HCSS Extracorporeal Membrane Oxygenation (ECMO) specialist/RRT

The ECMO Specialist (ES) is a licensed allied health care professional with a strong clinical background in neonatal, pediatric and/or adult critical care and advanced cardiopulmonary support. The ES has ≥ 2 years ICU experience or completion of an accredited cardiovascular perfusion training program. The ES is responsible for the coordination of clinical care for patients requiring the support of extracorporeal life support (ECLS) & mechanical circulatory support (MCS) devices under the direction & supervision of credentialed ECMO and advanced heart failure physicians. The ES has successfully completed advanced training to operate ECLS & MCS devices, in accordance with guidelines established by the Extracorporeal Life Support Organization (ELSO) & the American Society of ExtraCorporeal Technology (AmSECT). The ES adheres to the policies, guidelines & best practices set forth by the director, manager & coordinator of the ECMO department. The ES plays a key role in device management, patient monitoring, emergency response, and quality improvement initiatives. Clinical Level Detail The ECMO Specialist (ES) is a competent technical specialist, preceptor & ECMO primer. The ES is a proficient clinician in two high acuity clinical environments where care of an ECLS or MCS patient is provided (2 ICU's or Any ICU + OR, CVL, Transport etc.) & in two patient populations (Adult, Pediatric &/or Neonatal). Clinical Level Minimal Experience The required experience to qualify as an ES is ≥ 2 years’ experience as an ES; or completion of an accredited program in cardiovascular perfusion, advanced practice registered nurse, physician assistant or medical school. Completed the annually required ELSO & AmSECT based didactic education, hands on drills, simulations & passed annual competency examination(s) for an ES. Completed clinical ECMO orientations in two patient populations (Adult, Pediatric &/or Neonatal). Major Duties / Critical Tasks Communication Participates in monthly interdisciplinary ECMO case reviews and in-services to share information and determine appropriateness of patient care plans. Supports ECMO team research through the collection of ECMO-related data, preparation, and presentation of research abstracts and/or other documentation. Utilizes the ECMO flow sheet to maintain ongoing complete and detailed documentation of patient history and the amount of blood and other fluids administered and any complications that may occur. Provides family/parental education and reinforces medical counseling initiated by the ECMO physician. Provides a clear and concise end of shift report for the oncoming ECMO Specialist regarding machine settings, patient status, and patient care plans. Technical Specialist Collaborates with multidisciplinary physician teams to identify patients indicated for ECLS or MCS therapies and guides care team to adhere to indications and contraindications as found in hospital guidelines and protocols. Coordinates & collaborates with multidisciplinary care team to prepare patient and environment for the timely and safe initiation of ECLS or MCS support. Assesses and manages patient clinical needs, including patient assessment, hemodynamic monitoring, NIRS, blood gas interpretation, laboratory results, fluid balance, nutrition, respiratory support, neurologic status, infection control, sedation, pain management, hematology, and cardiac function. Collaborates with the ECMO physician and other health care providers involved in the management of the patient to coordinate all tests and evaluations (e.g. head and cardiac ultrasounds and EEGs) and provide care in accordance with the patient’s individualized care plan. Recommends modifications in patient management to the ECMO physician based on the relationship between patient diagnosis and ECMO circuit and/or lab parameters. Coordinates with care team to ensure safe execution and delivery of diagnostic testing such as x-ray, ultrasound, echocardiography, EEG including safe and timely transportation to CT, cath lab or operating room. Evaluates chest x-rays for endotracheal tube, ECMO cannula, or MCS device position & placement. Assists the physician during insertion of extracorporeal VAD devices; manages and troubleshoots equipment issues such as pump failures or circuit occlusions; monitors and optimizes patient hemodynamics and anticoagulation strategies to prevent thrombosis or bleeding; coordinates discontinuation and removal processes, ensuring safe weaning and device explanation. Assists the physician during percutaneous insertion of VADs; manages and troubleshoots device‑specific issues like position migration or suction events; assesses patient hemodynamics and anticoagulation protocols; oversees discontinuation, including safe removal and post‑removal monitoring. Assists the physician & VAD coordinator during surgical implantation; manages and troubleshoots equipment such as driveline issues or pump thrombosis; evaluates and fine‑tunes patient hemodynamics and long‑term anticoagulation strategies; facilitates discontinuation through explanation or transition to other therapies following guidance of the VAD coordinator. Prepares and primes ECLS circuits, including pumps, oxygenators, heat exchangers, shunt lines and associated components, ensuring sterility and functionality prior to patient connection. Safely blood primes ECMO circuits for patients as indicated by department guidelines, policies or as requested by cannulating ECMO physician. Maintains competency in strategies to anticoagulate, buffer, reverse citrate, wash, & hemoconcentrate blood components added to the circuit. Evaluates circuit gases and monitors circuit integrity. Continuously monitors and maintains ECMO circuit integrity, adjusting blood flow rates, monitoring pressure gradients, to prevent complications such as hemolysis or clot formation. Calculates metrics such as oxygen consumption (VO2), oxygen delivery (DO2), oxygen transfer rate, recirculation & sweep gas adjustment rate using in‑line tools and blood gas analyses. Identifies and resolves issues such as circuit leaks, component failures, or suboptimal performance, including elective or emergent component changes when indicated. Monitors and adjusts anticoagulation levels to balance the risk of circuit thrombosis and patient hemostasis. Follows guidelines for gradual weaning, assessing patient readiness, and assisting in safe decannulation procedures. Participates in daily rounds, case reviews, and ECMO transport (in‑hospital or inter‑facility), ensuring secure patient handling and circuit integrity. Contributes to staff training, continuing education, critical incident reviews, and tracking performance indicators such as bleeding events, supporting ECMO program’s quality improvement initiatives. Assists in setup of continuous veno‑venous hemodiafiltration (CVVHD) or hemodialysis devices integrated into the ECMO circuit; monitors therapy parameters including dialysate flow, ultrafiltration rates, electrolyte balance, and fluid removal; manages ongoing therapy by adjusting settings for optimal clearance and patient stability; troubleshoots issues such as filter clotting, pressure alarms, or access problems. Implements slow continuous ultrafiltration (SCUF) within the ECMO circuit for fluid removal; monitors ultrafiltration volumes, patient hemodynamics, and electrolyte shifts; manages and troubleshoots technique‑specific issues such as inadequate fluid extraction or circuit pressures. Applies zero‑balanced ultrafiltration (ZBUF) in the ECMO circuit to achieve iso‑volumic fluid removal while maintaining balance; monitors replacement fluid administration, ultrafiltrate output, and patient volume status; troubleshoots imbalances or circuit complications. Utilizes counter‑current hemodialysis integrated into the ECMO circuit for solute clearance and fluid control; monitors dialysate and blood flow directions, clearance efficiency, and patient responses; manages and troubleshoots diffusion gradients, membrane fouling, or hemodynamic instability. Integrates cytokine adsorbers into the ECMO circuit for removal of cytokines, endotoxins, and inflammatory markers in conditions such as sepsis or ARDS; monitors adsorption efficiency, cartridge performance, and patient inflammatory biomarkers; manages and troubleshoots adsorber saturation or circuit integration issues. Administers patient‑required medications directly into the ECMO circuit, accounting for circuit sequestration and pharmacokinetic alterations; monitors drug levels and effects, troubleshooting suboptimal responses or interactions. Administers blood products via the ECMO circuit to maintain target hemoglobin, platelet counts, and coagulation factors; monitors transfusion effects on circuit function and patient hematology; troubleshoots transfusion‑related complications such as hemolysis or clotting. Evaluates clot formation through visual inspection, pressure monitoring, triage severity, and recommends anticoagulation adjustments to mitigate risks of major patient events such as embolism or circuit failure. Manages ECMO system flow, interpreting alarm triage, and troubleshooting to resolve deviations greater than 10% from physician‑ordered goals while ensuring stable hemodynamics. Interprets and troubleshoots ECMO system alarms, triaging the need for planned or emergency component and system replacement strategies for all hospital‑owned devices used in extracorporeal life support or mechanical circulatory support. Addresses alarms from any device connected to the ECMO circuit, triaging the need for replacement and coordinating with the allied health care team to replace equipment in a safe and timely manner. Emergency Responses Respond to ECMO circuit power or equipment failures by activating backup systems and hand‑cranking if necessary, ensuring minimal interruption of continuous therapy. Detect and eliminate air bubbles in the circuit using bubble detectors and de‑airing techniques. Stabilize and reposition dislodged cannulas, coordinating with the team for immediate surgical intervention while maintaining patency of functioning cannula. Manage acute bleeding or hypotensive episodes by adjusting flow rates, administering fluids or blood products, and optimizing anticoagulation strategies. Collaborate with the multidisciplinary team to stabilize hemodynamics of the patient and adjust ACLS & PALS algorithm to augment the support capabilities of the current ECLS or MCS strategy. Triage the need for planned or emergent circuit exchange and coordinate with the allied health care team to safely complete a full circuit exchange. Rapidly triage and differentiate blood pump failures (clotted cone, decoupling) and address failures by replacing the failed blood pump. Respond to circuit tubing fractures or ruptures by clamping affected sections, replacing tubing, and restoring circuit integrity to prevent blood loss or air entry. Detect and correct circuit tubing kinks or occlusions by repositioning tubing or replacing segments, restoring optimal flow. Manage oxygenator failure by monitoring gas exchange metrics, triaging for immediate replacement, and executing change‑out procedures to maintain support. Address heat exchanger failure by assessing temperature control issues, isolating the component, and replacing it to prevent thermal dysregulation. Triage blood path circuit component failures such as filters or connectors, determining emergency versus planned replacement strategies, and performing replacements to sustain circuit function. Respond to failures in connected equipment such as monitors or heaters by isolating the issue, activating backups, and coordinating repairs or replacements. Apply emergency clot removal techniques when flow through cannulas, pump, or oxygenator is compromised, using aspiration, component replacement, or emergent surgical intervention. Manage cannula dislodgment, malpositioning, or flow impedance by identifying the failing cannula, isolating if necessary, and preserving patency of the remaining functional cannula. Triage the need to initiate emergency hand‑cranking, coordinating with the allied health care team to maintain goal‑directed flow and replace failed motor, cables, or ECMO system components. Knowledge / Skills / Abilities Maintain clinical competencies for level of position through regular clinical simulations & hands‑on emergency drills. Complete the annual ECMO didactic program with a satisfactory score of 90 % or above on the annual ECMO exam. Complete required special procedure classes. Knowledge regarding quality improvement and standards of care within practice area. Experience teaching patients and families. Knowledge of and ability to evaluate and assess arterial blood gas measurements. Ability to respond to emergent or stressful situations appropriately, calmly, and in a timely manner. Respond to ECMO activation within 45‑60 minutes. Provide 1‑2 on‑call shifts per month; will not sign up for regular shifts on other units in conjunction with call shifts unless notice is given to ECMO Coordinator/Manager with approval. Required Education / Experience Licensed as Respiratory Care Practitioner and RRT credentialed by the National Board for Respiratory Care or Registered Nurse license in the state of Texas or Certified Clinical Perfusionist (CCP) as recognized by the American Board of Cardiovascular Perfusion (ABCP) and State of Texas licensure. Graduate of a Commission on Accreditation for Respiratory Care (CoARC) accredited School for Respiratory Care or degree in Nursing or graduate of Perfusion Program. Preferred Baccalaureate degree and certification in care specific area. Two (2) years of experience as an ECMO Specialist (ECMO Primer) & maintains active competencies to prime and initiate ECMO. Bachelor’s degree or higher in allied health or healthcare related discipline. Must have current ACLS, BLS, and PALS obtained through American Heart Association (AHA). ECMO Specialist Certification through ELSO or AmSECT. ELSO’s Adult (E-AEC) or Neonatal/Pediatric (E-NPEC) or AmSECT’s Adult (CES‑A) or Pediatric (CES‑P). May be required to travel in ambulance with patient. Ability to lift up to 50 pounds maximum with frequent lifting or carrying objects weighing up to 25 pounds. Any qualifications to be considered as equivalents in lieu of stated minimums require the prior approval of the Executive Director of Human Resources. Compensation Hiring Range: $100.00 #J-18808-Ljbffr