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
48:27
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)
20:35
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)
17:47
Webinar 12 Records
01:32:12
Module 4 POST test
Extra Corporeal Membrane Oxygenation (ECMO) and Mechanical Circulatory Support (MCS) course
About Lesson

Case Scenario: Persistent hypoxemia despite VV ECMO

Presenter: Raj Ramanan Moderator: Ahmed Hegazy Discussion: A Systematic Approach to Hypoxemia on VV ECMO Interactive Poll: What are the initial steps you would take to treat hypoxemia on VV ECMO?

 

Case Scenario: Acute right ventricular dysfunction associated with ARDS: Which is best, VV or VA ECMO?

Presenter: Kumait Al Lawati Moderator: Hesham Faisal Discussion:

Effects of ARDS on right ventricular (RV) function VV ECMO effects on RV function Choice of ECMO modality in patients with RV failure Interactive Poll: Which ECMO choice would you go with, VV or VA?

 

Summary of the Webinar:

Talk 1 – Refractory Hypoxemia in Severe ARDS on VV ECMO

  • Case: 56-year-old male, H1N1 influenza → severe ARDS.

    • Initially on high-flow O₂ → intubated day 4.

    • CT: bilateral GGOs, subsegmental PE (no RV strain).

    • Developed MSSA bacteremia and later ESBL Klebsiella superinfection.

    • Managed with proning, low tidal volume ventilation, deep sedation, paralysis.

    • By day 7: PF ratio <80, plateau pressure 35, FiO₂ 100%, PEEP 16 → refractory hypoxemia → cannulated for VV ECMO.

  • Key evidence reviewed:

    • Mortality benefit: low tidal volume ventilation, prone positioning (PROSEVA).

    • Not beneficial: recruitment maneuvers, HFOV, paralytics (ROSE trial negative).

    • VV ECMO considered for PF ratio <80 >6–12 hrs despite optimal care.

  • Relative contraindications discussed:

    • E-cigarettes, mild alcohol use, subsegmental PE, treated bacteremia → not true contraindications.

    • Persistent uncontrolled bacteremia would be concerning.

  • Cannulation strategy:

    • Tall 120-kg man → large vessel diameters → required 27 Fr drainage + 21 Fr return cannula to achieve adequate flows.

    • Teaching point: always size cannulas to anatomy & flow needs.

  • Complications:

    • Necrotizing pneumonia, pulmonary hemorrhage, pneumothorax, renal failure.

    • Despite advanced support (including dual ECMO circuits), patient died with multi-organ failure.

  • Teaching highlights:

    • Hypoxemia on VV ECMO results from:

      1. ↓ Effective ECMO flow (drainage insufficiency, recirculation, insufficient pump flow).

      2. ↑ Native cardiac output (fever, sepsis, agitation).

      3. Membrane lung dysfunction (gas failure, low FiO₂, excessive flow > rated capacity).

      4. ↓ SvO₂ (low CO, anemia, fever).

    • ECMO flow / cardiac output ratio must be >60% to maintain SaO₂ >90%.

    • Beta-blockers ↑ SaO₂ but ↓ DO₂ → not useful.

    • Adding a parallel circuit can augment flow when one oxygenator maxed out.

    • Always treat cause of hypoxemia systematically with an algorithmic approach.

Talk 2 – ARDS with RV Dysfunction & ECLS

  • Background:

    • ARDS increases pulmonary vascular resistance (PVR) via hypoxemia, hypercapnia, acidosis, high PEEP, and vascular leak.

    • This leads to RV dilation, dysfunction, and failure.

    • RV dysfunction complicates ~25% of ARDS; up to 50% of severe cases considered for ECMO.

    • Mortality increases significantly when RV failure coexists with ARDS.

  • Rescue therapies for RV dysfunction:

    • Optimize preload (avoid over/underfilling).

    • Reduce PVR (treat hypoxemia/hypercapnia, inhaled NO or prostacyclin, milrinone).

    • Support systemic BP (vasopressors to optimize SVR/PVR ratio).

    • Proning improves oxygenation and RV function.

  • ECMO effects on RV:

    • VV ECMO: corrects hypoxia, hypercapnia, acidosis → lowers PVR, reduces RV afterload.

    • VA ECMO: bypasses RV → decompresses RV and supports circulation, but risks LV overload and Harlequin syndrome.

  • Cannulation strategies & hybrid circuits:

    • VV ECMO first-line in ARDS + RV dysfunction if no severe circulatory shock.

    • VA ECMO indicated if severe shock coexists.

    • Hybrid (V-AV) can avoid Harlequin syndrome by providing both systemic and pulmonary oxygenation.

    • Correct labeling: drainage cannulas before the dash (V), return cannulas after (A or V).

  • Case examples:

    • Case 1: COVID ARDS + RV dysfunction → started on VV ECMO → improved, later discharged.

    • Case 2: ARDS + RV failure + severe shock → started on VA ECMO, developed Harlequin → converted to hybrid V-AV ECMO.

  • Key teaching points:

    • Bad lungs + bad RV but preserved circulation → VV ECMO.

    • Bad lungs + bad RV + shock → VA ECMO (or V-AV hybrid if risk of Harlequin).

    • RVAD alone not useful in ARDS (doesn’t oxygenate).

    • Hybrid configurations (VV-A, V-AV, etc.) useful in complex physiology.

  • Adjuncts:

    • Inhaled NO may improve oxygenation and reduce RV afterload short-term, though no mortality benefit.

    • Inhaled prostacyclin (epoprostenol) sometimes used; effect mainly on PA pressures.

    • Steroids not beneficial for viral ARDS with bacterial superinfection (risk of fungal infections).

Overall Take-Home

  • Talk 1: Hypoxemia on VV ECMO must be analyzed algorithmically → maintain ECMO flow/CO ratio >60%, avoid “futile” fixes.

  • Talk 2: ARDS + RV dysfunction requires careful ECMO selection: VV for lungs, VA if shock, hybrid to avoid Harlequin.

  • Both talks stress cannula strategy, flow optimization, and physiology-driven decision making as keys to outcomes.

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