DAY 1 (WEDNESDAY, OCTOBER 25, 2023):

7:00-8:00 a.m.     Registration and Breakfast

8:00-8:30 a.m.     Welcome and Overview         
Keri Hickman, CCP

ECMO OVERVIEW
Different modes of ECMO support
Global trends in ECMO utilization

8:30-9:00 a.m.     Past to Present: History and Recent Evidence    
Holt Murray, MD

HISTORY OF ECMO
List the key milestones in the development of ECMO
Describe the evolution of the Extracorporeal Life Support Organization

HISTORICAL STUDIES
List the historical ECMO studies and their limitations

RECENT EVIDENCE FOR VV ECMO
Interpret results and limitations of the main cohort studies on VV ECMO
Interpret results and limitations of the CESAR and the EOLIA trials

RECENT EVIDENCE FOR VA ECMO
Interpret results and limitations of the main cohort studies on VA ECMO
Interpret results of studies/trials comparing temporary VADs to VA ECMO

9:00-09:30 a.m.     Circuit Components  
Brandon D’Aloiso, CCP

CIRCUIT OVERVIEW
Define the main components of an ECMO circuit
List circuit monitoring tools

CANNULAS & TUBING
Describe the differences in ECMO cannula design
List the considerations for selecting the appropriate ECMO cannula

PUMP
Describe the requirements of a blood pump used in ECMO
Explain the physics and working principles of a centrifugal pump

MEMBRANE LUNG & BLENDER
Describe the structure and function of the membrane lung
Describe the function of the blender

PRESSURE MONITORING
List the different pressure zones in an ECMO circuit
Discuss the utility of monitoring drainage pressure

OTHER CIRCUIT COMPONENTS
Describe the utility of the flowmeter
Describe the function of the heater
Describe the utility of circuit clamps

9:30-10:00 a.m.     Configurations & Cannulations
Pablo Sanchez, MD

CANNULATION
List the differences between percutaneous and open cannulation
Outline the process of percutaneous cannulation
Discuss the role of ultrasound in cannulation

VV ECMO CONFIGURATIONS
List the different configurational options for VV ECMO
Review the benefits and limitations of specific configurations

VA ECMO CONFIGURATIONS
List the different configurational options for VA ECMO
Review benefits and limitations of specific configurations

CANNULATION COMPLICATIONS
Identify complications of ECMO cannulation
Describe steps to prevent, recognize, and treat complications

10:00-10:15 a.m.     Break

10:15-10:45 a.m.     ECMO Physiology       
Raj Ramanan, MD

OXYGEN DELIVERY & UPTAKE
Describe the normal physiology of oxygen delivery and uptake

GAS TRANSFER IN MEMBRANE LUNG
Describe the key determinants of oxygen uptake in the membrane lung
Describe the key determinants of carbon dioxide removal in the membrane lung

HEMODYNAMIC MONITORING OF VV
List the hemodynamic changes that accompany VV ECMO
Describe the changes in hemodynamic monitoring on VV ECMO

HEMODYNAMIC MONITORING OF VA
Discuss the hemodynamic changes that accompany VA ECMO
Describe the changes in hemodynamic monitoring on VA ECMO

10:45-11:15 a.m.     Anticoagulation   
Ryan Rivosecchi, PharmD

ANTICOAGULATION
List anticoagulation strategies on ECMO
Discuss anticoagulation monitoring on ECMO

11:15-11:45 a.m.     Daily Management for the ECMO Specialist       
Keri Hickman, CCP

RENAL REPLACEMENT THERAPY
Identify the benefits and limitations of administering RRT via a dialysis catheter
Identify the benefits and limitations of administering RRT via the ECMO circuit

INTRAHOSPITAL TRANSPORT
Identify considerations and logistics for intrahospital transport

11:45am – 12:45 p.m.     Lunch

12:45-1:00 p.m.     Introduction to Simulation
Keri Hickman, CCP

1:00-5:15 p.m.      Simulations
Instructors: Raj Ramanan, Veronica Garvia-Bianchini, Timothy Kaselitz, Keri Hickman, Brandon D’Aloiso, Peter Arlia, Amber Palmer, Tyler Eadie

1. Circuit Components

2. CardioHelp Setup, Priming, & Knobology

3. CentriMag Setup, Priming, & Knobology

4. Pressures 101/CRRT

5:15 p.m.      Adjournment Day One

DAY 2 (THURSDAY, OCTOBER 26):

7:00-8:00 a.m.     Breakfast

8:00-8:30 a.m.     Respiratory Failure  
Timothy Kaselitz, MD

Provide an overview of respiratory failure
List standard management strategies for respiratory failure
Discuss the rationale of VV ECMO in respiratory failure

8:30-9:00 a.m.     Patient Selection for VV ECMO       
Raj Ramanan, MD

List the indications and contraindications for VV ECMO support

9:00-9:15 a.m.     Break

9:15-9:45 a.m.     Management of VV ECMO
Raj Ramanan, MD

INTIATION OF VV ECMO
Describe the steps in initiating a patient onto VV ECMO

VV ECMO MAINTENANCE
Describe titration of blood flow and gas flow to achieve adequate support on VV ECMO
Describe the concept of native lung rest

WEANING VV ECMO
Describe the process of weaning VV ECMO support
List exit strategies for the VV ECMO patient

9:45-10:15 a.m.     VV ECMO Case Vignettes
Raj Ramanan, MD

DRAINAGE INSUFFIENCY
Define and diagnose drainage insufficiency
Troubleshoot drainage insufficiency

RETURN OBSTRUCTION
Define return obstruction and identify its causes
Diagnose and manage return obstruction

RECIRCULATION
Define and identify recirculation
Troubleshoot recirculation

10:15-10:30 a.m.     Break

10:30-11:00 a.m.     Circuit Complications     
Peter Arlia, CCP

(MECHANICAL) COMPLICATIONS OVERVIEW
PUMP FAILURE
Define pump failure
Describe how to identify and manage pump failure

MEMBRANE LUNG DYSFUNCTION
Define membrane lung dysfunction
Describe how to diagnose and manage membrane lung dysfunction

AIR EMBOLISM
Define air embolism and its determinants
Define strategies to prevent air embolism
Describe how to detect and manage air embolism

CIRCUIT DISRUPTION
Identify determinants of circuit disruption
Recognize early signs of circuit disruption
Manage circuit disruption

ACCIDENTAL DECANNULATION
Manage an accidental decannulation

COMING OFF ECMO EMERGENTLY
List the indications for coming off ECMO emergently
List the steps required to come off and back on ECMO emergently

11:00am – Noon     Lunch

Noon – 4:15 p.m.     Simulations
Instructors: Raj Ramanan, Veronica Garvia-Bianchini, Timothy Kaselitz, Keri Hickman, Brandon D’Aloiso, Peter Arlia, Amber Palmer, Tyler Eadie

4:15  p.m.      Adjournment Day Two

5:30-7:30 p.m.     Vendor Meet & Greet

DAY 3 (FRIDAY, OCTOBER 27):

7:00-8:00 a.m.     Breakfast

8:00-8:30 a.m.     Cardiac Failure
David Kaczorowski, MD

Provide an overview of cardiac failure
List standard management strategies for cardiac failure
Discuss the rationale of VA ECMO in cardiac failure

8:30-9:00 a.m.     Patient Selection for VA ECMO  
Michael Lazar, MD

List the indications and contraindications for VA ECMO support

9:00-9:15 a.m.     Break       

9:15-9:45 a.m.     Management of VA ECMO       
David Kaczorowski, MD

INITIATION OF VA ECMO
Describe the steps for initiating a patient

VA MAINTENANCE
Describe vasopressor use and blood flow titration for cardiovascular support
Describe the concept of native heart rest
Describe ventilator management and blood and gas flow titration for pulmonary support

WEANING VA ECMO
Describe the process of weaning VA ECMO support
List exit strategies for the VA ECMO patient

9:45-10:15  a.m.     VA ECMO Case Vignettes
Raj Ramanan, MD

LV DISTENTION
Describe the mechanism of LV distention
List strategies to unload the left ventricle

DIFFERENTIAL OXYGENATION
Define and identify differential oxygenation
Troubleshoot differential oxygenation

10:15-10:30 a.m.     Break

10:30-11:00 a.m.     ECPR     
David Kaczorowski, MD

Describe ECPR
Interpret results and limitations of the major clinical trials on ECPR
Patient selection with emphasis on inclusion and exclusion criteria
Logistics of establishing and maintaining an ECPR program

11:00 a.m. – Noon      Lunch

Noon – 4:15 p.m.     Simulations
Instructors: Raj Ramanan, Veronica Garvia-Bianchini, Timothy Kaselitz, Keri Hickman, Brandon D’Aloiso, Peter Arlia, Amber Palmer, Tyler Eadie

4:15 p.m.     Adjournment Day Three

DAY 4 (SATURDAY, OCTOBER 28):

7:00-8:00 a.m.      Breakfast

8:00-8:30 a.m.      Daily Management for the ECMO Physician
Timothy Kaselitz, MD

SEDATION
Identify the role of sedation during ECMO support
Discuss the paradigm shift towards awake ECMO

PROCEDURES
Discuss considerations for procedures on the ECMO patient

PHYSIOTHERAPY
Describe the rationale for physiotherapy during ECMO
Identify appropriate candidates for physiotherapy on ECMO

8:30-9:00 a.m.      Patient Complications   
Veronica Garvia, MD

(MEDICAL) COMPLICATIONS OVERVIEW NEUROLOGICAL COMPLICATIONS
List the etiology and risk factors for neurological complications
Discuss the management of ischemic and hemorrhagic strokes

BLEEDING
List the etiology of bleeding
Discuss the management of bleeding

THROMBOSIS
List the etiology of thrombosis
Discuss the management of thrombosis

HEMOLYSIS
Understand the etiology and risk factors of hemolysis on ECMO
Discuss how to prevent and manage hemolysis

LIMB ISCHEMIA
List the risk factors for developing limb ischemia on VA ECMO
Describe how to monitor limb perfusion
Discuss the prevention and management of limb ischemia

CARDIAC ARREST DURING ECMO
Discuss the management of cardiac arrest on VV ECMO
Discuss the management of cardiac arrest on VA ECMO

9:00-9:15 a.m.      Break

9:15-9:35 a.m.      Inter-Hospital Transport    
Frank Guyette, MD

INTERHOSPITAL TRANSPORT
Identify considerations and logistics for interhospital transport

9:35-9:55  a.m.     Coding & Billing for the ECMO Provider
Alexandrea Bartow, MBA, MSN

Describe rationale for accurate documentation
Describe process of coding & billing Quality assurance

9:55-10:15 a.m.     Ethical & Legal Challenges
TBD

END-OF-LIFE DECISION MAKING WITHDRAWAL OF ECMO SUPPORT

10:15-10:30 a.m.     Break

10:30 a.m. – 1:30 p.m.     Simulations: Comprehensive Sim/LUNCH
Instructors: Raj Ramanan, Veronica Garvia-Bianchini, Timothy Kaselitz,Keri Hickman, Brandon D’Aloiso, Peter Arlia, Amber Palmer, Tyler Eadie

1:30-2:00 p.m.     Q&A With Faculty
Moderator: Raj Ramanan

2:00 p.m.     Course Adjournment

Course Directors

Raj Ramanan, MD
Assistant Professor of Critical Care Medicine
Department of Critical Care Medicine
Medical Director, ECMO
Director, Procirca ECMO Education
University of Pittsburgh Medical Center
Pittsburgh, PA

Pablo G. Sanchez, MD, PhD, FACS
Brack G. Hattler Professor in Cardiothoracic Transplantation
Vice-Chair for Diversity, Equity & Inclusion
Chief, Division of Lung Transplant & Lung Failure
Surgical Director, ECMO
Associate Program Director CT Surgery Residency Program
Department of Cardiothoracic Surgery
University of Pittsburgh School of Medicine
Pittsburgh, PA

David Kaczorowski, MD
Associate Professor of Cardiothoracic Surgery
Surgical Director, Advanced Heart Failure Center
Department of Cardiothoracic Surgery
University of Pittsburgh School of Medicine
Pittsburgh, PA

Faculty

Brandon D’Aloiso, MS, CCP
Lead Perfusionist of Education
University of Pittsburgh Medical Center
Pittsburgh, PA

Peter Arlia, BS, CCP, LP, MBA
Director, Perfusion Services
University of Pittsburgh Medical Center
Pittsburgh, PA

Alexandrea Bartow, MBA, MSN, ACNP-BC, RN, CSSGB
Director, Clinical/Quality Documentation
Wolff Center, Division of Corporate Quality
University of Pittsburgh Medical Center
Pittsburgh, PA

Veronica Garvia-Bianchini, MD
Assistant Professor of Critical Care Medicine
Department of Critical Care Medicine
University of Pittsburgh Medical Center
Pittsburgh, PA

Francis Guyette MD, MPH
Medical Director, STAT MedEvac
Professor of Emergency Medicine
University of Pittsburgh Medical Center
Pittsburgh, PA

Keri Hickman, CCP
Director, ECMO Management
University of Pittsburgh Medical Center
Pittsburgh, PA

Timothy Kaselitz, MD
Assistant Professor of Critical Care Medicine
Department of Critical Care Medicine
University of Pittsburgh Medical Center
Pittsburgh, PA

Michael Lazar, MD, MHA, FACC
Executive Medical Director, UPMC Williamsport HVI
Regional Director, HVI Cardiac Surgery UPMC Williamsport, Altoona and Western Maryland
University of Pittsburgh Medical Center
Williamsport, PA

Holt Murray, MD
Assistant Professor of Critical Care Medicine
Department of Critical Care Medicine
Medical Director, CTICU
University of Pittsburgh Medical Center
Pittsburgh, PA

Ryan Rivosecchi, PharmD, BCCCP
Clinical Pharmacist Cardiothoracic ICU
Supervisor of Critical Care, Cardiology and Transplant Clinical Pharmacy Services
University of Pittsburgh Medical Center
Pittsburgh, PA

Additional Simulation Faculty

Amber Palmer, MS, CCP
Lead Perfusionist of Simulation
University of Pittsburgh Medical Center
Pittsburgh, PA

Tyler Eadie, MS, CCP
Lead Perfusionist of Simulation
University of Pittsburgh Medical Center
Pittsburgh, PA

The Cambria Hotel Pittsburgh – Downtown
1320 Centre Avenue
Pittsburgh, PA 15219
412-381-6687

A block of rooms is reserved at a special rate of $139/night.

Make a hotel reservation for the October 2023 Course >>

25 minutes from the Pittsburgh International Airport

Transportation options:  car rental, ride sharing (Uber, Lyft), public transportation (28X Airport Flyer), and taxis (Yellow Cab, ZTrip)

In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician (CME)
The University of Pittsburgh designates this live activity for a maximum of 26.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing (CNE)
The maximum number of hours awarded for this Continuing Nursing Education activity is 20.0 contact hours.

Physician Assistant (AAPA)
The University of Pittsburgh has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 20.0 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

ASET CEUs
ASET – The Neurodiagnostic Society has granted 19.5 Continuing Education Units [ASET-CEUs] for this program.  Such crediting, however, should not be construed by program participants as an endorsement of any type of instruments or supplies mentioned or involved in these presentations.

Procirca is an ABRET-accredited Intraoperative Neuromonitoring lab.
Participation by all individuals is encouraged. Advance notification of any special needs will help us provide better service. Please notify us of your needs at least two weeks in advance of the program by calling 412-647-3450.  This program is presented by Procirca in conjunction with the University of Pittsburgh Department of Neurology and The Center for Clinical Neurophysiology.