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Paredes RM, Inman B, Davis WT, Castaneda M, Mireles AA, Baldwin DS, Rodriguez DC, Medellin KL, Ng PC, Maddry JK. Efficacy of a Single Day Extracorporeal Membrane Oxygenation Training Course for Critical Care Air Transport Team Eligible Personnel. Mil Med 2024; 189:e2211-e2219. [PMID: 38687647 DOI: 10.1093/milmed/usae138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/22/2024] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is an advanced medical technology that is used to treat respiratory and heart failure. The U.S. military has used ECMO in the care of combat casualties during Operation Enduring Freedom and Operation Iraqi Freedom as well as in the treatment of patients during the recent Coronavirus Disease 2019 pandemic. However, few Military Health System personnel have training and experience in the use of ECMO therapy. To address this dearth of expertise, we developed and evaluated an accelerated ECMO course for military medical personnel. OBJECTIVES To compare the efficacy of an accelerated ECMO course for Military Health System critical care teams. METHODS Seventeen teams, each consisting of a physician and nurse, underwent a 5-h accelerated ECMO course. Similar to our previous live-tissue ECMO training program (phases I and II), each team watched prerecorded ECMO training lectures. Subjects then practiced priming the ECMO circuit, cannulating ECMO, initiating ECMO, and correcting common complications on an ECMO simulation model. An added component to this phase III project included transportation and telemedicine consultation availability. Training success was evaluated via knowledge and confidence assessments, and observation of each team attempting to initiate ECMO on a Yorkshire swine patient model, transport the patient model, and troubleshoot complications with the support of telemedicine consultation when desired. RESULTS Seventeen teams successfully completed the course. All seventeen teams (100%) successfully placed the swine on veno-arterial ECMO. Of those, 15 teams successfully transitioned to veno-arterial-venous ECMO. The knowledge assessments of physicians and nurses increased by 12.2% from pretest (mean of 62.1%, SD 10.4%) to posttest (mean of 74.4%, SD 8.2%), P < .0001; their confidence assessments increased by 41.1% from pretest (mean of 20.1%, SD 11.8%) to posttest (mean of 61.2%, SD 18.6%). CONCLUSIONS An abbreviated 1-day lecture and hands-on task-trainer-based ECMO course resulted in a high rate of successful skill demonstration and improvement of physicians' and nurses' knowledge assessments and confidence levels, similar to our previous live-tissue training program. When compared to our previous studies, the addition of telemedicine and patient transportation to this study did not affect the duration or performance of procedures.
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Affiliation(s)
- R Madelaine Paredes
- United States Air Force, 59th Medical Wing, Clinical Resuscitation, Emergency Science, Triage and Toxicology (CRESTT), Lackland AFB, TX 78236, USA
| | - Brannon Inman
- Department of Critical Care Medicine, Orlando Regional Medical Center, Orlando, FL 32806, USA
| | - William T Davis
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
- United States Air Force, 59th Medical Wing, En Route Care Research Center, Lackland AFB, TX 78236, USA
| | - Maria Castaneda
- United States Air Force, 59th Medical Wing, En Route Care Research Center, Lackland AFB, TX 78236, USA
| | - Allyson A Mireles
- United States Air Force, 59th Medical Wing, En Route Care Research Center, Lackland AFB, TX 78236, USA
| | - Darren S Baldwin
- United States Air Force, 59th Medical Wing, En Route Care Research Center, Lackland AFB, TX 78236, USA
| | - Dylan C Rodriguez
- United States Air Force, 59th Medical Wing, Clinical Resuscitation, Emergency Science, Triage and Toxicology (CRESTT), Lackland AFB, TX 78236, USA
| | - Kimberly L Medellin
- United States Air Force, 59th Medical Wing, En Route Care Research Center, Lackland AFB, TX 78236, USA
| | - Patrick C Ng
- Emergency Medicine/Medical Toxicology, Department of Emergency Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA
| | - Joseph K Maddry
- United States Air Force, 59th Medical Wing, Clinical Resuscitation, Emergency Science, Triage and Toxicology (CRESTT), Lackland AFB, TX 78236, USA
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
- Clinician Scientist Investigator Opportunity Network (CSION), United States Air Force, 59th Medical Wing Lackland ABF, TX 78236, USA
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Department of Clinical Investigation, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
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Cui AN, Wang Y, Li YL, Li ZSZ, Xu AR, Li X, Han YX. ICU Nurses' Perception of Sensitive Indicators of Quality of Care for ECMO Patients in Guizhou Province, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:1417-1426. [PMID: 38835952 PMCID: PMC11147946 DOI: 10.2147/rmhp.s453800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/10/2024] [Indexed: 06/06/2024] Open
Abstract
Purpose This study aimed to investigate the cognitive evaluation level of ICU nurses in Guizhou Province, China, on the sensitivity indicators of nursing quality for ECMO patients. Patients and Methods This was a cross-sectional observational study conducted in Guizhou Province, China, from May to July 2023, 259 ICU nurses were surveyed. Objective sampling method was used to select the participants from 10 hospitals in Guizhou Province that carried out ECMO. Data were collected through questionnaire survey. Two researchers checked and recorded Epidata 3.1. SPSS 25.0 was used for statistical analysis of the data, and frequency, mean and component ratio were used for descriptive statistical analysis. The importance rating was used to reflect the degree of nurses' agreement with the indicators. Results The results of this study showed that 79.1% of the 253 ICU nurses in Guizhou Province, China, had not participated in training and courses related to indicators of quality of care evaluation for ECMO patients. The main way for ICU nurses to acquire knowledge related to indicators of quality of care sensitivity for ECMO patients was departmental training, which accounted for 87.4%. And the other ways, in descending order, were public, the matic lectures or academic conferences, journals and magazines; their evaluation scores of the importance of most of the quality of care sensitivity indicators for ECMO patients was moderate, with the scores ranging from 73 to 150. Among them, the range of importance evaluation scores for each indicator was 4.01 ~ 4.48. Conclusion The overall cognitive evaluation of ICU nurses in Guizhou Province, China, on most sensitivity indicators of quality of care for ECMO patients was moderate, and there is a general lack of systematic courses and training on the knowledge related to ECMO care quality sensitive indicators.
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Affiliation(s)
- An-Ni Cui
- School of Nursing, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Yun Wang
- School of Nursing, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Ya-Ling Li
- School of Nursing, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
- Nursing Department, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Zhang-Shuang-Zi Li
- School of Nursing, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
- Department of Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Ao-Ran Xu
- School of Nursing, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Xin Li
- School of Nursing, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Ya-Xian Han
- School of Nursing, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
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Maddry JK, Paredes RM, Abdurashidov T, Davis WT, Paciocco JA, Castaneda M, Araña AA, Perez CA, Baldwin DS, Rodriguez DC, Medellin KL, Ng P. Efficacy of a single-day task trainer-based extracorporeal membrane oxygenation training course. AEM EDUCATION AND TRAINING 2022; 6:e10806. [PMID: 36482985 PMCID: PMC9720576 DOI: 10.1002/aet2.10806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 06/17/2023]
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is an advanced medical technology used to treat respiratory and heart failure. The coronavirus pandemic has resulted in significantly more ECMO patients worldwide. However, the number of hospitals with ECMO capabilities and ECMO-trained staff are limited. Training of personnel in ECMO could supplement this demand. Objective To evaluate our previously developed ECMO course using a task trainer-based training, as opposed to an existing live tissue-training model, and determine if such a program was adequate and could be expanded to other facilities. Methods Seventeen teams, each consisting of a physician and nurse, underwent a 5 hour accelerated ECMO course in which they watched prerecorded ECMO training lectures, primed circuit, cannulated, initiated ECMO, and corrected common complications. Training success was evaluated via knowledge and confidence assessments and observation of each team attempting to initiate ECMO while troubleshooting complications on a Yorkshire swine. Results Seventeen teams successfully completed the course. Sixteen teams (94%, 95% CI = 71%-100%) successfully placed the swine on veno-arterial ECMO. Of those 16 teams, 15 successfully transitioned to veno-arterial-venous ECMO. The knowledge assessments and confidence levels of physicians and nurses increased by 24.3% from pretest (mean of 65.3%, SD 14.4%) to posttest (mean of 89.6%, SD 10.3%), p < 0.0001. Conclusions An abbreviated one day lecture and hands-on task trainer-based ECMO course resulted in a high rate of successful skill demonstration and improvement of physicians' and nurses' knowledge assessments and confidence levels, similar to our previous live tissue training program.
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Affiliation(s)
- Joseph K. Maddry
- Department of Emergency MedicineBrooke Army Military Medical CenterFt Sam HoustonTexasUSA
- United States Army Institute of Surgical Research (USAISR)Ft Sam HoustonTexasUSA
- United States Air Force59 Medical Wing, Clinical Resuscitation, Emergency Sciences, Triage and Toxicology (CRESTT)Lackland AFBTexasUSA
- F. Edward Hébert School of MedicineUniformed Services UniversityBethesdaMarylandUSA
| | - R. Madelaine Paredes
- United States Air Force59 Medical Wing, Clinical Resuscitation, Emergency Sciences, Triage and Toxicology (CRESTT)Lackland AFBTexasUSA
| | - Timur Abdurashidov
- Department of Emergency MedicineBrooke Army Military Medical CenterFt Sam HoustonTexasUSA
| | - William T. Davis
- Department of Emergency MedicineBrooke Army Military Medical CenterFt Sam HoustonTexasUSA
- F. Edward Hébert School of MedicineUniformed Services UniversityBethesdaMarylandUSA
- United States Air Force59 Medical Wing, En route Care Research CenterLackland AFBTexasUSA
| | - Joni A. Paciocco
- United States Air Force59 Medical Wing, En route Care Research CenterLackland AFBTexasUSA
- Fort Hood, United States Army
| | - Maria Castaneda
- United States Air Force59 Medical Wing, Clinical Resuscitation, Emergency Sciences, Triage and Toxicology (CRESTT)Lackland AFBTexasUSA
- Fort Hood, United States Army
| | | | - Crystal A. Perez
- United States Air Force59 Medical Wing, En route Care Research CenterLackland AFBTexasUSA
- IQVIA MedTech Clinical SolutionsSan AntonioTexasUSA
| | - Darren S. Baldwin
- United States Air Force59 Medical Wing, En route Care Research CenterLackland AFBTexasUSA
| | - Dylan C. Rodriguez
- United States Air Force59 Medical Wing, Clinical Resuscitation, Emergency Sciences, Triage and Toxicology (CRESTT)Lackland AFBTexasUSA
| | | | - Patrick Ng
- Department of Emergency MedicineBrooke Army Military Medical CenterFt Sam HoustonTexasUSA
- United States Air Force59 Medical Wing, En route Care Research CenterLackland AFBTexasUSA
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Han PK, Purkey NJ, Kuo KW, Ryan KR, Woodward AL, Jahadi O, Prom NL, Halamek LP, Johnston LC. A Scoping Review and Appraisal of Extracorporeal Membrane Oxygenation Education Literature. ATS Sch 2022; 3:468-484. [PMID: 36312813 PMCID: PMC9585707 DOI: 10.34197/ats-scholar.2022-0058re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Despite a recent rise in publications describing extracorporeal membrane oxygenation (ECMO) education, the scope and quality of ECMO educational research and curricular assessments have not previously been evaluated. Objective The purposes of this study are 1) to categorize published ECMO educational scholarship according to Bloom's educational domains, learner groups, and content delivery methods; 2) to assess ECMO educational scholarship quality; and 3) to identify areas of focus for future curricular development and educational research. Methods A multidisciplinary research team conducted a scoping review of ECMO literature published between January 2009 and October 2021 using established frameworks. The Medical Education Research Study Quality Instrument (MERSQI) was applied to assess quality. Results A total of 1,028 references were retrieved; 36 were selected for review. ECMO education studies frequently targeted the cognitive domain (78%), with 17% of studies targeting the psychomotor domain alone and 33% of studies targeting combinations of the cognitive, psychomotor, and affective domains. Thirty-three studies qualified for MERSQI scoring, with a median score of 11 (interquartile range, 4; possible range, 5-18). Simulation-based training was used in 97%, with 50% of studies targeting physicians and one other discipline. Conclusion ECMO education frequently incorporates simulation and spans all domains of Bloom's taxonomy. Overall, MERSQI scores for ECMO education studies are similar to those for other simulation-based medical education studies. However, developing assessment tools with multisource validity evidence and conducting multienvironment studies would strengthen future work. The creation of a collaborative ECMO educational network would increase standardization and reproducibility in ECMO training, ultimately improving patient outcomes.
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Affiliation(s)
- Peggy K. Han
- Division of Critical Care Medicine, Department of Pediatrics
| | | | - Kevin W. Kuo
- Division of Critical Care Medicine, Department of Pediatrics
| | | | | | - Ozzie Jahadi
- Lucile Packard Children’s Hospital, Palo Alto, California; and
| | - Nicole L. Prom
- Lucile Packard Children’s Hospital, Palo Alto, California; and
| | - Louis P. Halamek
- Division of Neonatology, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Lindsay C. Johnston
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
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Prichard E, Staudt AM, Garcia-Choudary T, Mu T. Prior Extracorporeal Membrane Oxygenation (ECMO) Experience and Performance in High-Fidelity Simulation Scenarios. Cureus 2022; 14:e29301. [DOI: 10.7759/cureus.29301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/17/2022] [Indexed: 11/05/2022] Open
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Development of a Standardized Assessment of Simulation-based Extracorporeal Membrane Oxygenation Educational Courses. ATS Sch 2022; 3:242-257. [PMID: 35924196 PMCID: PMC9341478 DOI: 10.34197/ats-scholar.2021-0068oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background In 2020, the Extracorporeal Life Support Organization education task force identified seven extracorporeal membrane oxygenation (ECMO) educational domains that would benefit from international collaborative efforts. These included research efforts to delineate the impact and outcomes of ECMO courses. Objective Development of a standardized online assessment tool to evaluate the effectiveness of didactic and simulation-based ECMO courses on participants’ confidence, knowledge, and simulation-based skills; participant satisfaction; and course educational benefits. Methods We performed a prospective multicenter observational study of five different U.S. academic institution–based adult ECMO courses that met Extracorporeal Life Support Organization endorsement requirements for course structure, educational content, and objectives. Standardized online forms were developed and administered before and after courses, assessing demographics, self-assessment regarding ECMO management, and knowledge examination (15 simple-recall multiple-choice questions). Psychomotor skill assessment was performed during the course (time to complete prespecified critical actions during simulation scenarios). Self-assessment evaluated cognitive, behavioral, and technical aspects of ECMO; course satisfaction; and educational benefits. Results Out of 211 participants, 107 completed both pre- and postcourse self-assessment forms (97 completed both pre- and postcourse knowledge forms). Fifty-three percent of respondents were physician intensivists, with most (51%) practicing at academic hospitals and with less than 1 year of ECMO experience (50%). After the course, participants reported significant increases in confidence across all domains (cognitive, technical, and behavioral, P < 0.0001, 95% confidence interval [CI], 1.2–1.5; P < 0.0001, 95% CI, 2.2–2.6; and P = 0.002, 95% CI, 1.7–2.1, respectively) with an increase in knowledge scores (P < 0.001; 95% CI, 1.4–2.5). These findings were most significant in participants with less ECMO experience. There were also significant reductions in times to critical actions in three of the four scored simulation scenarios. The results demonstrated participants’ satisfaction with most course aspects, with more than 95% expressing that courses met their educational goals. Conclusion We developed and tested a structured ECMO course assessment tool, demonstrating participants’ self-reported benefit as well as improvement in psychomotor skill acquisition, course satisfaction, and educational benefits. Course evaluation is feasible and potentially provides important information to improve ECMO courses. Future steps could include national implementation, addition of questions targeting clinical decision making to further assess knowledge gain, and multilanguage translation for implementation in international courses.
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