This curriculum is designed to provide a comprehensive understanding of the management of patients requiring advanced mechanical support devices including extracorporeal membrane oxygenation (ECMO), impella, and left ventricular assist device (LVAD). At IU School of Medicine, our lung transplant and ECMO programs are closely tied together. While rotating in the ICU, in addition to management of mechanical circulatory devices, fellows will also have the opportunity to care for lung and heart transplant recipients. This includes the management of peri-operative lung transplant patients, prior lung transplant recipients with acute critical illness, new heart transplant recipients and ECMO bridge to transplant as well as post pulmonary thromboendarterectomy CTEPH patients.
All advanced lung disease fellows will rotate through our ECMO service at Indiana University. This allows for deep conceptual understanding of ECMO candidacy and unique challenges of caring for patients on ECMO. ECMO specific fellows will spend a majority of their time on the ECMO service inpatient and have several unique opportunities.
Fellows will manage:
- Peri-operative lung transplant recipients
- Urgent inpatient referrals for ECMO
- Determination of candidacy for ECMO
- Determination of candidacy for E-CPR
- Previous lung transplant recipients who are critically ill
- ECMO patients:
- VA, VV, V-AV, Oxy-RVAD.
- Bridge to transplant (lung, heart)
- Post-operative LVAD patients
- Pulmonary Thromboendarterectomy post-operative management
ECMO program stats
- Top 20% of ECMO programs in the U.S. and top 13% globally (for adult volumes)
- Over 1000 ECMO runs since program inception (2011)
- Over 80 ECMO runs in 2023 (as of 8/17/23)
- Consistently at or above national outcomes
- Mobile ECMO program
Teams
- CV/CT Surgery - Staff, Residents, PAs
- Transplant Pulmonology - Staff, NPs
- Pharmacy - Transplant trained
- ECMO Technicians - Specifically trained RTs and RNs who have completed course work in ECMO
Rotations
Advanced lung disease fellows will spend one month on the ECMO rotation:
- Inpatient ICU rotations Monday through Friday starting at 7am
- Two weekends a month
- Opportunity to participate in organ procurement, mobile ECMO
ECMO fellows will complete the following rotations:
- One month orientation
- One month on critical care ultrasound rotation
- One month on cardiovascular surgery ECMO team
- Six months on ECMO service
- Three months of elective time
Procedures
- Diagnostic/therapeutic bronchoscopy
- Percutaneous tracheostomy
- Chest tube placement (Percutaneous, surgical cut down)
- Central line insertion
- Arterial line insertion
- Argon Plasma Coagulation (bronchoscopy)
- Cryotherapy (bronchoscopy)
- Critical care ultrasonography and TEE