The Department of Critical Care Medicine at the First Affiliated Hospital, Zhejiang University School of Medicine is one of the earliest units in Zhejiang Province to adopt ECMO (Extracorporeal Membrane Oxygenation) technology. It boasts 15 ECMO consoles, including the state-of-the-art Cardio help models, and performs over 200 ECMO treatments annually, ranking among the top in the country for ECMO quantity and possessing robust remote rescue capabilities. With years of teaching experience, the Department has successfully held 42 sessions of the “Zhejiang Provincial Health Emergency High-Level Cadre Training Project - ECMO Specialized Talent Training”. The Department is now focused on patient-centered care, aiming to enhance the clinical application of ECMO technology and promote the development of a high-quality workforce, in line with the national instructions on the reform of the industrial worker team construction. It offers ECMO workshops for emergency and critical care medical staff.

The First Affiliated Hospital, Zhejiang University School of Medicine’s ECMO Base has been at the forefront in the country with its ECMO patients, including complex cases that other centers find difficult to handle, such as ECMO combined with intestinal surgery, ECMO combined with lower limb amputation, ECMO combined with thrombectomy interventional surgery, ECMO combined with tracheal rupture repair surgery, ECMO mode change, nearly 40 cases of ECMO bridging heart transplant surgery, and dozens of ECMO bridging lung transplant surgeries. This has allowed trainees at the First Affiliated Hospital, Zhejiang University School of Medicine’s Training Center to experience highly challenging and rare ECMO cases. The inter-hospital cooperation sees an average annual transfer of 100 cases, covering multiple regions across the province, truly fulfilling the function of Zhejiang Province’s ECMO Training Center and contributing to the enhancement of emergency rescue capabilities and ECMO technology in the province. The independent simulated ICU is equipped with beds, towers, ventilators, monitors, and transport beds identical to those in an ICU unit, and ECMO-related supporting rooms such as equipment rooms, storage rooms, and bedside laboratories are all available. The training center is equipped with ECMO training-specific simulators, simulated ECMO puncture, and circulation perfusion equipment, ensuring the authenticity of the operations. All training uses real consumables, not just teaching simulation tools as in other training classes. The training center has 5 different models of ECMO training machines and more than 10 sets of ECMO kits. After the training, we also follow up with trainees to assist in the implementation of actual cases, providing comprehensive support. After the training, many hospitals have successfully completed their first cases.

From July 2020 to October 2024, a total of 123 teams and 492 medical staff across the province participated in our Zhejiang Province ECMO Special Talent Training Project. From May 2021 to October 2024, 71 hospitals nationwide, with a total of 80 doctors, completed the training and passed the assessment through the ECMO Restricted Technology Special Advanced Study method. The faculty is strong, including experts from various disciplines related to ECMO. After the training, the trainees formed localized teams, and the number of ECMO cases in Zhejiang Province continued to increase. In May 2024, the Zhejiang Medical Association hosted the Zhijiang ECMO Technology Conference, which our hospital undertook, with nearly 600 participants from 23 provinces across the country. In 2024, the ECMO Skills Competition hosted by the Zhejiang Provincial Federation of Trade Unions and the Zhejiang Provincial Health Commission was also undertaken by our hospital.

Vision: To provide support for critically ill patients in need of ECMO in the first instance, and to secure valuable time for the recovery of patients' organ functions.

Expected Outcomes: To enhance the level of ECMO diagnosis and treatment, and to promote standardized ECMO practices. Strive to quickly master and flexibly apply ECMO technology, ensuring that ECMO is implemented in an orderly, safe, and efficient manner.

Training Objectives:

- To master the preparation of ECMO materials and the workflow;

- To become familiar with the priming and establishment of the ECMO system;

- To grasp all technical points of the ECMO system;

- To be familiar with comprehensive management of ECMO patients;

- To master the handling of common ECMO complications;

- To collaborate effectively within an ECMO team.

1 month

Fellows: Critical care medical professionals with professional qualifications.

Professional Fields and Subspecialties: Internal Medicine, Surgery, Emergency Medicine, Critical Care Medicine, Pediatrics, Anesthesiology, or other clinical specialties adapted to the conduct of ECMO technology.

Technologies: ECMO in Neurocritical Care, ECMO in Acute and Critical Care Ultrasound, ECMO with CRRT, etc.

The First Month

Week One:

Monday: registration; department tour + study of the training class system

Tuesday: ECMO indications/contraindications and assessment; ECMO circuit priming theory + demonstration; ECMO system equipment; ECMO accessories and scenario simulation

Wednesday: ECMO daily management + documentation; ECMO membrane function evaluation; ECMO circuit priming practice; ECMO cannulation and initiation process; ECMO cannulation and initiation process training

Thursday: ECMO nursing + routine equipment maintenance; ECMO nutrition; ECMO sedation and analgesia; left ventricular decompression

Friday: vascular management in ECMO cases; ECPR initiation theory + demonstration; ECPR cannulation and initiation process; ECMO weaning + training

Week Two:

Monday: ECMO in and out of the operating room; theory of common ECMO-related emergencies; operation of common ECMO-related emergencies

Tuesday: VA ECMO hemodynamic strategies; ECMO and ethics; management during ECMO operation; ECMO anticoagulation

Wednesday: ECMO ultrasound operation; ultrasound application in ECMO implementation management; ECMO and CRRT management

Thursday: ECMO transport and prone positioning; operation of ECMO transport and prone positioning; multimodal brain function monitoring in ECMO; TCD operation

Friday: simulation drill; joint drill; Make-up exam; summary + group photo

Week Three and Four:

Clinical handover + internship; clinical management of actual patients

Theoretical Training: Including a standardized operation process teaching form that covers 9 training sections, an ECMO patient full-process record and evaluation manual, and 3 training videos, totaling over 140 hours of training content per month. It also includes a training textbook that was completely independently designed and edited three times, totaling 40,000 words.

Operational Training: 3 teams of training instructors, a simulated training ward, 5 sets of ECMO training machines and consumables, independently designed simulation ECMO dummies, and simulation systems.

Simulation Assessment: 12 sets of simulated assessment questions designed based on actual cases, even recreating special scenarios such as those that occurred during the COVID-19 pandemic.

Real Machine Operation: Follow professional ECMO teams throughout the assessment, initiation, management, and weaning processes. Time is also arranged weekly for patient management.

Clinical Practice: Unlike other training centers, manage ECMO patients independently throughout the process, without managing other non-ECMO patients. From patient initiation to daily management, ECMO transport, ECMO prone positioning, handling of abnormal events, and weaning assessment, a 24-hour shift schedule is implemented, with an average of 8-10 ECMO patients managed per month. Daily management of ECMO patients requires meticulous assessment of all systems, with a comprehensive evaluation system form. The assessment includes not only the regular content of other training centers but also the brain function monitoring that other centers find difficult to train, such as TCD, brain oxygen, and EEG, as well as daily monitoring of systemic vascular and tissue oxygen supply. Each patient's assessment record requires 3,000-5,000 words daily. At the end of the second month of training, a clinical assessment is required again, where each team must summarize the condition of the ECMO patients managed during the month and present a PPT report that lasts over 1 hour. The report is followed by five rounds of questioning from five examiners, with a pass mark of over 60% correct answers to succeed in the assessment.

After completing the training, we conduct follow-up visits for all trainees and their institutions to assist in the development of new technologies. For institutions that have already implemented ECMO, we have made quality improvements and conducted joint transport treatments for critically ill patients. All trainees and institutions have updated their processes and forms after the training, which has helped to enhance their capabilities and standardize practices. Most institutions that had never conducted ECMO technology before the training have started to implement it after the training, such as Wenzhou Central Hospital, which has successfully initiated several cases after the training, and Ningbo Second Hospital, which has exceeded 20 ECMO cases annually (too many examples to list). Hospitals that had already been conducting ECMO have made standardized adjustments to their operational details based on the systematic content of the training, improving the accuracy of preoperative patient assessment and the safety of the initiation process. All trainees have established a DingTalk group to regularly conduct online case sharing and discussions, accumulating dozens of online discussions and training sessions, totaling over 80 hours, which has strengthened the connections between major hospitals.

The program is free of charge.