UPMC PROCIRCA ADULT ECMO TRAINING COURSE

THURSDAY, OCTOBER 16

0700-0730          BREAKFAST/REGISTRATION

0730-0800          ECMO OVERVIEW                                                                   

KERI HICKMAN, CCP

• ECMO OVERVIEW
  • Different modes of ECMO support
  • Global trends in ECMO utilization

0800-0830          PAST TO PRESENT: HISTORY & RECENT EVIDENCE

HOLT MURRAY, MD

• HISTORY OF ECMO
  • List the key milestones in the development of ECMO
  • Describe the evolution of the Extracorporeal Life Support Organization
• HISTORICAL STUDIES
  • List the historical ECMO studies and their limitations
• RECENT EVIDENCE FOR VV ECMO
  • Interpret results and limitations of the main cohort studies on VV ECMO
  • Interpret results and limitations of the CESAR and the EOLIA trials
• RECENT EVIDENCE FOR VA ECMO
  • Interpret results and limitations of the main cohort studies on VA ECMO
  • Interpret results of studies/trials comparing temporary VADs to VA ECMO

0830-0900          CIRCUIT COMPONENTS

BRANDON D’ALOISO, CCP

• CIRCUIT OVERVIEW
  • Define the main components of an ECMO circuit
  • List circuit monitoring tools
• CANNULAS & TUBING
  • Describe the differences in ECMO cannula design
  • List the considerations for selecting the appropriate ECMO cannula
• PUMP
  • Describe the requirements of a blood pump used in ECMO
  • Explain the physics and working principles of a centrifugal pump
• MEMBRANE LUNG & BLENDER
  • Describe the structure and function of the membrane lung
  • Describe the function of the blender
• PRESSURE MONITORING
  • List the different pressure zones in an ECMO circuit
  • Discuss the utility of monitoring drainage pressure
• OTHER CIRCUIT COMPONENTS
  • Describe the utility of the flowmeter
  • Describe the function of the heater
  • Describe the utility of circuit clamps

0900-0930          CONFIGURATIONS & CANNULATIONS

MICHAEL LAZAR, MD

• CANNULATION
  • List the differences between percutaneous and open cannulation
  • Outline the process of percutaneous cannulation
  • Discuss the role of ultrasound in cannulation
• VV ECMO CONFIGURATIONS
  • List the different configurational options for VV ECMO
  • Review the benefits and limitations of specific configurations
• VA ECMO CONFIGURATIONS
  • List the different configurational options for VA ECMO
  • Review benefits and limitations of specific configurations
• CANNULATION COMPLICATIONS
  • Identify complications of ECMO cannulation
  • Describe steps to prevent, recognize, and treat complications

0930-0945          BREAK

0945-1030          ECMO PHYSIOLOGY

RAJ RAMANAN, MD

• OXYGEN DELIVERY & UPTAKE
  • Describe the normal physiology of oxygen delivery and uptake
• GAS TRANSFER IN MEMBRANE LUNG
  • Describe the key determinants of oxygen uptake in the membrane lung
  • Describe the key determinants of carbon dioxide removal in the membrane lung
• HEMODYNAMIC MONITORING OF VV
  • List the hemodynamic changes that accompany VV ECMO
  • Describe the changes in hemodynamic monitoring on VV ECMO
• HEMODYNAMIC MONITORING OF VA
  • Discuss the hemodynamic changes that accompany VA ECMO
  • Describe the changes in hemodynamic monitoring on VA ECMO

1030-1100          ANTICOAGULATION

RYAN RIVOSECCHI, PHARMD

• ANTICOAGULATION
  • List anticoagulation strategies on ECMO
  • Discuss anticoagulation monitoring on ECMO

1100-1130          DAILY MANAGEMENT FOR THE ECMO SPECIALIST

AMBER PALMER, CCP

• RENAL REPLACEMENT THERAPY
  • Identify the benefits and limitations of administering RRT via a dialysis catheter
  • Identify the benefits and limitations of administering RRT via the ECMO circuit
• INTRAHOSPITAL TRANSPORT
  • Identify considerations and logistics for intrahospital transport

1130-1230          LUNCH

1230-1300          DAILY MANAGEMENT FOR THE ECMO PROVIDER

TIM KASELITZ, MD

• SEDATION
  • Identify the role of sedation during ECMO support
  • Discuss the paradigm shift towards awake ECMO
• PROCEDURES
  • Discuss considerations for procedures on the ECMO patient
• PHYSIOTHERAPY
  • Describe the rationale for physiotherapy during ECMO
  • Identify appropriate candidates for physiotherapy on ECMO

1300-115            INTRODUCTION TO SIMULATION

KERI HICKMAN, CCP

1315-1345          PUZZLE BOX

1345-1515          CENTRIMAG KNOBOLOGY, PRIMING, CONSOLE EXCHANGE, AIR REMOVAL TECHNIQUES,                     CIRCUIT CHECK

1515-1530          BREAK

1530-1700          CARDIOHELP KNOBOLOGY, PRIMING, HAND CRANKING, AIR REMOVAL TECHNIQUES,                             CIRCUIT CHECK

SIMULATION FACULTY: RAJ RAMANAN, MD; TIM KASELITZ, MD; VERONICA GARVIA, MD; KERI HICKMAN, CCP; BRANDON D’ALOISO, CCP; TYLER EADIE, CCP; AMBER PALMER,CCP

FRIDAY, OCTOBER 17

0700-0730          BREAKFAST/SIGN IN

0730-0800          RESPIRATORY FAILURE

TIM KASELITZ, MD

• Provide an overview of respiratory failure
• List standard management strategies for respiratory failure
• Discuss the rationale of VV ECMO in respiratory failure

0800-0830          PATIENT SELECTION FOR VV ECMO

RAJ RAMANAN, MD

• List the indications and contraindications for VV ECMO support

0830-0915          MANAGEMENT OF VV ECMO

RAJ RAMANAN, MD

• INTIATION OF VV ECMO
  • Describe the steps in initiating a patient onto VV ECMO
• VV ECMO MAINTENANCE
  • Describe titration of blood flow and gas flow to achieve adequate support on VV ECMO
  • Describe the concept of native lung rest
• WEANING VV ECMO
  • Describe the process of weaning VV ECMO support
  • List exit strategies for the VV ECMO patient

0915-0930          BREAK

0930-1000          VV ECMO CASE VIGNETTES

RAJ RAMANAN, MD

• DRAINAGE INSUFFIENCY
  • Define and diagnose drainage insufficiency
  • Troubleshoot drainage insufficiency
• RETURN OBSTRUCTION
  • Define return obstruction and identify its causes
  • Diagnose and manage return obstruction
• RECIRCULATION
  • Define and identify recirculation
  • Troubleshoot recirculation

1000-1030          CIRCUIT COMPLICATIONS

PETER ARLIA, CCP

• (MECHANICAL) COMPLICATIONS OVERVIEW
• PUMP FAILURE
  • Define pump failure
  • Describe how to identify and manage pump failure
• MEMBRANE LUNG DYSFUNCTION
  • Define membrane lung dysfunction
  • Describe how to diagnose and manage membrane lung dysfunction
• AIR EMBOLISM
  • Define air embolism and its determinants
  • Define strategies to prevent air embolism
  • Describe how to detect and manage air embolism
• CIRCUIT DISRUPTION
  • Identify determinants of circuit disruption
  • Recognize early signs of circuit disruption
  • Manage circuit disruption
• ACCIDENTAL DECANNULATION
  • Manage an accidental decannulation
• COMING OFF ECMO EMERGENTLY
  • List the indications for coming off ECMO emergently
  • List the steps required to come off and back on ECMO emergently

1030-1100          PATIENT COMPLICATIONS

VERONICA GARVIA, MD

• (MEDICAL) COMPLICATIONS OVERVIEW
• NEUROLOGICAL COMPLICATIONS
  • List the etiology and risk factors for neurological complications
  • Discuss the management of ischemic and hemorrhagic strokes
• BLEEDING
  • List the etiology of bleeding
  • Discuss the management of bleeding
• THROMBOSIS
  • List the etiology of thrombosis
  • Discuss the management of thrombosis
• HEMOLYSIS
  • Understand the etiology and risk factors of hemolysis on ECMO
  • Discuss how to prevent and manage hemolysis
• LIMB ISCHEMIA
  • List the risk factors for developing limb ischemia on VA ECMO
  • Describe how to monitor limb perfusion
  • Discuss the prevention and management of limb ischemia
• CARDIAC ARREST DURING ECMO
  • Discuss the management of cardiac arrest on VV ECMO
  • Discuss the management of cardiac arrest on VA ECMO

1100-1130          CODING & BILLING FOR THE ECMO PROVIDER

JAMIE DEANGELIS, MSN, ANP-BC

• • Describe rationale for accurate documentation
  • Describe process of coding & billing
  • Quality assurance

1130-1230          LUNCH

1230-1245          INTRODUCTION TO SIMULATION

KERI HICKMAN, CCP

1245-1645          VV SIMULATION

SIM 1 SCENARIO

SIM 2 SCENARIO

SIM 3 SCENARIO

SIM 4 SCENARIO

SIMULATION FACULTY: RAJ RAMANAN, MD; TIM KASELITZ, MD; VERONICA GARVIA, MD;  KERI HICKMAN, CCP; BRANDON D’ALOISO, CCP; TYLER EADIE, CCP; AMBER PALMER,CCP; ALYSSA MCCUNE, CCP

1715-1915          EXHIBITOR MEET & GREET AT THE OAKLANDER HOTEL

SATURDAY, OCTOBER 18

0700-0730          BREAKFAST/SIGN IN

0730-0800          CARDIAC FAILURE

DAVID KACZOROWSKI, MD

• Provide an overview of cardiac failure
• List standard management strategies for cardiac failure
• Discuss the rationale of VA ECMO in cardiac failure

0800-0830          PATIENT SELECTION FOR VA ECMO

MICHAEL LAZAR, MD

• List the indications and contraindications for VA ECMO support

0830-0900          MANAGEMENT OF VA ECMO

DAVID KACZOROWSKI, MD

• INITIATION OF VA ECMO
  • Describe the steps for initiating a patient
• VA MAINTENANCE
  • Describe vasopressor use and blood flow titration for cardiovascular support
  • Describe the concept of native heart rest
  • Describe ventilator management and blood and gas flow titration for pulmonary support
• WEANING VA ECMO      
  • Describe the process of weaning VA ECMO support
  • List exit strategies for the VA ECMO patient

0900-0930          VA ECMO CASE VIGNETTES

RAJ RAMANAN, MD

• LV DISTENTION
  • Describe the mechanism of LV distention
  • List strategies to unload the left ventricle
• DIFFERENTIAL OXYGENATION
  • Define and identify differential oxygenation
  • Troubleshoot differential oxygenation

0930-0945          BREAK

0945-1015          ECPR

DAVID KACZOROWSKI, MD

• Describe ECPR
• Interpret results and limitations of the major clinical trials on ECPR
• Patient selection with emphasis on inclusion and exclusion criteria
• Logistics of establishing and maintaining an ECPR program

1015-1045          INTERHOSPITAL TRANSPORT

FRANK GUYETTE, MD

• INTERHOSPITAL TRANSPORT
  • Identify considerations and logistics for interhospital transport

1045-1100          INTRODUCTION TO SIMULATION

KERI HICKMAN, CCP

1100-1200          LUNCH

1200-1600          VA SIMULATION

SIM 1 SCENARIO

SIM 2 SCENARIO

SIM 3 SCENARIO

SIM 4 SCENARIO

SIMULATION FACULTY: RAJ RAMANAN, MD; TIM KASELITZ, MD; VERONICA GARVIA, MD; KERI HICKMAN, CCP; BRANDON D’ALOISO, CCP; TYLER EADIE, CCP; AMBER PALMER,CCP; ALYSSA MCCUNE, CCP

1600-1630          Q&A WITH FACULTY

RAJ RAMANAN, MD; TIM KASELITZ, MD; VERONICA GARVIA, MD; KERI HICKMAN, CCP

1630                    COURSE ADJOURNMENT