Neonatal Fellowship Advanced ECMO Training at UPMC Children’s Continues to Evolve and Expand Six Years After Launch

The Advanced ECMO Training Program for Neonatal Fellowship was established in 2019 by the UPMC Newborn Medicine Program. Now entering its seventh year, the program has steadily evolved since its launch, with significant growth in fellow participation and program structure. The training remains one of only a few dedicated neonatal ECMO educational initiatives nationally. It is a distinct element of the UPMC Newborn Medicine Program fellowship training experience.

Building Dedicated Neonatal Fellow ECMO Competency

The ECMO program at UPMC Children’s Hospital of Pittsburgh has been operating for over four decades. Since treating its first neonatal patient in 1979, the program has cared for more than 800 neonates with severe cardiorespiratory failure. In 1989, UPMC Children’s became the second center in the United States to join the Extracorporeal Life Support Organization (ELSO), and it remains a high-volume ECMO referral center to this day.

Recognizing the need to build dedicated ECMO competency among neonatology fellows, Burhan Mahmood, MD, FAAP, Professor of Pediatrics and Medical Director of the Neonatal ECMO Program, led the development and launch of the advanced ECMO training track in 2019. The program was created to offer advanced ECMO training electives for neonatal-perinatal medicine fellows in their second or third year of fellowship.

“There are very few fellowship programs in the United States that offer the kind of advanced ECMO training program we have designed for our fellows. You must have the ECMO expertise and infrastructure in place, and you should have sufficiently large case volume to offer ample opportunity for fellows to obtain hands-on training with actual patients,” says Dr. Mahmood.

Structural Evolution and Adaptations

When first launched, the advanced ECMO training followed an intensive two-week elective format. Feedback from graduated fellows led to modifications of the program’s structure, transitioning to a longitudinal, checklist-based model that better integrates ECMO training throughout the fellowship.

“Based on fellow recommendations, we transitioned away from the time-based format and instead built a competency-based checklist that fellows work through during their fellowship,” says Dr. Mahmood. “This approach offers greater flexibility and allows fellows to complete various components over time, ensuring they meet educational objectives while accommodating the unpredictability of ECMO case volume,” says Dr. Mahmood.

Marit Aspenleiter, CCP, served as the second ECMO fellowship coordinator for five years and continues to work as a perfusionist at UPMC Children’s. In her role, she worked directly with the fellows to organize training schedules, track checklist completion, and facilitate hands-on ECMO training.

“One of the biggest challenges for fellows is simply the unpredictable nature of ECMO. Cases arise sporadically, and fellows have to take initiative to ensure they can observe key procedures,” says Ms. Aspenleiter.

Core Components of ECMO Training

The advanced ECMO training curriculum incorporates bedside clinical exposure, hands-on management of the ECMO circuit, and structured didactic instruction. Key elements include:

• Direct patient care of ECMO-supported patients.
• Attendance at ECMO cannulation and decannulation.
• Hands-on ECMO circuit assembly and priming procedures.
• Bedside pump management in partnership with perfusion staff.
• Completion of online educational modules and simulation training.
• Presentation at ECMO journal clubs and design of ECMO simulation scenarios.
• Successful completion of the UPMC Children’s ECMO Specialist Training Course and Neonatal ECMO Certification exam before fellowship graduation.

Fellows gain exposure to ECMO patients not only in the neonatal intensive care unit but also across the pediatric and cardiac intensive care units, enhancing their breadth of experience. Simulated cannulation sessions supplement clinical exposures when real-time procedural cases are unavailable.

The Role of Simulation and Perfusion Collaboration

The perfusion team has played a central role in delivering hands-on ECMO education. Fellows spend time directly with perfusionists, learning critical practical aspects of ECMO operation, including circuit assembly, priming, and troubleshooting.

“Many of the fellows are eager to learn the technical aspects of ECMO, including pump mechanics and circuit management,” says Ms. Aspenleiter. “We have also challenged fellows to design and present their own ECMO simulation cases, many of which incorporate complex decision-making scenarios, not simply technical troubleshooting,” says Ms. Aspenleiter.

The ECMO simulation scenarios designed by fellows during their advanced training are utilized at the annual UPMC Children’s Neonatal & Pediatric ECLS Educational Conference each fall, which attracts hundreds of participants worldwide through a virtual format. The conference offers high-quality educational opportunities for clinicians committed to caring for children requiring extracorporeal life support (ECLS) therapies, including ECMO and ventricular assist device (VAD) support. Participants can engage in a diverse range of sessions covering various topics.

Fellow Feedback and Early Outcomes

In 2024, Dr. Mahmood and colleagues completed a structured program evaluation based on survey responses from all prior neonatology fellows who had completed the advanced ECMO training at UPMC Children’s. The feedback highlighted strong satisfaction with the program’s educational value and its effectiveness in preparing participants for independent clinical practice.

Between 2019 and 2024, nineteen neonatal fellows completed fellowship training, with 11 electing to complete the advanced ECMO curriculum. Among these graduates:

• 91% are now practicing at academic medical centers that operate neonatal ECMO programs.
• 73% are active members of ECMO core teams at their institutions.

“This training has not only prepared our fellows to manage ECMO patients but has also positioned many of them to help lead and expand ECMO programs and training at their new institutions,” says Dr. Mahmood.

Transition in Program Coordination

While Ms. Aspenleiter was instrumental in coordinating the program during its formative years, there have been recent changes in leadership. In late 2024, Michael Anselmi, CCP, joined UPMC Children’s as the director of ECMO management. He is now responsible for coordinating the advanced fellow ECMO training and overseeing the ongoing development of the program.

“Mike brings extensive experience to his role and is now spearheading initiatives to enhance ECMO education for our fellows and advanced practice providers,” says Dr. Mahmood.

Expansion to Include Advanced Practice Providers

More recently, UPMC Children’s has begun offering an ECMO educational track for neonatal advanced practice providers (APPs). While still in its early stages, the APP track closely mirrors the fellowship curriculum, enabling neonatal nurse practitioners to develop deeper ECMO competencies and enhance their critical role in overnight and longitudinal patient care.

“The APPs play a vital role in ECMO care delivery, and this training opportunity allows them to gain many of the same skills our fellows develop, which benefits patient care across the entire NICU team,” says Ms. Aspenleiter.

Program Refinement and Broader Impact

As the program continues to mature, future directions include refining simulation content, enhancing troubleshooting education, expanding interactive learning modules, and exploring credentialing pathways for faculty and advanced practice providers (APPs).

“There has been tremendous national interest in what we have built here. Several fellows have told us they hope to develop similar programs at their institutions,” says Dr. Mahmood.

A Fellow’s Perspective on ECMO Training

Adriana Phillips, MD, completed her pediatric residency and neonatal–perinatal medicine fellowship at UPMC and has joined the UPMC Newborn Medicine Program as a faculty member in July 2025. As a fellow, Dr. Phillips elected to complete the optional advanced ECMO training elective. It was an experience she found to be formative and eye-opening, particularly in developing a more complete understanding of the interdisciplinary expertise and care that is the foundation of ECMO.

“I spent most of the elective with the perfusion team, trying to understand how they think, how they manage the circuit, and what their challenges are,” says Dr. Phillips. “That cross-disciplinary exposure was incredibly valuable and not something you can find in most training programs.”

Dr. Phillips ECMO training extended beyond bedside care, simulations, and didactics in the NICU with the ability to observe cardiac bypass and ECMO procedures in the operating room to contextualize ECMO physiology. Dr. Phillips also participated in simulation-based scenarios for managing emergencies with ECMO-supported patients.

“My biggest takeaway was a respect for how much expertise lives in every member of the ECMO team,” says Dr. Phillips. “When you’re in a critical situation, having rehearsed those scenarios in training is immensely helpful. It gives you a logical framework to fall back on when things are moving fast with patient care and you need to react without hesitation.”

For Dr. Phillips, her fellowship training proved the point that working with ECMO and understanding how the technology functions, how its use in each patient is highly specific, and training in this complex supportive patient care is never finished, but rather a lifelong area of education.

“There’s no end to the training in ECMO,” she says. “It’s something I’ll continue to build on for years to come.”

As an attending physician in the UPMC Newborn Medicine Program, Dr. Phillips will continue the research project she undertook as a fellow that is focused on improving anticoagulation strategies in neonatal ECMO patients.

Save the Date: 2025 ECLS Conference at UPMC Children’s

The 16^th annual Neonatal and Pediatric ECLS Educational Conference will be held October 8-10, 2025, in Pittsburgh. The conference offers both virtual and in-person attendance options.

This conference is dedicated to providing high quality educational opportunities to clinicians committed to caring for children requiring Extracorporeal Life Support (ECLS) therapies including, Extracorporeal Membrane Oxygenation (ECMO) and Ventricular Assist Device (VAD) support.

This exciting course is designed to provide an interactive educational activity that brings together a multidisciplinary group of health care providers that embrace the challenges of caring for patients receiving ECLS therapies. The virtual platform allows providers worldwide to participate in interactive sessions. We have put together an exciting program that includes lectures on the following topics:

• Ethical Challenges and Pediatric ECMO
• Selection Criteria for Pediatric ECMO
• ECMO Use in Trauma
• ECPella
• ECMO Algorithms
• Neuro Considerations, Complications and Outcomes for Neonatal & Pediatric ECMO
• Fireside Chats
• Interactive Case Scenarios
• ECMO Education

Learn more and register for the conference.