ECMO has become one of the biggest growth areas in perfusion, and as it's grown, a real debate has opened up around who should actually be running it day to day. 

Some programs keep ECMO inside perfusion the same way they've always run the pump, with a perfusionist covering the circuit for the entire length of the run. Others have shifted ECMO almost entirely to dedicated ECMO specialists, usually RNs or RTs, cutting perfusion out of ECMO altogether and keeping them confined to the OR.

Perfusionists talk about this a lot, and the worry cuts two ways. Some of it is about capacity, whether a workforce this size can keep up as ECMO volume keeps climbing. The rest of it is about territory, a fear that a technology positioned to be the field's next big growth area could end up mostly staffed by someone else.

Both of those options have real costs, and a lot of perfusionists have felt the effects of one or the other firsthand. But the debate assumes those are the only two options. In reality, a handful of high-volume programs are showing this doesn't have to be an either-or decision. Other options exist; ones that keep ECMO multidisciplinary, capturing the strength of all specialties without asking either group to cover everything. 

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Two Extremes, One Bad Starting Point

The all-perfusion model has an obvious problem. A perfusionist covering a multi-day ECMO run isn't available for the OR schedule, and small teams don't have the depth to absorb that without something else giving. It also isn't cheap; a study comparing nurse-led and perfusionist-led ECMO staffing found that once a program passes roughly ten cases a year with runs averaging more than about ten days, the perfusionist-led model gets more expensive to sustain, even though survival outcomes were the same across both approaches.

A fully RN- or RT-led specialist model solves the cost and coverage problem, but it comes with its own cost. Perfusion loses touch with a technology that a lot of the field is counting on for its future, and the program loses the ability to draw on the deep, extracorporeal experience perfusion has built over years in the OR.

Framed as a binary, this looks like a tradeoff with no good answer. 

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Existing Middle Models

Rather than an all-perfusion or all-RN/RT model, a few different hybrid structures exist. Each keeps perfusion and dedicated bedside staff involved together, just in different proportions and different divisions of labor. 

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Perfusion at the Core

In this version, perfusion stays the primary ECMO specialist, and technology helps make it sustainable at scale. 

Instead of a 1:1 model with a perfusionist stationed at every bedside, perfusionists round on every circuit once an hour. Each round covers pump performance, alarm settings, tubing, the oxygenator, and temperature, with documentation updated along the way.

In between rounds, a remote monitoring system tracks the circuit continuously, pump speed and pressure on one side, and patient data like oxygen saturation, blood gas values, blood pressure, and tissue oxygen readings on the other. Anything that moves outside a set range triggers an alert straight to a screen in the perfusionists' workroom and to their phones. Plus, that workroom sits close to the unit so any emergencies or unexpected changes can be responded to promptly. 

In short, perfusion owns the pump while nurses and RTs handle their usual patient care at the bedside: medications, vent management, hemodynamic monitoring, respositioning, etc. 

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Perfusion On Call

In this model, an RN or RT ECMO specialist fully manages the pump hour to hour and day to day, but perfusion still owns a defined set of responsibilities: things like cannulation, clearing air from the oxygenator, managing a clot forming at the oxygenator outlet, exchanging a failing oxygenator, or responding to a pump or motor failure. 

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Depending on the program, that on-call perfusionist might be in-house or reachable from home, and the field's general on-call standards call for arriving within 60 minutes of being paged for an unscheduled emergency. 

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Either way, it lets a program guarantee perfusion's expertise is available exactly when it's needed, without paying to keep someone physically present for hours that don't require it. It's also not a new operational lift for most programs, since perfusion is typically already on call for cardiac surgery.

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Shared Pool of Specialists

The third version doesn't split the job by profession at all. Nurses, respiratory therapists, and perfusionists all train into the same ECMO Specialist role and staff the bedside interchangeably, based on who's available rather than what their underlying credential is.

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When the first dedicated full-time ECMO specialist team was established at the University of Michigan in 1980, it deliberately included nurses, respiratory therapists, and perfusionists. A pooled model like this trades a clean division of labor for flexibility, since coverage doesn't depend on any one profession's schedule, but it requires everyone in the pool to be trained to the same standard, regardless of what letters follow their name.

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Different Models, Shared Expertise

Each of these models solves the same problem in different ways, each keeping perfusion connected to ECMO instead of handing it off entirely, and all without asking a small in-house perfusion team to cover every bedside around the clock. Which version fits a given program probably comes down to size, case volume, and how much flexibility the staff already has, more than which model is objectively “best.” 

In fact, in the limited research that has directly compared these staffing approaches, patient outcomes and safety have held steady across the different setups, regardless of which profession is running the bedside day to day.

That leaves the decision mostly practical rather than clinical, a matter of fitting the model to what a program can actually sustain. For example, a small program with only a couple of perfusionists might lean toward the on-call consult version, while a high-volume center might build something closer to the perfusion-as-core model.

Ultimately, ECMO was built by mixed teams because different parts of the job call for different kinds of expertise. The strength of a multidisciplinary model is that no single profession has to hold all of the expertise; each discipline brings something different to the patient and the program.

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