ECMO patients are some of the most acutely ill patients in critical care, requiring an unparalleled level of care, support, and expertise. Typically, each ECMO patient is supported by a duo of experts: a bedside RN and an ECMO specialist. The bedside RN diligently oversees the patient’s overall well-being, managing their medication and monitoring vital signs, while the ECMO specialist is tasked with the meticulous operation and adjustment of the life-support system itself. Together, these two crucial roles synchronize their efforts to provide seamless care, often integrating with a larger team of healthcare professionals to ensure every aspect of the patient’s needs is met.

Being an ECMO specialist is an incredibly rewarding role—but what does an ECMO specialist do? Their days are filled with monitoring intricate ECMO circuits, analyzing blood gas results, and adjusting blood flow rates to ensure optimal oxygenation and perfusion. They work in tandem with a multidisciplinary team, communicating critical information, participating in emergency interventions, and often providing the crucial bridge between life-threatening moments and recovery. 

Those drawn to this field are often seeking more than a job; they are in pursuit of a vocation that promises the reward of saving lives, the thrill of engaging with cutting-edge medical technology, and the satisfaction of mastering one of the most critical skills in intensive care medicine. But where to begin? Unlike the clear-cut academic paths pursued in a university, becoming an ECMO specialist isn’t standardized and varies from institution to institution. But here’s a good road map:

Step 1: Complete education

ECMO specialists come from diverse professional backgrounds, not limited to one specific area of healthcare. Registered nurses (RNs), respiratory therapists (RTs), and certified clinical perfusionists (CCPs) can all step into this role, each bringing a unique set of skills and perspectives to the ECMO team. The journey to becoming an ECMO specialist begins with education and licensure in one of these fields.

To become an RN, one must complete either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) from an accredited nursing program. Following their education, candidates must pass the NCLEX-RN to obtain their nursing license. RTs require an Associate’s or Bachelor’s degree in respiratory therapy from an accredited program and must pass the NBRC exam to become certified. CCPs follow a more specialized path, requiring a Bachelor’s degree followed by completion of a perfusionist certificate or master’s program. After completing their education, CCP candidates must pass the ABCP certification exam. For each of these roles, licensure and certification ensure that individuals have met the minimum competency standards to practice in their respective fields, laying the groundwork for further specialization in ECMO support and management.

Step 2: Obtain clinical experience

Once graduated and licensed, aspiring ECMO specialists must acquire the appropriate clinical experience, a crucial step that varies slightly depending on their primary discipline. For RNs and RTs, securing at least 1 to 2 years of experience in an Intensive Care Unit (ICU) is essential. However, the depth and complexity of the role often make two or more years of ICU experience preferable, reflecting the critical nature of ECMO support. Also, while some hospitals and employers may accept experience from any type of ICU, there’s a marked preference for experience specifically within a Cardiovascular Intensive Care Unit (CVICU). Even if not explicitly required, experience in a CVICU is invaluable. It immerses RNs and RTs in the types of patient cases they will encounter as ECMO specialists and provides a deep understanding of the cardiac and circulatory systems, laying an essential foundation for their future roles.

For CCPs, the path to gaining relevant clinical experience looks a bit different. They typically start their careers in the operating room (OR), supporting cardiac surgeries and other procedures requiring cardiopulmonary bypass. The benefit of this is that it involves direct interaction with ECMO equipment, which uniquely prepares them for the transition to an ECMO specialist. For this reason, it is recommended that CCPs have 1-2 years of experience in their current role before becoming an ECMO specialist.

Step 3: Complete an ECMO training course

After obtaining the appropriate clinical experience, prospective ECMO specialists embark on the next phase of their journey by applying for or seeking out available ECMO specialist positions. Upon securing a role, the employer will guide them towards a tailored ECMO training program that adheres to their specific protocols and standards, ensuring that the ECMO staffing requirements are met with well-trained, competent professionals. Different programs will vary in structure, length, and content, but most programs include a didactic component (which involves lectures and online coursework to cover the foundational knowledge) as well as a hands-on component (in which participants actively engage with ECMO equipment and simulations to practice real-world scenarios).

At Innovative ECMO Concepts (IEC), we pride ourselves on being pioneers in the field, having introduced the industry’s first on-demand, online ECMO training and education platform. Our comprehensive program has successfully trained thousands of specialists, offering an accredited curriculum for CME/CEU credits. The course encompasses both pediatric and adult ECMO modalities, delivered through a 69-video series accessible online, allowing learners to engage with the material at their own pace and convenience. For hands-on learning, our program includes a “wet lab” training component. This term refers to a laboratory setting where participants can work with actual ECMO circuits and equipment, simulating real-life patient scenarios. Over twenty hours of hands-on training, learners engage in activities like priming the ECMO circuit, managing emergencies, and practicing other critical skills necessary for effective ECMO management.

Step 4: Precept with an ECMO specialist

The next step is to shadow and train with an experienced ECMO specialist caring for a real patient. This immersive learning experience allows the novice ECMO specialist to apply theoretical knowledge and hands-on skills in a clinical setting under the mentorship of a seasoned professional. This reinforces clinical judgment, fosters critical thinking in high-pressure situations, and hones the technical competencies necessary for independent practice. While each institution may set its own requirements for the duration of precepting, at IEC, we recommend a minimum of 72 hours. This ensures that emerging ECMO specialists gain ample exposure to a variety of clinical scenarios, equipping them with the confidence and expertise needed to excel in this demanding and rewarding field.

Step 5: Practice independently with close supervision

At this stage, the specialist begins to take full responsibility for the care of ECMO patients, albeit with close supervision from experienced colleagues. This step is designed to foster a safe and supportive environment where the specialist can apply their comprehensive training and precepting experiences to real patient care scenarios while still having access to mentorship and guidance. The duration of this phase varies from one specialist to another, tailored to each individual’s comfort level and guided by the insights and evaluations of managers and experienced specialists.

Step 6: Achieve full independence and pursue advanced specialization

After successfully navigating the previous steps, ECMO specialists reach a significant milestone—full independence! At this stage, they are adept at managing adult ECMO patients autonomously and become integral members of the multidisciplinary team, collaborating effectively with physicians, nurses, and other healthcare professionals. To maintain the highest level of competency, many institutions require specialists to pass an annual exam and participate in water drills every six months. Additionally, at IEC, we offer weekly adjunct lessons as part of our commitment to ongoing competency maintenance, ensuring that our specialists stay abreast of the latest developments and best practices in ECMO care.

After accumulating 1000-1500 hours of experience with adult ECMO cases, specialists have the opportunity to broaden their expertise to include pediatric and neonatal patients, areas that demand a deeper understanding of the unique physiological challenges and intricacies these patient groups present. Additionally, some specialists opt to pursue further certification, such as the Certified ECMO Specialist – Adult (CES-A), Certified ECMO Specialist – Pediatric (CES-P), or the Advanced ECMO Specialist Certification (E-AEC), to validate their expertise and commitment to excellence in the field. Obtaining these certifications is a testament to a specialist’s advanced knowledge and skill set, enhancing their credibility and professional development. It also reflects a dedication to adhering to the highest standards of ECMO care, contributing to improved patient outcomes, and fostering trust among colleagues and patients alike.

Ready to become an ECMO Specialist and join the IEC team? Apply here!