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)

Anticoagulation Management in ECMO Patients (Ryan Rivosecchi)

 

ECMO Anticoagulation Strategies and Monitoring

Ryan discussed the use of anticoagulation and extracorporeal life support, focusing on experiences at UPMC. He outlined three main learning objectives: evaluating anticoagulation strategies for ECMO, discussing monitoring strategies, and justifying anticoagulation recommendations based on literature. Ryan emphasized the balance between bleeding and thrombotic complications in ECMO circuits, noting that despite best practices, over 50% of patients experience at least one major bleeding event while on ECMO.

ECMO Anticoagulation Management Challenges

Ryan discussed the challenges and considerations in managing anticoagulation for ECMO patients, highlighting the lack of strong evidence in current guidelines. He explained the pros and cons of unfractionated heparin and direct thrombin inhibitors, including their pharmacokinetics, potential side effects, and cost implications. Ryan also compared bivalirudin and argatroban, noting their differences in metabolism, dosing, and concerns about stagnant blood in ECMO circuits. He concluded by emphasizing the need for standardized anticoagulation targets and monitoring methods, while acknowledging the limitations of current studies due to small sample sizes and varying patient populations.

Anti-Xa Monitoring Shows Better Outcomes

Ryan presented data comparing different anticoagulation strategies, highlighting that an anti-ten A monitoring protocol had a significantly lower rate of patients being over-anticoagulated compared to an Aptt-driven protocol. He noted a shift in clinical practice from using unfractionated heparin with Aptt monitoring to using bivalirudin with anti-ten A monitoring, which UPMC implemented in 2017 based on its reduced risk of heparin-induced thrombocytopenia and more predictable kinetics.

Bivalirudin Superiority in ECMO Patients

Ryan discussed the reasons behind the switch to bivalirudin in ECMO patients, highlighting the lack of standardization in protocols, small patient populations, and equipment changes over time. He presented the results of two UPMC studies comparing bivalirudin to unfractionated heparin in VV and VA ECMO patients. The studies, which included larger, more homogeneous patient populations, showed that bivalirudin was associated with a lower risk of in-circuit thrombosis and similar bleeding rates compared to heparin. Ryan concluded that bivalirudin is a superior anticoagulant for ECMO patients, with the benefits becoming apparent as early as 2-3 days after initiation.

Bivalirudin Benefits in ECMO Patients

Ryan presented data comparing bivalirudin and unfractionated heparin in ECMO patients, showing bivalirudin was associated with less bleeding and lower mortality. A study by Sealehammer from the Mayo group confirmed these findings, with a significant reduction in mortality (odds ratio 0.39) and lower circuit intervention rates in adult patients receiving bivalirudin. When combining multiple studies, including their own manuscript, the meta-analysis showed a consistent 10% decrease in mortality with bivalirudin compared to heparin.

Challenges in ECMO Study Design

Ryan discussed the challenges of using mortality as an endpoint in ECMO studies, noting that while it is the most reliable measure, larger sample sizes are needed. He highlighted that the Eolia study, which enrolled 250 patients over 5 years, was still below the calculated sample size of 500 patients for an 80% powered study. Ryan also explored potential mechanisms behind the observed differences in outcomes, including improved anticoagulant effects and better therapeutic ranges due to more reliable PKPD profiles. He concluded by noting the lack of consensus on optimal anticoagulation goals and the ongoing enrollment in two clinical trials.

Optimizing ECMO Anticoagulation Strategies

Ryan presented a detailed analysis of anticoagulation strategies in ECMO patients, focusing on a 2021 systematic review and a 2022 study by Shah and colleagues. He discussed the limited data on truly anticoagulation-free ECMO runs and the risks of bleeding and thrombotic events. The review found that anticoagulation-free ECMO was associated with a 30% bleed rate and a 23% thrombotic event rate. The 2022 study compared different anticoagulation levels in VV ECMO patients, finding that lower anticoagulation goals were associated with lower bleeding and thrombotic events. Ryan concluded that targeting lower anticoagulation levels might be beneficial, but more research is needed to determine the optimal balance between bleeding and thrombotic risks.

ECMO Anticoagulation Management Recommendations

Ryan presented his recommendations on anticoagulation management for ECMO patients. He concluded that bivalirudin is at least as safe and efficacious as unfractionated heparin, and is now used as the primary anticoagulant at his institution. Ryan also introduced a “start low and go slow” approach with a PTT goal of 61-75 for both VV and VA ECMO patients. He mentioned a new low-dose protocol for VV patients with a PTT goal of 40-60, which has shown positive results in initial trials. Ryan emphasized the importance of individualizing anticoagulation management based on each patient’s specific needs and circumstances.

Bivalirudin Use in Cardiac Surgery

Ryan presented a talk on the use of bivalirudin as an anticoagulant in his center, highlighting its cost-effectiveness and potential to reduce blood product usage. Walid expressed surprise at the limited use of routine anticoagulation methods in Ryan’s center and discussed the slow adoption of new practices in medicine. They agreed that while bivalirudin is promising, more randomized controlled trials are needed for wider acceptance. Ryan mentioned that his center now uses bivalirudin for most impella patients to avoid heparin products.
Previous
Next
Saving Lives Academy
Powered by  GDPR Cookie Compliance
Privacy Overview

This website uses cookies so that we can provide you with the best user experience possible. Cookie information is stored in your browser and performs functions such as recognising you when you return to our website and helping our team to understand which sections of the website you find most interesting and useful.