The ECMO multidisciplinary team: roles, responsibilities and governance

The ECMO multidisciplinary team: roles, responsibilities and governance

ECMO is not a machine. It is a system — and like all complex systems in high-acuity medicine, it depends absolutely on the people who operate it. No ECMO console, regardless of its design, can substitute for a well-trained, well-coordinated team with clear role definition, documented escalation pathways, and institutional governance that holds those elements together.

This article describes the team structure of a functional ECMO programme, the distinct role of each discipline, and the governance requirements expected of credentialled programmes in Australia and New Zealand.

Why team structure matters in ECMO

ECMO patients are among the most physiologically complex in any ICU. They have at least one organ system so severely impaired that conventional support has failed. They are on a circuit that requires continuous monitoring, has its own failure modes, demands precise anticoagulation titration, and can decompensate at any hour. And they are frequently candidates for interventions — surgical, cardiological, or haematological — that require coordination across multiple specialist teams.

In this environment, role clarity is not administrative preference. It is a safety requirement. When everyone knows precisely what they are responsible for — and what they are not — the chances of a critical task being missed or duplicated are minimised.

The ECMO physician / intensivist

The ECMO physician holds overall clinical responsibility for the patient. In most Australian and New Zealand ECMO programmes, this is an intensive care specialist, though the role may be shared with cardiothoracic surgery, cardiology, or other specialties depending on the indication and institution.

Core responsibilities:

• Overall patient management strategy — fluid balance, sedation, nutrition, organ support
• ECMO indication and cannulation decision
• Weaning strategy and decannulation decision
• Goals of care discussion with the patient and family
• Escalation decision-making: transplant referral, VAD bridge, palliation
• Coordination of the multidisciplinary team across specialties

The perfusionist

Perfusionists are the technical specialists of the ECMO circuit. In Australia and New Zealand, clinical perfusionists hold certification through the Australian and New Zealand College of Perfusionists (ANZCP). In some programmes, ECMO-trained nurses or intensivists share circuit management duties, particularly outside operating hours.

Core responsibilities:

• Circuit setup, priming, and deairing before cannulation
• Flow, pressure, and sweep gas management during the ECMO run
• Oxygenator function monitoring: ΔTMP, gas analysis, sweep gas adjustment
• Circuit troubleshooting: identifying and responding to alarms, recirculation, air detection
• Component changeout: oxygenator, pump head, or full circuit replacement when indicated
• Anticoagulation monitoring in conjunction with the medical team

The cardiothoracic or vascular surgeon

Surgical involvement in ECMO depends on the configuration and the cannulation approach. For central VA-ECMO (right atrium to aorta), cardiothoracic surgical involvement is essential. For peripheral cannulation, a vascular or cardiothoracic surgeon may assist with femoral vessel access or manage arterial complications.

Core responsibilities:

• Surgical cannulation for central VA-ECMO (post-cardiotomy failure, re-do surgery)
• Management of surgical bleeding complications — haemostasis at cannulation sites, re-exploration
• Decannulation and arterial repair when required
• Management of limb ischaemia on the cannulated side
• Surgical bridge to transplant or VAD implantation

The interventional cardiologist

In programmes offering ECPR (extracorporeal CPR), the cardiac catheterisation laboratory is a central node in the clinical pathway. VA-ECMO is established and the patient is taken directly to the cath lab for coronary angiography and percutaneous coronary intervention (PCI) while on circuit.

Core responsibilities:

• Percutaneous cannulation in the catheterisation laboratory or emergency department
• Coronary angiography and PCI under ECMO support
• Left heart decompression in patients with severe LV distension on VA-ECMO (Impella or atrial septostomy)
• Structural or electrophysiological interventions in cardiac ECMO patients

The ECMO nurse / coordinator

The bedside ECMO nurse provides the continuity of care that no other team member is positioned to deliver. They are present continuously — across shifts, overnight, and on weekends — and are often the first to notice a change in circuit behaviour or patient status.

Core responsibilities:

• Continuous bedside circuit monitoring: flow, pressures, sweep gas, alarm response
• Patient monitoring and nursing care — skin integrity on cannula sites, positioning, hygiene
• Documentation of circuit parameters and trends
• Recognising and escalating early signs of oxygenator dysfunction, recirculation, or patient deterioration
• Patient and family communication and support
• Shift handover: ensuring the oncoming team has complete circuit and patient information

In many Australian programmes, ECMO nurses hold formal ECMO specialist certification through Perfusion Downunder or equivalent programme, which includes circuit theory, alarm management, and changeout simulation.

The biomedical and clinical engineer

Biomedical engineers are the infrastructure layer of any ECMO programme. They may not be present at the bedside during the ECMO run, but their work before, during, and after determines whether the equipment the clinical team relies on is fit for purpose.

Core responsibilities:

• Incoming inspection: verification of device specifications, ARTG status confirmation, labelling and IFU review for all new consoles and consumables entering the hospital
• Preventive maintenance: scheduled maintenance of console drive units, battery testing, calibration verification per manufacturer IFU and AS3551 requirements
• Equipment troubleshooting: first response for console alarms or error codes not resolvable by the clinical team
• Consumable inventory: ensuring circuit sets, oxygenators, pump heads, and ancillary consumables are in stock, within date, and correctly stored
• Supply chain continuity: managing re-order levels and communicating with the distributor (OHM Healthcare for Lifemotion in ANZ) regarding supply issues or product changes
• Training support: participation in competency days, circuit familiarisation for new staff, and simulation equipment maintenance

Hospital procurement

ECMO equipment and consumable procurement in Australia must navigate the ARTG — only devices included on the Australian Register of Therapeutic Goods can be legally supplied. Procurement teams are responsible for ensuring contracts cover ARTG-registered products, and that any product changes (new lot numbers, revised circuit configurations) are flagged to the clinical and biomedical team before reaching the bedside.

Core responsibilities:

• ARTG-registered device and consumable sourcing — verifying ARTG inclusion number against the TGA website before purchase
• Supply chain continuity planning — maintaining strategic stock levels during known shortage periods
• Service and maintenance agreements — ensuring covered under contract for all ECMO consoles in the hospital fleet
• Capital planning — lifecycle management and replacement scheduling for console hardware
• Vendor management — communication with the authorised distributor (OHM Healthcare for Lifemotion ANZ) regarding supply, service, and training

Governance: what credentialled programmes require

ELSO (the Extracorporeal Life Support Organization) publishes training guidelines defining minimum competency standards for each discipline. Programmes seeking ELSO centre recognition or operating under state-level clinical governance frameworks must demonstrate:

• Documented competency assessment for all rostered ECMO staff (physicians, perfusionists, nurses)
• Formal escalation pathways — who to call, in what sequence, at what threshold
• Defined run time protocols: anticoagulation, circuit surveillance, changeout thresholds
• Morbidity and mortality review incorporating all ECMO cases — including circuit complications
• Simulation-based training on an annual or competency-driven cycle

In Australia, ECMO governance intersects with state ICU network frameworks (e.g. ANZICS standards), hospital credentialling systems, and — for the equipment side — TGA regulatory requirements. OHM Healthcare supports ECMO programmes across ANZ with local clinical engineering resources, training days, and first-line technical support for the Lifemotion ECMO platform.

To learn more about the Lifemotion ECMO system — ARTG-listed and exclusively distributed across Australia and New Zealand by OHM Healthcare — visit us.

lifemotionecmo.com.au  |  ohmhealthcare.com.au

For healthcare professionals and healthcare organisations. Educational only — ECMO programme governance requirements should be verified against current ELSO guidelines, state health network standards, and institutional credentialling frameworks.