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)

 Evidence Behind VV ECMO

Historical Evolution

  • 1970s–1990s: Early use, poor outcomes, limited support

  • 2009 CESAR Trial: Demonstrated ECMO benefit in specialized centers

  • 2018 EOLIA Trial: Confirmed ECMO improves survival in severe ARDS despite crossover limitations

  • COVID-19 era: Registry data validated ECMO outcomes in high-volume centers

Landmark Studies

CESAR Trial

  • Randomized trial (UK, 2001–2006), 180 patients

  • Outcome: ECMO in a specialized center reduced death/severe disability

  • Key insight: Referral to high-volume ECMO centers improves outcomes

Australian H1N1 Study

  • Observational, high survival (71%) in severe viral ARDS

  • Showed ECMO is feasible, safe, and life-saving in a pandemic

EOLIA Trial

  • Randomized controlled trial, 249 patients

  • Strict criteria: Severe hypoxia/hypercapnia despite optimal ventilation

  • Results: Trend toward mortality benefit (34% vs. 46%)

  • Significant crossover (28%): Confirmed rescue ECMO saves lives

Post-EOLIA Practice

  • ECMO recognized in international ARDS management guidelines

  • Recommended for severe ARDS in specialized centers

  • ECMO strategy now focuses on early initiation, careful patient selection, and lung-protective ventilation

 Technological Advances

  • Shift from roller to centrifugal pumps

  • Reduced hemolysis, improved safety, smaller portable machines

  • Improved outcomes due to better devices, circuits, and anticoagulation protocols

Risk Prediction and Decision-Making

RESP Score

  • 12-variable tool to stratify survival likelihood in VV ECMO

  • Class I (>90% survival) to Class V (<20%)

  • Variables include age, days on ventilation, PaCO₂, driving pressure, CNS dysfunction, etc.

  • Online calculator available to support decision-making

Patient Selection Criteria

  • Favorable predictors: <7 days MV, viral ARDS, prone use, neuromuscular blockade

  • Poor prognosis: >14 days MV, fibrosis, comorbidities, age >65, multi-organ failure

When to Say No

  • Absolute contraindications: irreversible lung damage, advanced age/frailty, uncontrolled sepsis

  • Referral pathways essential: Central ECMO coordination improves timely access

Changing Paradigms in Ventilation on VV ECMO

Mechanical Power Concept

  • Unifying model to quantify lung stress

  • Power = 0.098 × RR × VT × (Ppeak – ½ × ΔP)

  • High mechanical power >17 J/min linked to VILI

Ventilator-Induced Lung Injury (VILI) Mechanisms

  • Volutrauma: excessive VT

  • Barotrauma: high plateau pressure

  • Atelectrauma: inadequate PEEP

  • Ergotrauma: high mechanical power

  • Biotrauma: inflammatory response from ventilation

  • Corotrauma: excessive respiratory drive

  • Energotrauma: high driving pressure

Ultraprotective Ventilation Strategy

  • Tidal volume ≤4 ml/kg, plateau ≤25, driving pressure <14, PEEP 10–24

  • Mechanical power <8 J/min is ideal

  • Respiratory rate 4–30/min, FiO₂ 30–50%

Supported by CESAR and EOLIA Trials

Weaning Strategies and Recovery Pathways

Types of VV ECMO Recovery

  • Rapid Recovery (<7 days): Quick improvement, early decannulation

  • Slow Recovery (7–21 days): Gradual lung healing, often tracheostomy

  • Fibroproliferative (>21 days): Consider lung transplant

  • Non-Recovering: Multiorgan failure, consider withdrawal

Monitoring Markers of Recovery

  • ↓ ECMO sweep/flow

  • ↓ ventilator settings (FiO₂, PEEP)

  • ↑ compliance, ↓ plateau pressure

  • Stable ABG, ↓ IL-6, improved imaging (CXR, CT, LUS)

 Awake ECMO vs Conventional Weaning

Conventional Pathway

 

  • Wean ECMO, then extubate

  • More controlled, lung-protective, familiar

  • Sedation risks: delirium, diaphragmatic dysfunction

Awake ECMO Pathway

  • Extubate first, wean ECMO later

  • Less sedation, early mobilisation, diaphragm preserved

  • Risks: P-SILI, accidental decannulation, resource intensive

  • Ideal patient: Cooperative, intact airway, low RR drive, hemodynamically stable

Challenges

  • Balance between lung protection and diaphragm preservation

  • Monitor for P-SILI (↑RR, ↑VT, signs of distress)

  • Use diaphragm ultrasound, pressure monitoring, stepwise weaning

Final Concepts

  • ECMO doesn’t kill patients; it buys time for recovery

  • Time-limited trial of ECMO helps avoid futile interventions

  • ECMO should be initiated early in reversible severe ARDS

  • Multidisciplinary collaboration is key (intensivist, nurse, perfusionist, physiotherapist)

  • No one-size-fits-all strategy; continuous reassessment essential

  • Future research needed in ECMO timing, ventilator strategies, and weaning protocols

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