Extracorporeal Life Support Fellowship

Our fellows train at Texas Children's Hospital, which consistently ranked among the top pediatric hospitals in the nation.

About the Program

The rapid proliferation and adoption of extracorporeal therapies is driving a concomitant demand for professionals with greater experience with these technologies than they normally receive during a subspecialty fellowship in pediatrics or pediatric surgery. In the spring of 2019, Texas Children’s inaugurated its ECLS fellowship program. The objective of the program is to train pediatric subspecialists (intensivists, neonatologists, pediatric surgeons) in the principles and practice of different extracorporeal support modalities, including ECMO (VV or VA), ventricular assist and Impella VAD for cardiac and respiratory disease. When they finish the training, graduates of the fellowship will possess the competencies to join a high-functioning ECMO team at any leading children’s hospital or start a new ECMO program from scratch at an institution wanting to establish one.

Although called a “fellowship,” the 1-year training program is not ACGME-sanctioned. Approved trainees are appointed as Instructors in the Department of Pediatrics (or Pediatric Surgery) at Baylor College of Medicine, and provide attending-level coverage within their respective disciplines (pediatric critical care, neonatology, or pediatric surgery) during 6-10 weeks of their year.

The fellowship is designed to be tailored to the particular needs of our trainees. Our first three fellows were pediatric intensivists who spent 8 weeks in adult ECMO rotations here in Houston and conducted several ECMO transports. Our fourth fellow, also a pediatric intensivist, will receive similar broad-based training that includes rotations on adult ECMO services at collaborating institutions, ECMO transport (ground and air), priming, maintenance and troubleshooting of extracorporeal circuits, training in renal and liver replacement therapies, transfusion medicine, imaging and supervised cannulations.

Admissions

To apply, please address a letter of interest together with an updated CV and two letters of reference to:

James A. Thomas, M.D.
Medical Director, ECMO Program
Texas Children’s Hospital
Email: jathoma1@texaschildrens.org

Applications will be reviewed by a panel of ECMO physicians and promising candidates will be invited for interviews (to be conducted virtually again this year).

Curriculum

The curriculum is designed to flex to the needs of each fellow. An example curriculum with objectives is included below.

Be familiar with the indications for, as well as, benefits and risks of ECMO for various physiologic indications.

Respiratory ECMO
Post-cardiotomy ECMO
ECMO for refractory shock
E-CPR

Perform consultations in the ICU to help determine the appropriate candidacy of patients for ECMO therapy.

VV ECMO candidates
VA ECMO candidates

Round on cannulated ECMO and VAD patients in all critical care units.

Be capable of constructing and priming an ECMO circuit.

Understand tubing size selection
Be familiar with the different types of oxygenators available
Be able to choose an appropriate cannula size for a given patient
- Dual-lumen cannula
- Single-lumen cannula
  - Venous
  - Arterial
Be familiar with both the standard ECMO circuit and the transport ECMO circuit.

Understand the anticoagulation strategies for patients requiring ECMO.

Be able to initiate and manage anticoagulation for patients on ECMO.
Understand coagulation assays used for patients on ECMO.
Become familiar with special situations that may require changes in anticoagulation management (e.g., surgery, bleeding, thrombosis, DIC, elevations in plasma-free Hgb, etc.).
Have the opportunity to work closely with the transfusion medicine team.

Acquire the ability to cannulate patients onto VV ECMO with a dual-lumen cannula using ultrasound and fluoroscopy guidance.

To be done in conjunction with pediatric surgery.

Understand and be able to construct, prime and initiate ultrafiltration and/or dialysis via the ECMO circuit.

Basic ultrafiltration
Dialysis using the ECMO circuit
CRRT in tandem with ECMO

Become familiar with ECMO transport

Manage patients during transport.
Be capable of cannulating a patient at an outside institution.

Create practice guidelines to assist with management of ECMO patients at Texas Children's Hospital.

Sedation
Ventilation
Coagulation

Complete project/manuscript related to ECMO by the end of instructor year.

Become involved in simulation.

Help run ECMO simulation scenarios for Fellows and Advanced Practice Providers.
Attend Lectures for ECMO orientation sessions.
Help create additional scenarios for senior fellows and junior faculty.
Will help give lectures for ECMO RN group.

Take ownership of the consult log, keep it updated and follow up on curbside consults.

Be a member of the ECMO journal club and present at least one article every 6 months..

Lead Thursday ECMO/VAD meetings.

Running the list of current patients on mechanical devices.
Help maintain didactic schedule and speakers each week.
Present 5-6 topics during the year (One per month).

Attend high-impact national ECMO meetings to gain insight into current trends and future directions of mechanical support (e.g., ELSO international or regional (Euro oro LATAM) meeting, Keystone or SCCM).

PICU Service Attending (8 weeks)

ECMO Call (24 weeks)

Will be on-call with the ECMO attending 24/7 during 2 month critical care blocks except for designated vacation time.
Will be on all ECMO transport..
Will attend ECMO rounds in all units as able (PICU, CICU, NICU)

CVOR Perfusionist (1 week)