1
|
Sayed A, Alhomsi Y, Alsalemi A, Bensaali F, Meskin N, Ait Hssain A. IoT-based Mock Oxygenator for Extracorporeal Membrane Oxygenation Simulator. Artif Organs 2022; 46:2135-2146. [PMID: 35578949 DOI: 10.1111/aor.14318] [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: 11/29/2021] [Revised: 04/20/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Training is an essential aspect of providing high-quality treatment and ensuring patient safety in any medical practice. Because extracorporeal membrane oxygenation (ECMO) is a complicated operation with various elements, variables, and irregular situations, doctors must be experienced and knowledgeable about all conventional protocols and emergency procedures. The conventional simulation approach has a number of limitations. The approach is intrinsically costly since it relies on disposable medical equipment (i.e., oxygenators, heat exchangers, pumps) that must be replaced regularly due to the damage caused by the liquid used to simu- late blood. The oxygenator, which oxygenates the blood through a tailored membrane in ECMO, acts as a replacement for the patient's natural lung. For the context of simulation-based training (SBT) oxygenators are often expensive and cannot be recy- cled owing to contamination issues. METHODS Consequently, it is advised that the training process include a simu- lated version of oxygenators to optimize re-usability and decrease training expenses. Toward this goal, this article demonstrates a mock oxygenator for ECMO SBT, designed to precisely replicate the real machine structure and operation. RESULTS The initial model was reproduced using 3D modeling and printing. Addi- tionally, the mock oxygenator could mimic frequent events such as pump noise and clotting. Furthermore, the oxygenator is integrated with the modular ECMO simula- tor using cloud-based communication technology that goes in hand with the internet of things (IoT) technology to provide remote control via an instructor tablet applica- tion (App). CONCLUSIONS The final 3D modeled oxygenator body was tested and integrated with the other simulation modules at Hamad Medical Corporation (HMC) with several participants to evaluate the effectiveness of the training session.
Collapse
Affiliation(s)
- Aya Sayed
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Yahya Alhomsi
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Abdullah Alsalemi
- Department of Electrical Engineering, Qatar University, Doha, Qatar.,De Montfort University, Leicester, United Kingdom
| | - Faycal Bensaali
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Nader Meskin
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
2
|
Duran HT, McIvor W. Simulation Training for Crisis Management: Demonstrating Impact and Value. Adv Anesth 2021; 39:241-257. [PMID: 34715977 DOI: 10.1016/j.aan.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Huong Tram Duran
- UPMC Mercy, Suite 2192, 1400 Locust Street, Pittsburgh, PA 15219, USA.
| | - William McIvor
- UPMC Presbyterian, Suite C222, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| |
Collapse
|
3
|
A Review of Human Circulatory System Simulation: Bridging the Gap between Engineering and Medicine. MEMBRANES 2021; 11:membranes11100744. [PMID: 34677510 PMCID: PMC8537247 DOI: 10.3390/membranes11100744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/12/2021] [Accepted: 09/20/2021] [Indexed: 01/22/2023]
Abstract
(1) Background: Simulation-based training (SBT) is the practice of using hands-on training to immerse learners in a risk-free and high-fidelity environment. SBT is used in various fields due to its risk-free benefits from a safety and an economic perspective. In addition, SBT provides immersive training unmatched by traditional teaching the interactive visualization needed in particular scenarios. Medical SBT is a prevalent practice as it allows for a platform for learners to learn in a risk-free and cost-effective environment, especially in critical care, as mistakes could easily cause fatalities. An essential category of care is human circulatory system care (HCSC), which includes essential-to-simulate complications such as cardiac arrest. (2) Methods: In this paper, a deeper look onto existing human circulatory system medical SBT is presented to assess and highlight the important features that should be present with a focus on extracorporeal membrane oxygenation cannulation (ECMO) simulators and cardiac catheterization. (3) Results: A list of features is also suggested for an ideal simulator to bridge the gap between medical studies and simulator engineering, followed by a case study of an ECMO SBT system design. (4) Conclusions: a collection and discussion of existing work for HCSC SBT are portrayed as a guide for researchers and practitioners to compare existing SBT and recreating them effectively.
Collapse
|
4
|
Noorizadeh M, Alsalemi A, Alhomsi Y, Sayed ANKM, Bensaali F, Meskin N, Hssain AA. Advanced Thermochromic Ink System for Medical Blood Simulation. MEMBRANES 2021; 11:membranes11070520. [PMID: 34357170 PMCID: PMC8306066 DOI: 10.3390/membranes11070520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022]
Abstract
Simulators for extracorporeal membrane oxygenation (ECMO) have problems of bulky devices and low-fidelity methodologies. Hence, ongoing efforts for optimizing modern solutions focus on minimizing expenses and blending training with the intensive care unit. This is particularly evident following the coronavirus pandemic, where economic resources have been extensively cut. In this paper, as a part of an ECMO simulator for training management, an advance thermochromic ink system for medical blood simulation is presented. The system was developed and enhanced as a prototype with successful and reversible transitions between dark and bright red blood color to simulate blood oxygenation and deoxygenation in ECMO training sessions.
Collapse
Affiliation(s)
- Mohammad Noorizadeh
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (A.A.); (Y.A.); (A.N.K.M.S.); (F.B.); (N.M.)
- Correspondence:
| | - Abdullah Alsalemi
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (A.A.); (Y.A.); (A.N.K.M.S.); (F.B.); (N.M.)
| | - Yahya Alhomsi
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (A.A.); (Y.A.); (A.N.K.M.S.); (F.B.); (N.M.)
| | - Aya Nabil Khalaf Mohamed Sayed
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (A.A.); (Y.A.); (A.N.K.M.S.); (F.B.); (N.M.)
| | - Faycal Bensaali
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (A.A.); (Y.A.); (A.N.K.M.S.); (F.B.); (N.M.)
| | - Nader Meskin
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (A.A.); (Y.A.); (A.N.K.M.S.); (F.B.); (N.M.)
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| |
Collapse
|
5
|
Alhomsi Y, Alsalemi A, Noorizadeh M, Bensaali F, Meskin N, Hssain AA. A Modular Approach for a Patient Unit for Extracorporeal Membrane Oxygenation Simulator. MEMBRANES 2021; 11:membranes11060424. [PMID: 34073086 PMCID: PMC8228980 DOI: 10.3390/membranes11060424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022]
Abstract
Despite many advancements in extracorporeal membrane oxygenation (ECMO), the procedure is still correlated with a high risk of patient complications. Simulation-based training provides the opportunity for ECMO staff to practice on real-life scenarios without exposing ECMO patients to medical errors while practicing. At Hamad Medical Corporation (HMC) in Qatar, there is a critical need of expert ECMO staff. Thus, a modular ECMO simulator is being developed to enhance the training process in a cost-effective manner. This ECMO simulator gives the instructor the ability to control the simulation modules and run common simulation scenarios through a tablet application. The core modules of the simulation system are placed in the patient unit. The unit is designed modularly such that more modules can be added throughout the simulation sessions to increase the realism of the simulation sessions. The new approach is to enclose the patient unit in a trolley, which is custom-designed and made to include all the components in a modular fashion. Each module is enclosed in a separate box and then mounted to the main blood simulation loop box using screws, quick connect/disconnect liquid fittings, and electrical plugs. This method allows fast upgrade and maintenance for each module separately as well as upgrading modules easily without modifying the trolley’s design. The prototype patient unit has been developed for portability, maintenance, and extensibility. After implementation and testing, the prototype has proven to successfully simulate the main visual and audio cues of the real emergency scenarios, while keeping costs to a minimum.
Collapse
Affiliation(s)
- Yahya Alhomsi
- Department of Electrical Engineering, Qatar University, Doha P.O. Box. 2713, Qatar; (A.A.); (M.N.); (F.B.); (N.M.)
- Correspondence:
| | - Abdullah Alsalemi
- Department of Electrical Engineering, Qatar University, Doha P.O. Box. 2713, Qatar; (A.A.); (M.N.); (F.B.); (N.M.)
| | - Mohammad Noorizadeh
- Department of Electrical Engineering, Qatar University, Doha P.O. Box. 2713, Qatar; (A.A.); (M.N.); (F.B.); (N.M.)
| | - Faycal Bensaali
- Department of Electrical Engineering, Qatar University, Doha P.O. Box. 2713, Qatar; (A.A.); (M.N.); (F.B.); (N.M.)
| | - Nader Meskin
- Department of Electrical Engineering, Qatar University, Doha P.O. Box. 2713, Qatar; (A.A.); (M.N.); (F.B.); (N.M.)
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| |
Collapse
|
6
|
Sin SWC, Ng PY, Ngai WCW, Lai PCK, Mok AYT, Chan RWK. Simulation training for crises during venoarterial extracorporeal membrane oxygenation. J Thorac Dis 2019; 11:2144-2152. [PMID: 31285909 DOI: 10.21037/jtd.2019.04.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) education, in particular with regards to crisis management during the provision of venoarterial extracorporeal membrane oxygenation (VA ECMO), is challenging due to its intrinsic characteristics-a complex, high risk, low volume clinical activity which requires dynamic decision making, interdisciplinary teamwork and communication, and rapid response. Simulation training that focuses on crisis resource management and interprofessional communication is well-suited to address these training needs. Institutional commitment to provide both capital and human resources is instrumental to the success of ECMO training programs. Future multicenter studies with standardized training curricula are required to investigate the impact of ECMO simulation training on patient outcome.
Collapse
Affiliation(s)
- Simon W C Sin
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China.,Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Pauline Y Ng
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China.,Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wallace C W Ngai
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China
| | - Peter C K Lai
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China
| | - Andy Y T Mok
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China
| | - Ricky W K Chan
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China
| |
Collapse
|
7
|
Al Disi M, Alsalemi A, Alhomsi Y, Bensaali F, Amira A, Alinier G. Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution. Perfusion 2018; 34:183-194. [DOI: 10.1177/0267659118802749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Patients under the error-prone and complication-burdened extracorporeal membrane oxygenation (ECMO) are looked after by a highly trained, multidisciplinary team. Simulation-based training (SBT) affords ECMO centers the opportunity to equip practitioners with the technical dexterity required to manage emergencies. The aim of this article is to review ECMO SBT activities and technology followed by a novel solution to current challenges. ECMO simulation: The commonly-used simulation approach is easy-to-build as it requires a functioning ECMO machine and an altered circuit. Complications are simulated through manual circuit manipulations. However, scenario diversity is limited and often lacks physiological and/or mechanical authenticity. It is also expensive to continuously operate due to the consumption of highly specialized equipment. Technological aid: Commercial extensions can be added to enable remote control and to automate circuit manipulation, but do not improve on the realism or cost-effectiveness. A modular ECMO simulator: To address those drawbacks, we are developing a standalone modular ECMO simulator that employs affordable technology for high-fidelity simulation.
Collapse
Affiliation(s)
- Mohammed Al Disi
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | | | - Yahya Alhomsi
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Fayçal Bensaali
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Abbes Amira
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Guillaume Alinier
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar
- University of Hertfordshire, Hatfield, Herts, UK
| |
Collapse
|
8
|
Al Disi M, Alsalemi A, Alhomsi Y, Bensaali F, Amira A, Alinier G. Using thermochromism to simulate blood oxygenation in extracorporeal membrane oxygenation. Perfusion 2018; 34:106-115. [DOI: 10.1177/0267659118798140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Extracorporeal membrane oxygenation (ECMO) training programs employ real ECMO components, causing them to be extremely expensive while offering little realism in terms of blood oxygenation and pressure. To overcome those limitations, we are developing a standalone modular ECMO simulator that reproduces ECMO’s visual, audio and haptic cues using affordable mechanisms. We present a central component of this simulator, capable of visually reproducing blood oxygenation color change using thermochromism. Methods: Our simulated ECMO circuit consists of two physically distant modules, responsible for adding and withdrawing heat from a thermochromic fluid. This manipulation of heat creates a temperature difference between the fluid in the drainage line and the fluid in the return line of the circuit and, hence, a color difference. Results: Thermochromic ink mixed with concentrated dyes was used to create a recipe for a realistic and affordable blood-colored fluid. The implemented “ECMO circuit” reproduced blood’s oxygenation and deoxygenation color difference or lack thereof. The heat control circuit costs 300 USD to build and the thermochromic fluid costs 40 USD/L. During a ten-hour in situ demonstration, nineteen ECMO specialists rated the fidelity of the oxygenated and deoxygenated “blood” and the color contrast between them as highly realistic. Conclusions: Using low-cost yet high-fidelity simulation mechanisms, we implemented the central subsystem of our modular ECMO simulator, which creates the look and feel of an ECMO circuit without using an actual one.
Collapse
Affiliation(s)
- Mohammed Al Disi
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | | | - Yahya Alhomsi
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Fayçal Bensaali
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - Abbes Amira
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Guillaume Alinier
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar
- University of Hertfordshire, Hatfield, Herts, UK
| |
Collapse
|
9
|
Puslecki M, Ligowski M, Kiel M, Dabrowski M, Stefaniak S, Sip M, Maciejewski A, Dabrowska A, Kiel-Puslecka I, Kłosiewicz T, Misterski M, Buczkowski P, Szarpak L, Ruetzler K, Perek B, Czekajlo M, Jemielity M. Prototype of extracorporeal membrane oxygenation (ECMO) therapy simulator used in regional ECMO program. J Thorac Dis 2018; 10:5073-5079. [PMID: 30233882 DOI: 10.21037/jtd.2018.07.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Simulation is widely accepted as an important tool in training and educating healthcare providers. The first regional polish extracorporeal membrane oxygenation (ECMO) program called "ECMO for Greater Poland" was recently started. Methods We present a prototype for ECMO prepared for high-fidelity medical simulation in extracorporeal life support. ECMO therapy is a complex, difficult and expensive therapy in patient care. We have constructed an advanced ECMO simulation prototype, which can be used as a training tool in scenarios that prepare for real-life experiences. The "ECMO for Greater Poland" program uses high-fidelity simulation as a superior tool to simulate several complex clinical scenarios, and consequently train healthcare providers in rare, complicated and expensive procedures. The training course is standardized and allows repeatable training, improvement of skills, and an objective verification of trained skills. Results The ECMO simulation prototype is designed to replicate the physiological circulatory system and simulate several scenarios (i.e., bleeding, low pressure, occlusion, reaction for proper and incorrect pharmacological treatment). The electronic core control unit (CCU) with silicone tubes, artificial vessels (modified polyethylene) and analog components can be connected to an ECMO machine to emulate the human body during an ECMO simulation. If necessary, damaged and used parts can easily be replaced. The total cost of the simulator is approximately 450 and 50 USD for disposable parts. Conclusions This newly developed advanced ECMO simulation prototype was recently introduced into education and regularly training of healthcare providers of the "ECMO for Greater Poland" program. The simulation based training program is financially affordable and enables clinical teaching in a wider range of clinical scenarios. The ECMO simulation prototype consequently improves level of expertise of the healthcare providers and finally improves quality in patient care.
Collapse
Affiliation(s)
- Mateusz Puslecki
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland.,Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.,Clinical Hospital SKPP, Poznan, Poland
| | - Marcin Ligowski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.,Clinical Hospital SKPP, Poznan, Poland
| | | | - Marek Dabrowski
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland.,Polish Society of Medical Simulation, Poznan, Poland
| | - Sebastian Stefaniak
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.,Clinical Hospital SKPP, Poznan, Poland
| | - Maciej Sip
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland.,Polish Society of Medical Simulation, Poznan, Poland
| | - Adrian Maciejewski
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
| | - Agata Dabrowska
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland.,Polish Society of Medical Simulation, Poznan, Poland
| | - Ilona Kiel-Puslecka
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Kłosiewicz
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Misterski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.,Clinical Hospital SKPP, Poznan, Poland
| | - Piotr Buczkowski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.,Clinical Hospital SKPP, Poznan, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.,Lazarski University, Warsaw, Poland
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bartlomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.,Clinical Hospital SKPP, Poznan, Poland
| | - Michael Czekajlo
- Polish Society of Medical Simulation, Poznan, Poland.,Department of Surgery, Hunter Holmes McGuire VA Medical Center, Richmond, USA.,Lublin Medical University, Medical Simulation Center, Lublin, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.,Clinical Hospital SKPP, Poznan, Poland
| |
Collapse
|