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
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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)
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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
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Extra Corporeal Membrane Oxygenation (ECMO) and Mechanical Circulatory Support (MCS) course (Copy 4)

Why ACHD Patients Are Complex

  • Altered anatomy/physiology: Fontan, Glenn, Mustard, Senning; single ventricle; right heart failure; pulmonary hypertension.

  • Prior surgery/occlusions: adhesions, venous/arterial occlusions.

  • Comorbidities: renal, neurologic, pulmonary, hepatic (Fontan congestion), restrictive lung disease, obstructive sleep apnea, cognitive/psychiatric issues, epilepsy, coagulopathies, iron deficiency, bleeding disorders.

Indications & (Relative) Contraindications

  1. Indications: cardiogenic shock, failure to wean from bypass, bridge to decision/transplant, ECPR, acute decompensation (arrhythmia/infection), peri-procedural stabilization.

  2. Contraindications (relative): multiple organ failure, sepsis with vasoplegia, severe aortic regurgitation, prolonged unwitnessed arrest, no recovery/transplant option.

Cannulation & Monitoring

  • Challenges: limited femoral/neck access, systemic-to-pulmonary shunts, pulmonary hypertension; central vs peripheral must be individualized.

  • Planning: imaging and surgical history are critical; cannula position influences oxygenation/flows.

  • Monitoring: continuous CVP and mixed venous saturation; hemodynamics must account for altered anatomy (e.g., IJ in Glenn = pulmonary artery pressure).

Case Highlights

1) Ebstein Anomaly, Right Heart Failure

  • Strategy: femoral vein–femoral artery VA-ECMO, lower flows, echo guidance.

  • Outcome: stabilized 5 days → surgical tricuspid valve replacement.

  • Learning: tailored cannulation and vigilant hemodynamic monitoring.

2) Fontan Circulation, Cardiogenic Shock

  • Strategy: dual cannulation (right IJ + femoral vein) with femoral arterial return.

  • Course: hemolysis, mild pulmonary hemorrhage, persistent low flows.

  • Outcome: MDT not for transplant → palliative care after 7 days.

  • Learning: limited efficacy of VA-ECMO in Fontan; selection and planning are essential; poor survival around 35%.

ECLS After ACHD Surgery

  • Use rare; mortality high. Risk factors: older age, increased surgical complexity, univentricular physiology, preoperative hospitalization, non-cardiac chronic conditions, renal/neurological/pulmonary complications.

ECPR in Fontan

  • Problems: raised intrathoracic/venous pressures, reduced pulmonary blood flow, difficult cannulation, venous drainage issues, neurological injury.

Bridge Strategies & Management

  • Bridge to VAD/transplant: choose ECLS vs VAD based on lungs, pulmonary hypertension, aortic regurgitation, anticipated wait time.

  • Always define an exit strategy.

  • Tailored circuits/anticoagulation; MDT collaboration is essential.

Take-Home

  • VA-ECMO is lifesaving but variable; outcomes depend on anatomy and comorbidities.

  • Fontan patients: poorest prognosis; best managed at high-volume ACHD/ECMO centers.

  • Future: improved circuits, compact devices, perioperative/bridge use, potential roles with gene/stem cell therapy and xenotransplant.

 

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