Background: The Alfred Intensive Care Unit (ICU) in Melbourne, Australia, is one of the country’s largest tertiary intensive care services, providing a formal extracorporeal membrane oxygenation (ECMO) program since 2003 and operating as an ELSO-accredited centre since 2016. The service supports more than 120 ECMO patients annually across Veno venous (VV) and Veno arterial (VA) modalities and delivers a 24/7 extracorporeal cardiopulmonary resuscitation (ECPR) program established in 2012. High-volume ECMO centres require sustainable workforce models capable of delivering complex therapies while maintaining patient safety and continuity of care. Clinical Activities: Since 2007, the Alfred ICU ECMO program has operated a nurse-led, single-caregiver model, replacing traditional bedside perfusionist support. ECMO specialist nurse’s provide continuous one-to-one patient care and manage advanced therapies including left ventricular (LV) venting strategies, Impella support, continuous renal replacement therapy (CRRT), and advanced mechanical ventilation. The selection process for nurses entering the ECMO education program is rigorous and structured. Eligible candidates must be certified with a minimum of one year of postgraduate intensive care experience. The ECMO nursing workforce is highly specialised, with nurses selected based on demonstrated advanced clinical expertise, peer recommendation, and endorsement from the ICU nursing leadership team, reflecting strong clinical judgement and situational awareness. Ongoing professional development is integrated into a structured education pathway aligned with ELSO guidelines, in-service education, simulation training, bedside orientation, and mentorship from the ECLS Clinical Nurse Consultant. Discussion: This Nursing ECMO model demonstrates how structured governance and education enable safe workforce expansion, enhance clinical autonomy, promote continuity of care, and offer a scalable framework for emerging ECMO services. Conclusion: This nurse-led single-caregiver ECMO model supports advanced nursing practice, workforce capability, and continuity of care in a high-acuity environment. Through structured education and strong governance, it provides a sustainable and replicable framework for high-volume ECMO centres.
Dicocco et al. (Mon,) studied this question.