The ECMO program at St. Louis Children’s Hospital is a robust, multidisciplinary service offered in all in the NICU, PICU, and CICU. As an institution, we are a regional leader in ECMO technology and our survival rates have been consistently above the national average. We are proud to be an Extracorporeal Life Support Organization (ELSO) Platinum Center of Excellence, a level of designation awarded by ELSO to programs with highest level of performance, innovation, and quality.
On average, our NICU has 7-12 annual ECMO runs that are medically managed by core ECMO faculty and the on-service fellows. We treat a variety of diagnoses including congenital diaphragmatic hernia (CDH), pulmonary hypertension, respiratory failure from respiratory distress syndrome or meconium aspiration, and giant omphalocele, among others. Our NICU is also equipped to provide renal replacement therapy (CRRT and aquadex) for neonates with renal failure.
Education
Bootcamp
Our incoming neonatal-perinatal medicine fellows are provided with an all-day ECMO boot camp prior to starting on service in the NICU (July). This program consists of didactic lectures, a hands-on overview of the ECMO circuit, discussion of clinical cases, and simulation scenarios with our ECMO faculty and bedside ECMO specialists.
Rounds
With each patient that is cannulated onto ECMO, we offer daily clinical rounds both in person and virtually to facilitate fellow education. These rounds are multidisciplinary and include the on-service clinical fellow and faculty leading ECMO education that is tailored to the specific patient and their medical challenges. On-service fellows caring for patients on ECMO are also encouraged to create informal “chalk-talks” for learners present on the team. All fellows are encouraged to attend cannulations, low flow/clamp trials and decannulations to encourage continued exposure to the entirety of the ECMO process.
Didactics
ECMO case reviews occur quarterly and focus on specific challenges for NICU patients who received ECMO. The fellow who cared for that patient will present the ECMO course, discuss challenges and teaching points, and relevant ECMO topics (e.g., anti-coagulation, nutrition, fluid management) under the guidance of a core ECMO faculty member. A yearly ECMO refresher course (1-2 hours) is offered by the ECMO leadership to all providers including fellows who care for infants treated with ECMO.
Follow-up
Our Newborn Medicine Follow-Up clinic offers a monthly ECMO/CDH clinic that all fellows attend at least once during their training, with the option to attend additional clinics, if interested.
Additional training
We offer additional clinical training in ECMO for fellows through an ECMO pathway which includes additional education, more in-depth, hands-on circuit training with our advanced ECMO specialists and perfusion team, and presentations on ECMO-related topics, under the guidance of our NICU ECMO medical director Tasnim Najaf. Fellows who complete this advanced training will receive an advanced ECMO certificate upon fellowship graduation.