Course Content
Module 1: Basic ECMO
Module I: Extracorporeal Membrane Oxygenation Basics (ECMO Basics) This module covers the foundational knowledge of ECMO, including circuit physiology, components, and basic ECMO management. Duration: 3 Weeks (Course weeks 1 to 3) Week 1: Introduction to ECMO Week 2: ECMO Physiology & Circuit Management Week 3: ECMO Complications and Troubleshooting Module I Pretest: 30 MCQs
0/20
Handbook Module 1
Module 1 Pre test
Week 1 – Lecture A – Overview of ECMO Therapy, History of ECMO, and The Evidence behind ECMO (Dr. Giles Peek)
35:21
Week 1- Lecture B – Indications, and Basic Configurations of ECMO (Dr. Ahmed Hegazy)
39:31
Week 1 – Lecture C – ECMO Circuit Components: cannulas, tubing, pump, membrane oxygenator, pressure/flow monitors, and other additional components (Ahmed Hegazy)
26:29
Week 1 – Lecture D – Physiotherapy and Ambulation on ECMO Mr. Aaron Trush
36:31
Webinar 1 Records
02:15:27
Week 2 – Lecture A – ECMO physiology including oxygenation and CO2 removal – Dr Ahmed El Masry
48:26
Week 2 – B. Anticoagulation Management in ECMO Patients (Ryan Rivosecchi)
43:48
Week 2 – Lecture C – Pharmacodynamics and pharmacokinetics of sedatives and antimicrobials on ECMO ( Safa Al Marzooq)
31:47
Week 2 – Lecture D – Outcomes of VA & VV ECMO (Dr Amr Hashim)
26:51
Webinar 2 Records
57:00
Week 3 – Lecture A – ECMO Complications- Bleeding, thrombosis, hemolysis, and neurologic complications (Akram Zaaqoq) Mod
40:11
Week 3 – Lecture B – Troubleshooting ECMO Part I_ Drainage insufficiency, pump failure, and oxygenator failure (Ahmed Hegazy) Mod
36:59
Week 3 – Lecture C – Troubleshooting ECMO Part II/ Circuit disruption, air embolism and accidental decannulation (Ahmed El Masry)
28:34
Week 3 – Leture D – Management of cardiac arrest on VV ECMO (Ahmed Magdy)
26:36
Webinar 3A Records- Dr Maria De Piero
41:39
Webinar 3B Records- Dr Amr Hashem
32:48
Module 1 Post test
MODULE 1 Post Test Answer Key
Module II: Veno-venous Extracorporeal Membrane Oxygenation (VV ECMO)
This module focuses on the use of VV ECMO in patients with respiratory failure. Topics include ARDS management, VV ECMO cannulation strategies, and VV ECMO troubleshooting. Duration: 3 Weeks (Course weeks 4 to 6) Module II Pretest: 30 MCQs Week 4: VV ECMO Fundamentals Start Date: July 20, 2025 a. Respiratory failure and ARDS management (Ahmed Magdey) b. Evidence for VV ECMO use and landmark trials (Hesham Faisal) c. VV ECMO cannulation techniques and pros and cons of different VV ECMO configuration choices (Moustafa Esam) d. ECMO Retrieval and Patient Transport on ECMO (Ahmed Labib)
0/22
Handbook Module II
Module 2 Pre test
Week 4 – Lecture A – Respiratory failure and ARDS management. (Ahmed Magdy)
32:00
Week 4- Lecture B – Evidence for VV ECMO use and landmark trials. (Hesham Faisal)
36:53
Week 4 – Lecture C – VV ECMO cannulation techniques and pros and cons of different VV ECMO configuration choices. (Mostafa Esam)
28:16
Week 4 – Lecture D1 – Week 4 – D. ECMO Retrieval and Patient Transport on ECMO. (Ahmed Labib)
20:06
Week 4 – D2 – ECMO Retrieval Human Factors (Ahmed Labib).mp4
26:11
Webinar 4 Records
01:17:51
Week 5 – Lecture – A – Monitoring patients on VV ECMO. (Alyaa Al Hazmi)
17:36
Week 5 – Lecture B – Determinants of oxygenation on VV ECMO (Dr Ahmed Hegazy)
38:51
Week 5 – Lecture – C – Extracorporeal CO2 removal. (Mostafa Esam)
33:38
Week 5 – Lecture – D – Antithrombotic in ECMO and Impella. (Ryan Risovecci)
45:49
Week 5 – Lecture E – Mechanical ventilation goals on VV ECMO. (Abdel Hameed Abdel Haleem)
54:11
Webinar 5 Records
01:28:23
Week 6 – A – VV ECMO for ARDS in the setting of hematopoietic stem-cell transplant. (Dr Maria De Peiro)
34:20
Week 6 – Lecture B – ARDS in HIV Patients and VV ECMO Considerations Dr Mohamed Hussein Ahmed
25:30
Week 6 – Lecture C – Prone positioning on VV ECMO. (Akram Zaaqoq)
16:03
Week 6 – D – Weaning VV ECMO. (Hesham Faisal)
41:04
Week 6 – E – VV ECMO as a bridge to transplant or long-term support. (Ahmed Rabie)
32:01
Webinar 6 Records
58:44
Module 2 Post test
Module II Post Test Answer Key
Module III: Veno-arterial Extracorporeal Membrane Oxygenation (VA ECMO)
This module focuses on VA ECMO for cardiogenic shock, including cannulation strategies, LV unloading, and advanced applications. Duration: 3 Weeks (Course weeks 7 to 9) Module II Pretest: 30 MCQs
0/19
Handbook Module III
Module 3 Pre Test
Week 7 – Lecture A – Cardiogenic shock overview: Pathophysiology, Classifications, Initial Management Steps, and Prognosis. (Hussam Ghalib)
22:47
Week 7- B – Short-term mechanical circulatory support in cardiogenic shock. Dr Babar Basir
41:52
Week 7 – Lecture C – Postcardiotomy shock: Peripheral versus Central VA ECMO cannulation. (Ahmed Hegazy)
45:09
Week 7 – Lecture D – PVA ECMO for Adult Congenital Heart Disease (Amr Hashem)
21:04
Webinar 7 Records
01:12:11
Week 8 – Lecture A – Monitoring patients on VA ECMO. (Amr Hashem)
30:57
Week 8 – Lecure B – Anticoagulation targets and heparin-induced thrombocytopenia (HIT) Dr Ahmed Zaki
22:20
Week 8 – Lecture C – Complications- Limb ischemia, differential hypoxia, LV distention (Ahmed Hegazy)
43:06
Week 8 – Lecture D – D. Weaning from VA ECMO. (Aws Alherbish)
31:08
Webinar 8 Records
01:41:20
WEEK 9 – A – VA ECMO for sepsis-induced cardiomyopathy and trauma patients. (Ahmed Labib)
26:23
Week 9 – Lecture B – B. ECMO in pregnancy and peripartum cardiomyopathy. (Hesham Faisal)
33:10
Week 9 – Lecture C – Extracorporeal cardiopulmonary resuscitation (ECPR). (Kumait Al Lawati)
35:05
Week 9 – Lecture D – Death by neurologic criteria (DNC) on VA ECMO. (Akram Zaaqoq)
00:00
Webinar 9 Records
50:26
Module 3 Post Test
03-MODULE 3 Post Test with Answer Key
Module IV: Mechanical Circulatory Support (MCS)
This module focuses on short-term MCS devices, including IABP, Impella, and RVADs, and their role in cardiogenic shock. In addition, acute post-implant care of the durable LVAD patient is discussed. Duration: 3 Weeks (Course weeks 10 to 12)
0/15
Module 4 PRE test
Week 10 – A – Cardiogenic shock: Presentation, monitoring, and management. (Aws Alherbish)
39:22
Week 10 – Lecture B – Intra-aortic balloon pump (IABP): Indications, insertion, and complications. (Ahmed Hegazy)
46:51
Week 10 – Lecture C – Micro-axial flow pumps (Impella): Indications and troubleshooting. (Hussam Ghalib)
33:15
Webinar 10 Records
01:29:04
Week 11 – A
Week 11 – B – Durable LVADs_ Acute post-implant care. (Ahmed Hegazy)
57:29
Week 11 – C – Team-based care: Cardiogenic shock (CS) teams and Pulmonary Embolism Response Teams. (Ahmed El-Masry)
29:06
Webinar 11 Records
50:38
Week 12 – Lecture A – The role of echocardiography in MCS patients. (Hatem Soliman)
31:06
Week 12 – Lecture B
Week 12 – Lecture C – Future therapeutic uses of nitric oxide in Extra Corporeal Membrane Oxygenation (Prof Giles Peek)
16:33
Week 12 – Lecture D – Future directions in ECMO. (Prof. Giles Peek)
19:37
Webinar 12 Records
01:32:12
Module 4 POST test
Extra Corporeal Membrane Oxygenation (ECMO) and Mechanical Circulatory Support (MCS) course (Copy 4)

 

Breaking the Clot: Can eNO Protect the ECMO Circuit? — Summary

1. Introduction

  • Focus: Relationship between coagulation, inflammation, and the potential of nitric oxide (NO) in ECMO sweep gas to reduce both.

  • Context: ECMO circuit safety, anticoagulation evolution, and the role of team-based care.

2. Historical Background

  • Pioneers:

    • Early ECMO developments by Ted Cobo and Warren Zapol.

    • First successful ECMO case (1971) demonstrated importance of managing anticoagulation and bleeding.

  • Evolution of Oxygenators:

    • Transition from solid silicon to polymethyl pentene (PMP) membranes enabled coating and reduced surface area.

  • Anticoagulants:

    • Shift from unfractionated heparin to low molecular weight heparin and direct thrombin inhibitors (bivalirudin).

    • Persistent clot formation despite anticoagulation highlights ongoing challenges.

3. Nitric Oxide and Platelet Interaction

  • Role of NO:

    • Naturally reduces platelet activation at vascular endothelium.

    • Easily administered through ECMO sweep gas.

  • Clinical Interest:

    • NO may mitigate inflammation and clotting within ECMO circuits.

    • Early clinical experiences demonstrate safety, though efficacy remains uncertain.

4. Research and Trials

  • Retrospective Studies:

    • Early pediatric experience with NO in sweep gas showed safety but no clear efficacy.

  • NECTAR Trial:

    • Randomized, single-center study using 20 ppm NO.

    • Demonstrated feasibility and safety but limited by small sample size and heterogeneous patient population.

    • No differences in survival or methemoglobinemia; reduced blood product usage noted.

  • Ongoing Questions:

    • Optimal dosing and delivery method remain undefined.

    • Potential differential effect with direct thrombin inhibitors versus heparin.

5. Case Example — “Aubrey”

  • Clinical Story:

    • Infant with RSV pneumonia and MRSA infection managed on prolonged ECMO (234 days).

    • Supported with bivalirudin and 20 ppm NO in sweep gas.

    • Oxygenator remained clot-free after five months of use.

    • Full recovery, decannulation, and discharge after 301 hospital days.

  • Implications:

    • NO may prolong membrane life and exert anti-inflammatory effects aiding recovery.

6. Conclusion

  • Key Points:

    • eNO in sweep gas is safe and feasible in ECMO.

    • Evidence for efficacy remains limited but promising.

    • May reduce clot formation and inflammation, extending membrane life.

    • Further studies needed to determine optimal dosing, patient selection, and mechanisms.

 

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