Extracorporeal membrane oxygenation (ECMO) specialists perform a unique life support role in critical care medicine. While a patient’s body works to mend injuries or recover from a life-threatening infection, ECMO technology takes over the person's heart and lung functions. ECMO specialists come from a variety of medical professions that require years of education and experience and form the foundation for successful ECMO treatments.
What Is ECMO?
ECMO is life support technology that performs lung and heart functions for critically ill or injured patients. In hospital intensive care units (ICUs), medical staff use ECMO machines in the most severe life support cases, which can include near-fatal heart attacks, severe lung infections or trauma that limits heart and pulmonary function. At times, medical personnel use the technology to help keep organ transplant patients alive until their new organs arrive.
In most cases, medical staff employ ECMO technology for short periods – hours or days – but some patients require weeks of ECMO treatment. The ICU staff often turns to ECMO when a patient’s lungs cannot produce an adequate amount of oxygen, even with traditional oxygen administration. In other cases, a patient might need ECMO when a ventilator machine cannot adequately process carbon dioxide from the lungs. Likewise, a patient whose heart cannot adequately pump blood through the entire body might need ECMO.
About ECMO Machines
Essentially, an ECMO machine is a portable cart, with heart, lung and monitoring equipment attached to it. ECMO specialists connect the patient to the ECMO machine through plastic tubes inserted into arteries and veins in the chest, legs and neck.
The machine assumes the function of the lungs by pumping the patient’s blood through an oxygenator, which filters out carbon dioxide from the blood while adding oxygen to it. The machine’s pump emulates the heart by pumping the blood back into the patient at the same force and rhythm as a human heart would. ECMO specialists can fine-tune the machine’s functions to work in conjunction with a patient’s partially functioning heart and lungs.
The ECMO machine does not provide long-term life support. It functions as temporary life support while the medical team works to heal the patient’s underlying health issues. For example, a patient with a severe lung infection might need ECMO support until antibiotics reduce the infection. A heart transplant patient might need ECMO support for a few hours while a new heart is in transit from the donor site to the hospital in which the transplant will take place.
Who Are ECMO Specialists?
The ECMO specialty is a skill set that works in conjunction with another medical field. ECMO specialists work in teams within an ICU, under the supervision of a physician. Many ECMO specialists are registered nurses, who have several years of ICU experience. Other team members may include respiratory therapists and clinical perfusionists, also called cardiopulmonary bypass doctors. ECMO treatments require this complex combination of medical professionals, because a single patient may suffer from a range of issues, including cardiovascular, respiratory and ambulatory problems. Physicians such as cardiologists, pulmonologists and pathologists often work in ECMO teams to monitor a patient’s condition or respond to medical complications.
Prerequisite Education, Certification, Licensing
The term “ECMO specialist” refers to a specialty within critical care medicine. Before you can obtain ECMO specialist training, you must attain the requisite education and certification or licensing to become one of the health care professionals that make up an ECMO team. Types of ECMO specialists include registered nurses, physicians, perfusionists and respiratory therapists.
To become a registered nurse, you must earn an associate’s degree in nursing (ADN) or a bachelor of science degree in nursing (BSN). ADN courses typically take two to three years to complete, while BSN programs take four years. Typically, nursing programs include coursework in chemistry, anatomy, microbiology, psychology and nutrition, along with clinical exercises. Once you graduate, you must pass the National Council Licensure Examination, administered by the National Council of State Boards of Nursing, before you can practice nursing. Some states and employers also require nurses to pass a background check as part of the licensing or employment processes.
To work as a respiratory therapist, you must earn an associate’s degree in respiratory therapy from a community college or technical school. Some colleges and universities offer bachelor degree programs in respiratory therapy. Respiratory therapy programs often include coursework in pharmacology, physiology, physics, chemistry and microbiology. Most states require respiratory therapists to obtain a license before they can begin their practice.
Physicians must earn a bachelor’s degree and then complete medical school, which typically takes at least eight years. After graduating from medical school, a physician must complete a residency or internship, usually at a hospital or private practice, which takes three to seven years. Upon completing the internship or residency, physicians must obtain a medical license before they can practice. Medical school programs include coursework in pharmacology, anatomy, medical ethics, biochemistry and psychology, along with laboratory exercises.
Many perfusionist programs are post-baccalaureate courses. Most perfusionist programs require prerequisite coursework in subjects such as anatomy, biology, chemistry, physics and physiology. Typically, perfusionist courses take 12 to 18 months to complete and include up to 60 hours per week of classroom study and hands-on exercises. Most states require perfusionists to obtain a certification or license before they can practice.
ECMO Training Programs
ECMO training focuses on the operation of ECMO machinery, testing procedures that must accompany ECMO treatments and complications that can occur during such treatments. ECMO trainees must have a solid educational and experiential background in their given fields.
ECMO training varies and can range from a three-day course to extensive on-the-job training. For example, the University of Virginia Health System provides on-the-job ECMO specialist training, which takes several months to complete and includes classroom and practical coursework.
To join the Vanderbilt University Medical Center’s ECMO team, you first must work for at least two years in a critical care environment. Qualified candidates receive in-house training.
Thomas Jefferson University offers an intensive three-day ECMO specialist course that focuses on hands-on training on the ECMO machine. At the time of this writing, the course costs around $2,600.
Extensive ECMO training involves classroom study and practical exercises. ECMO coursework can include topics such as monitoring oxygen supply, anticoagulation and blood products.
ECMO Specialist Duties and Responsibilities
ECMO training prepares trainees for the unique duties and responsibilities of working as an ECMO specialist in their given fields.
Patients connected to ECMO machines require constant care; their oxygen levels, heart rate and blood pressure need frequent monitoring. ECMO specialists frequently test the patient’s blood to evaluate carbon dioxide and oxygen levels, referred to as blood gases. The results of these tests can help the team determine the viability of the ECMO treatment and inform them on how to adjust the functions of the ECMO machine.
Bleeding, stroke, leg damage, infection and kidney failure are common medical complications that can arise when a patient is connected to an ECMO machine. Bleeding in the lungs, stomach or brain can result from the use of blood-thinning drugs, which are required for ECMO treatment. ECMO specialists must monitor the patient’s blood tests to determine if bleeding has occurred, which could require surgery or a transfusion to boost platelets.
While connected to the ECMO machine, blood clots can form, and these can reduce blood flow to certain areas of the brain, leading to a stroke. ECMO specialists must evaluate blood tests to determine if the patient needs additional blood-thinning medication to prevent a stroke.
When a patient is connect to the ECMO machine via a tube inserted into a leg artery, the ECMO specialist must monitor the blood flow to the leg. If circulation in the leg does not provide adequate blood flow, it could lead to permanent tissue damage. When the leg shows signs of poor circulation, the ECMO team must decide how to connect the patient to the machine using an artery in a different part of the body. Preventing leg damage is critical, because poor circulation can lead to tissue loss, which can require amputation.
ECMO specialists must frequently monitor the patient for signs of infection, a complication that can arise from germs entering the bloodstream through the ECMO tubes or at insertion points. When infection occurs, specialists must administer antibiotics.
If the patient’s kidneys do not receive enough blood during the ECMO treatment, they might stop functioning. When kidney failure occurs, the ECMO team must connect the patient to a dialysis machine, which artificially performs kidney functions.
Nursing, Respiratory Therapy, Physician and Perfusionist Careers
The U.S. Bureau of Labor Statistics (BLS) offers general information about registered nurses, respiratory therapists, perfusionists and physicians – common ECMO team members – but does not provide specific pay or job outlook information for professionals within these fields who serve as ECMO specialists.
Registered nurses provide direct care to patients. They administer treatments and medications, maintain patients’ medical records, assist with diagnostic tests, collaborate with physicians about patients’ conditions and help educate patients and their families about medical conditions and treatments. Critical care nurses work in hospital ICUs, caring for patients with severe injuries or illnesses.
In 2017, registered nurses earned a median salary of around $70,000, according to the BLS. A median income is the wage at the center of an occupation’s pay scale. Registered nurses at the top of the pay scale made more than $100,000 during the same period.
Jobs for registered nurses should increase by around 15 percent through 2026.
Respiratory therapists treat patients who suffer from lung conditions and diseases such as emphysema and asthma. They conduct diagnostic tests, devise treatment plans and administer treatments. Respiratory therapists working in ICUs often must connect critically ill patients to ventilators and monitor their oxygen rate.
According to a BLS survey, respiratory therapists earned a median income of around $60,000 in 2017, with top earners taking home more than $83,000.
The BLS projects the need for respiratory therapists to increase by about 23 percent from now until 2026.
Physicians diagnose illnesses and injuries and devise treatment plans to help patients overcome their medical conditions. They prescribe medications, order diagnostic tests, analyze test results and advise patients on ways to improve their health. Cardiologists specialize in conditions that affect the heart. Pathologists specialize in medical issues related to body tissues, while pulmonologists focus on illnesses and conditions that affect the lungs.
According to the BLS, in 2017 physicians earned a median income of more than $200,000.
Job opportunities for physicians should increase by around 13 percent through 2026.
Perfusionists operate heart-lung equipment during open-heart surgery. During surgery, the perfusionist administers a drug that stops the heart, while the heart-lung machine assumes the responsibilities of the natural organs. Throughout the procedure, the perfusionist must monitor the heart-lung machine to assess the patient’s blood oxygen and carbon dioxide levels, as well as the blood pressure and blood flow.
In 2015, experienced perfusionists earned an average income of nearly $130,000, according to a Trident Health Resources study. Survey participants had an average of nearly 20 years of perfusion experience.