Corporate PSG: ECMO Basics for Intensive Care Consortium



Date & Location
Wednesday, September 23, 2026, 7:00 AM - Saturday, September 23, 2028, 7:00 PM, Corporate/ PSG

Target Audience
Specialties - Critical Care Medicine
Professions - Nurse Practitioner, Physician

Credits
AMA PRA Category 1 Credits™ (0.25 hours), Non-Physician Attendance (0.25 hours)

Overview
This continuing medical education activity is designed specifically for intensivists and advanced practice providers practicing in ICUs without on-site ECMO capability. The program provides a focused, clinically practical review of extracorporeal membrane oxygenation (ECMO), emphasizing foundational physiology, patient selection, stabilization strategies, and evidence-based referral timing. Early recognition of patients who may benefit from ECMO remains a critical determinant of survival in severe ARDS, refractory cardiogenic shock, and select cardiac arrest scenarios. Variability in referral timing and uncertainty regarding candidacy criteria contribute to delays in escalation of care. This activity equips critical care clinicians with a structured framework to identify appropriate candidates, optimize management prior to transfer, and engage ECMO centers efficiently. Content will include a concise review of veno-venous (VV) and veno-arterial (VA) ECMO physiology, current indications and contraindications, referral triggers, and practical pre-transfer management strategies tailored to the non-ECMO ICU setting.

Objectives
At the conclusion of this activity, learners will be able to:

  1. Differentiate the major types of ECMO support
  2. Describe the indications and basic components of veno-venous (VV) and veno-arterial (VA) ECMO and identify hybrid and specialized configurations (VAV, VVA) and when they may be considered
  3. Apply inclusion and exclusion criteria for ECMO referral. Recognize evidence-based inclusion criteria for respiratory and cardiac failure requiring ECMO. Identify absolute and relative exclusion criteria, including multiorgan failure, advanced age/frailty, neurologic injury, irreversible disease, and prolonged mechanical ventilation.
  4. Understand cannulation strategies used in ECMO support Compare peripheral vs central cannulation approaches. Describe common cannulation sites (IJ, femoral, subclavian) and the rationale for configuration selection. Discuss patient-specific considerations such as body habitus, vascular anatomy, and severity of shock or respiratory failure.
  5. Explain the fundamental physiology of ECMO. Describe how ECMO supports gas exchange or circulation and how it interacts with the native heart and lungs. Recognize how changes in ECMO settings affect patient hemodynamics and oxygenation.
  6. Identify appropriate referral triggers for ECMO consideration. Recognize early clinical markers of refractory respiratory failure (e.g., worsening P/F ratio, increasing plateau pressures, rising hypercapnia). Identify cardiac failure indicators such as escalating vasoactive support, low cardiac index, or shock unresponsive to standard therapy. Understand when to escalate and how referral timing impacts patient outcomes.
  7. Understand ECMO-related emergencies and transfer considerations Identify and respond to critical issues such as accidental decannulation, pump failure, oxygenator clotting, severe bleeding, limb ischemia, or differential hypoxemia. Understand communication pathways and stabilization steps before transfer.  

Accreditation
HCA Healthcare Graduate Medical Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

 


Additional Information

Publication Dates:

Release Date: September 23, 2026

Expiration Date: September 23, 2028

Bibliography:

•Barbaro, R. P., MacLaren, G., Boonstra, P. S., Combes, A., Agerstrand, C., Annich, G., Diaz, R., Fan, E., Hryniewicz, K., Lorusso, R., Paden, M. L., Stead, C. M., Swol, J., Iwashyna, T. J., Slutsky, A. S., Brodie, D., & Extracorporeal Life Support Organization. (2021). Extracorporeal membrane oxygenation for COVID-19: Evolving outcomes from the international Extracorporeal Life Support Organization Registry. Lancet, 398(10307), 1230–1238. https://doi.org/10.1016/S0140-6736(21)01960-7

•Bernhardt, A. M., Schrage, B., Schroeder, I., Trummer, G., Westermann, D., & Reichenspurner, H. (2022). Extracorporeal membrane oxygenation. Dtsch Arztebl International, 119(13), 235–244. https://doi.org/10.3238/arztebl.m2022.0068

•Bohman, J., Seelhammer, T. G., Mazzeffi, M., Gutsche, J., & Ramakrishna, H. (2022). The year in extracorporeal membrane oxygenation: Selected highlights from 2021. Journal of Cardiothoracic and Vascular Anesthesia, 36(7), 1832–1843. https://doi.org/10.1053/j.jvca.2022.03.002

•Brodie, D., Abrams, D., MacLaren, G., Brown, C. E., Evans, L., Barbaro, R. P., Calfee, C. S., Hough, C. L., Fowles, J. A., Karagiannidis, C., Slutsky, A. S., & Combes, A. (2022). Extracorporeal membrane oxygenation during respiratory pandemics: Past, present, and future. American Journal of Respiratory and Critical Care Medicine, 205(12), 1382–1390. https://doi.org/10.1164/rccm.202111-2661CP

•Brodie, D., Slutsky, A. S., & Combes, A. (2019). Extracorporeal life support for adults with respiratory failure and related indications: A review. JAMA, 322(6), 557–568. https://doi.org/10.1001/jama.2019.9302

•Combes, A., Schmidt, M., Hodgson, C. L., Fan, E., Ferguson, N. D., Fraser, J. F., Jaber, S., Pesenti, A., Ranieri, M., Rowan, K., Shekar, K., Slutsky, A. S., & Brodie, D. (2020). Extracorporeal life support for adults with acute respiratory distress syndrome. Intensive Care Medicine, 46(12), 2464–2476. https://doi.org/10.1007/s00134-020-06290-1

•Condella, A., Lentz, S., Upchurch, C., Badulak, J., Long, B., & Gottlieb, M. (2025). Extracorporeal membrane oxygenation (ECMO): A narrative review for the emergency clinician. American Journal of Emergency Medicine, 96, 6–14. https://doi.org/10.1016/j.ajem.2025.06.007

•Gajkowski, E. F., Herrera, G., Hatton, L., Velia Antonini, M., Vercaemst, L., & Cooley, E. (2022). ELSO guidelines for adult and pediatric extracorporeal membrane oxygenation circuits. ASAIO Journal, 68(2), 133–152. https://doi.org/10.1097/MAT.0000000000001630

•Graboyes, S. D. T., Owen, P. S., Evans, R. A., Berei, T. J., Hryniewicz, K. M., & Hollis, I. B. (2023). Review of anticoagulation considerations in extracorporeal membrane oxygenation support. Pharmacotherapy, 43(12), 1339–1363. https://doi.org/10.1002/phar.2857

•Lorusso, R., Shekar, K., MacLaren, G., Schmidt, M., Pellegrino, V., Meyns, B., Haft, J., Vercaemst, L., Pappalardo, F., Bermudez, C., Belohlavek, J., Hou, X., Boeken, U., Castillo, R., Donker, D. W., Abrams, D., Ranucci, M., Hryniewicz, K., Chavez, I., … Whitman, G. (2021). ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients. ASAIO Journal, 67(8), 827–844. https://doi.org/10.1097/MAT.0000000000001510

•McMichael, A. B. V., Ryerson, L. M., Ratano, D., Fan, E., Faraoni, D., & Annich, G. M. (2022). 2021 ELSO adult and pediatric anticoagulation guidelines. ASAIO Journal, 68(3), 303–310. https://doi.org/10.1097/MAT.0000000000001652

•Mendrala, K., Darocha, T., Pluta, M., Witt-Majchrzak, A., Hymczak, H., Nowak, E., Czarnik, T., Barteczko-Grajek, B., Dabrowski, W., Kosinski, S., Podsiadlo, P., & Hypothermia Study Group. (2024). Outcomes of extracorporeal life support in hypothermic cardiac arrest: Revisiting ELSO guidelines. Resuscitation, 205, Article 110424. https://doi.org/10.1016/j.resuscitation.2024.110424

•Niroomand, A., Olm, F., & Lindstedt, S. (2023). Extracorporeal membrane oxygenation: Set-up, indications, and complications. In Advances in Experimental Medicine and Biology (Vol. 1413, pp. 291–312). https://doi.org/10.1007/978-3-031-26625-6_15

•Rali, A. S., Abbasi, A., Alexander, P. M. A., Anders, M. M., Arachchillage, D. J., Barbaro, R. P., Fox, A. D., Friedman, M. L., Malfertheiner, M. V., Ramanathan, K., Riera, J., Rycus, P., Schellongowski, P., Shekar, K., Tonna, J. E., Zaaqoq, A. M., & Extracorporeal Life Support Organization Registry Committee. (2024). Adult highlights from the Extracorporeal Life Support Organization Registry: 2017–2022. ASAIO Journal, 70(1), 1–7. https://doi.org/10.1097/MAT.0000000000002038

•Rao, P., Khalpey, Z., Smith, R., Burkhoff, D., & Kociol, R. D. (2018). Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circulation: Heart Failure, 11(9), e004905. https://doi.org/10.1161/CIRCHEARTFAILURE.118.004905

•Rehder, K. J., & Alibrahim, O. S. (2023). Mechanical ventilation during ECMO: Best practices. Respiratory Care, 68(6), 838–845. https://doi.org/10.4187/respcare.10908

•Tonna, J. E., Abrams, D., Brodie, D., Greenwood, J. C., Rubio Mateo-Sidron, J. A., Usman, A., & Fan, E. (2021). Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO). ASAIO Journal, 67(6), 601–610. https://doi.org/10.1097/MAT.0000000000001432

•Tonna, J. E., Boonstra, P. S., MacLaren, G., Paden, M., Brodie, D., Anders, M., Hoskote, A., Ramanathan, K., Hyslop, R., Fanning, J. J., Rycus, P., Stead, C., Barrett, N. A., Mueller, T., Gomez, R. D., Malhotra Kapoor, P., Fraser, J. F., Bartlett, R. H., Alexander, P. M. A., … Extracorporeal Life Support Organization Member Centers Group. (2024). Extracorporeal Life Support Organization Registry international report 2022: 100,000 survivors. ASAIO Journal, 70(2), 131–143. https://doi.org/10.1097/MAT.0000000000002128

•Welker, C., Huang, J., & Ramakrishna, H. (2022). Analysis of the 2020 EACTS/ELSO/STS/AATS expert guidelines on the management of adult postcardiotomy extracorporeal life support. Journal of Cardiothoracic and Vascular Anesthesia, 36(7), 2207–2219. https://doi.org/10.1053/j.jvca.2021.06.022

•Wheeler, C. R., & Bullock, K. J. (2023). Extracorporeal membrane oxygenation. Respiratory Care, 68(8), 1158–1170. https://doi.org/10.4187/respcare.10929