Graduate Medical Education Fellowship in Extracorporeal Life Support

Program Leadership

Co-Directors of the Extracorporeal Life Support Fellowship Program

• Dennis Daniel, MD
• Peta Alexander, MBBS, MPH

Director of the Pediatric Critical Care Senior Fellowship Program

• Traci Wolbrink, MD, MPH

Director of the Pediatric Critical Care Fellowship Program

• Traci Wolbrink, MD, MPH

ECMO Program Leadership

• Peta Alexander, MBBS
• Jill Zalieckas, MD
• Dennis Daniel, MD
• Francis Fynn-Thompson, MD
• Christine Desrosiers, MBA, RRT-NPS
• Daniel Gagner, BS, RRT-NPS
• Craig Wheeler, DHSc, RRT-NPS

GME Program Administrator

• Jules Beuck, Jules.Beuck@childrens.harvard.edu

• Board eligible or equivalent/certified in Pediatric Critical Care Medicine after completion of an ACGME equivalent PCCM fellowship
• Board certified (or equivalent) in General Pediatrics
• USMLE certification or equivalent
• PALS, ACLS certifications
• Visa eligibility for training, if needed

The goal of the ECLS Senior Fellowship is to foster proficiency around the technical, practical, clinical, and administrative aspects of pediatric ECMO, providing fellows with the experiences and mentorship to develop as experts in the field. The ECLS Fellow will focus on areas including: indications for ECMO cannulation, physiological changes while on ECMO, maintenance of the ECMO circuit, acute management of mechanical circuit issues, complications while on ECMO, tandem therapies on ECMO, and the process of decannulation.

In addition to clinical service time in the Medical/Surgical ICU (MSICU), the ECLS Fellow will be incorporated into ECMO program activities at a hospital level, through participation in the BCH ECMO Clinical Governance Committee. They will also complete a multidisciplinary core ECMO curriculum, providing opportunities for exposure to a variety of related specialties, including transfusion medicine, perfusion medicine, anticoagulation therapies, anesthesia, non-invasive imaging, advanced cardiac therapies, neurocritical care, and ethics/palliative care.

The ECLS Fellow will attend regular meetings held by the ECMO program and will be a key contributor to efforts including ongoing review of patients receiving ECMO support; discussions of indications and candidacy for ECMO; analysis of ECMO-related morbidities and mortalities; evaluation of ECMO equipment; and quality/process improvement efforts.

The ECLS Fellow will be encouraged to pursue a scholarly project during their training period that could be research, education, or quality improvement focused. The trainee will be mentored by a faculty member based on their area of interest. The fellowship program will also support travel for an ECMO related conference to support effective scientific communication, teamwork, leadership, and educational skills.

General Objectives

1. To develop competence in recognizing the need for ECMO, selecting a modality, and determining the appropriate cannulation method.
2. To effectively understand the physiology and manage patients on both cardiorespiratory and respiratory ECMO.
3. To gain familiarity with ECMO circuit components and mechanics and understand what is required for the maintenance of a circuit. The trainee will learn how to monitor the circuit to manage and troubleshoot mechanical complications.
4. To develop competence in the evaluation and monitoring of patients on ECMO. The trainee will develop tools to assess progress as well as the clinical acumen that will allow for the early recognition of complications that can arise on ECMO.
5. To critically appraise the literature and design and implement ECMO focused research studies in the PICU population and attend a high-level meeting to appreciate the most up to date research and evolving topics.
6. To understand the interdisciplinary nature of Extracorporeal Life Support as well as the resources necessary to maintain an ECMO program at an academic Children’s Hospital.

Rotation

Duration (weeks

ECMO Core

20

Medical/Surgical Intensive Care Unit

10

Cardiac Intensive Care Unit

2

Transfusion medicine

1

Perfusion medicine

1

Anesthesia of the critically ill child

2

Non-invasive imaging

2

Advanced cardiac therapies

2

Neurocritical care

1

Adult ECMO

4

Palliative care/ethics

1

Electives

2

Vacation

4

Total

52

*Sample curriculum, will plan to be catered to the needs of the fellow

Clinical Experiences

Clinical skills will be accomplished through a combination of direct patient care, didactic sessions, and self-directed learning modules. Trainees will spend time in the fellow role in the MSICU and CICU where they will be exposed to the ECMO cannulation process and caring for patients on ECMO. They will also work directly with the ECMO program leadership as well as the ECMO specialist team to develop their clinical expertise. Trainees will keep a log of their clinical activities and patients they follow; this will ensure trainees are gaining sufficient clinical exposure and allow for educational review. They will also participate in and lead multidisciplinary ECMO simulation sessions. Trainees will participate in all weekly conferences relating to ECMO.

The clinical topic areas in which the fellow should gain expertise in are (but are not limited to):

1. Physiologic indications for ECMO, including both cardiac and non-cardiac
2. ECMO circuit mechanics and components
3. Anticoagulation strategies on ECMO
4. ECMO complications
5. Neuromonitoring
6. Tandem therapies on ECMO
7. Management of multiorgan dysfunction on ECMO
8. Decannulation strategies
9. Pharmacology (pharmacodynamics and kinetics) on ECMO
10. Ethics of ECMO

Overview of ECMO Core Rotation

The trainee will spend the majority of their time in the “ECMO Core Rotation”. The fellow will begin their year with an ECMO orientation course which they will take with the ECMO perfusionists. They will then go on to follow patients on ECMO in both the CICU and MSICU, round on these patients on a regular basis, and discuss their management with the primary teams. The fellow will have regular scheduled meetings with an ECMO program faculty member on a weekly basis to discuss the ongoing management of these patients. The fellow will be expected to be signed in to the “ECMO fellow pager” during this rotation with the goal of attend both emergent and elective ECMO cannulations, participate in ECMO consultations, and discuss active ECMO transports. Attendance will be required at regular scheduled ECMO meetings throughout the year. The fellow will also be responsible for preparing didactics for monthly ECMO conferences.

Clinical Expectations

1. Attendance at an ECMO training course run by the ECMO specialists.
2. Round daily on ECMO patients and maintain a log of all ECMO patients followed throughout the year.
3. Hold the ECMO fellow pager and respond to all ECMO Activation pages including: Cardiac ECMO, Code ECMO, ECMO consults, Elective ECMO.
4. Participation in ECMO and Crisis Resource Management Simulations as offered throughout the year.
5. The fellow will meet weekly with a member of the ECMO Program leadership to discuss ongoing management of cannulated patients.

Attendance at ECMO meetings/conferences

1. ECMO Morbidity and Mortality

• The fellow will work with ECMO leadership to present morbidities and mortalities for review and decide on pertinent points for discussion. Through this process, cases which require root cause analysis will be identified and coordinated with the Program for Patient Safety and Quality.

2. ECMO Clinical governance meeting

• During this meeting, the ECMO leadership group discusses emerging issues on a weekly basis. Action items that arise from this meeting should involve the fellow.

3. ECMO Consult group meetings

• The fellow will present patients to the ECMO leadership group to discuss candidacy.

Trainees will be encouraged  to pursue an academic project during their training period that could be research, education, or quality improvement focused. There will be time during the ECMO Core rotation to pursue such academic interests. The general expectations are as follows:

1. The trainee will establish a faculty research mentor who will work with the fellow on a project proposal that will meet the academic requirement of the fellowship. This proposal will ideally be submitted prior to the start of the fellowship, but by August 15th at the latest. The project proposal must be reviewed and approved by the program leadership.
2. The trainee will meet regularly with research mentor(s). Present one “works in progress” session during the year.
3. The trainee will complete the above ECMO-related project by the end of the year. This can be but is not limited to a research project and manuscript, a quality improvement project, or an educational intervention/curriculum.
4. The trainee should attend and is encouraged to present at a high-impact national meeting to gain insight on trends and topics in ECMO. Examples are:
   • Extracorporeal Life Support Organization Conference
   • Society of Critical Care Medicine Conference
   • European Society of Pediatric and Neonatal Intensive Care Conference
   • World Federation of Pediatric Intensive and Critical Care Societies Conference

Trainees will also work with the ECMO program leadership on developing educational materials for critical care fellows, attendings, and ECMO specialists that could include emerging ECMO topics, growing evidence for clinical practices, or other ECMO related themes. Trainees will also attend didactic sessions during their targeted rotations. They will attend weekly ICU case conferences and have weekly ECMO case discussions with the ECMO fellowship staff.

Applications must be received by October 1 to be considered for the July start date of the following year. The application will be reviewed by ECLS Fellowship leadership. 

Application materials:

• Current Curriculum Vitae
• Personal Statement
• Three (3) Letters of Reference

Selection Process

• The ECLS program leadership will review all applications and will inform applicants invited for an interview by Nov. 1.
• Virtual interviews will take place in November of the year prior to the start date
• Offers will be made by December of the year prior to the start date

Applications and inquiries should be sent by email to:

• Jules Beuck, GME Program Administrator, Jules.Beuck@childrens.harvard.edu