the cause of air entrainment and resolve prior to initiating flow to the patient & through the circuit.
If an ECMO cannula dislodges, clamp dislodged cannula, coordinating with the care team & ECMO physician for immediate
Manage cannula malpositioning or flow impedance by interpreting circuit pressures to identify the cannula with increased impedance. Reposition patient or attempt to correct cannula malpositioning to re-establish goal flow. If impedance is unresolvable, contact cannulating physician. Coordinating patient stabilization, positioning and diagnostic imaging to further investigate impedance. Prepare for surgical interventions, mechanical thrombectomy, or cannula exchange if indicated.
Manage acute or uncontrolled bleeding by administering fluids or blood products to ECMO circuit to maintain goal flow and stopping anticoagulation. Assist care team by utilizing ECMO circuit as a method of rapid & mass transfusion.
Collaborate with the multidisciplinary team to stabilize hemodynamics of the patient and adjust ACLS & PALS algorithm to augment the support capabilities of the current ECLS or MCS strategy.
Triage the need for planned or emergent circuit exchange and coordinate with the allied health care team safely complete a full circuit exchange if indicated.
Respond to circuit
Detect and correct obstruction of flow by evaluating circuit pressures, identifying problem location and visually inspecting for kinks, clamps or thrombus. Repositioning tubing, components, holders & brackets to restore optimal flow. If obstruction is unresolvable due to internal
Manage oxygenator failure by monitoring blood flow & gas exchange metrics (e.g., rising pressure drops or reduced oxygenation and/or ventilation), triaging for immediate or planned replacement & coordinating oxygenator or circuit change-out procedure with care team.