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Kruit N, Burrell A, Tian D, Barrett N, Bělohlávek J, Bernard S, Braude D, Buscher H, Chen YS, Donker DW, Finney S, Forrest P, Fowles JA, Hifumi T, Hodgson C, Hutin A, Inoue A, Jung JS, Kruse JM, Lamhaut L, Ming-Hui Lin R, Reis Miranda D, Müller T, Bhagyalakshmi Nanjayya V, Nickson C, Pellegrino V, Plunkett B, Richardson C, Alexander Richardson S, Shekar K, Shinar Z, Singer B, Stub D, Totaro RJ, Vuylsteke A, Yannopoulos D, Zakhary B, Dennis M. Expert consensus on training and accreditation for extracorporeal cardiopulmonary resuscitation an international, multidisciplinary modified Delphi Study. Resuscitation 2023; 192:109989. [PMID: 37805061 DOI: 10.1016/j.resuscitation.2023.109989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND A multidisciplinary group of stakeholders were used to identify: (1) the core competencies of a training program required to perform in-hospital ECPR initiation (2) additional competencies required to perform pre-hospital ECPR initiation and; (3) the optimal training method and maintenance protocol for delivering an ECPR program. METHODS A modified Delphi process was undertaken utilising two web based survey rounds and one virtual meeting. Experts rated the importance of different aspects of ECPR training, competency and governance on a 9-point Likert scale. A diverse, representative group was targeted. Consensus was achieved when greater than 70% respondents rated a domain as critical (> or = 7 on the 9 point Likert scale). RESULTS 35 international ECPR experts from 9 countries formed the expert panel, with a median number of 14 years of ECMO practice (interquartile range 11-38). Participant response rates were 97% (survey round one), 63% (virtual meeting) and 100% (survey round two). After the second round of the survey, 47 consensus statements were formed outlining a core set of competencies required for ECPR provision. We identified key elements required to safely train and perform ECPR including skill pre-requisites, surrogate skill identification, the importance of competency-based assessment over volume of practice and competency requirements for successful ECPR practice and skill maintenance. CONCLUSIONS We present a series of core competencies, training requirements and ongoing governance protocols to guide safe ECPR implementation. These findings can be used to develop training syllabus and guide minimum standards for competency as the growth of ECPR practitioners continues.
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Affiliation(s)
- Natalie Kruit
- Department of Perioperative Medicine, Westmead Hospital, Hawksbury Rd, Westmead, NSW 2145, Australia.
| | - Aidan Burrell
- The Alfred Hospital, Melbourne, Victoria, Australia.
| | | | | | - Jan Bělohlávek
- Chair EuroELSO Working Group on ECPR, Deputy Head, 2(nd) Dept. of Internal Medicine, Cardiovascular Medicine U Nemocnice 2, Prague 2 128 00, Czech Republic.
| | | | - Darren Braude
- Division of Prehospital, Austere and Disaster Medicine, NM, United States.
| | | | | | | | | | - Paul Forrest
- RPAH and Sydney University Medical School, Australia.
| | - Jo-Anne Fowles
- Royal Papworth NHS Foundation Trust, Cambridge Biomedical Campus l Cambridge, UK.
| | - Toru Hifumi
- St. Luke's International Hospital, Tokyo, Japan.
| | | | - Alice Hutin
- Assistance Publique-Hôpitaux de Paris, Paris, France.
| | | | - Jae-Seung Jung
- Korea University Anam Hospital, Seoul, Republic of Korea.
| | - J M Kruse
- Charité - Universitätsmedizin Berlin, Germany.
| | | | - Richard Ming-Hui Lin
- Director of Emergency and Critical Care Services, Lin Shin Hospital, Taichung, Taiwan.
| | | | | | | | | | | | | | | | | | - Kiran Shekar
- The Prince Charles Hospital, Brisbane, QLD, Australia.
| | | | - Ben Singer
- St Bartholomew's Hospital, London, UK London's Air Ambulance, London, UK.
| | - Dion Stub
- The Alfred Hosptial, Victoria, Australia.
| | | | | | | | | | - Mark Dennis
- Royal Prince Alfred Hospital, Faculty of Medicine and Health, University of Sydney, Australia.
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Sayed AN, Noorizadeh M, Alhomsi Y, Bensaali F, Meskin N, Ait Hssain A. Ambulatory extracorporeal membrane oxygenation simulator: The next frontier in clinical training. Perfusion 2023:2676591231201527. [PMID: 37707960 DOI: 10.1177/02676591231201527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Current medical simulators for extracorporeal membrane oxygenation (ECMO) are expensive and rely on low-fidelity methodologies. This creates a challenge that demands a new approach to eliminate high costs and integrate with critical care environments, especially in light of the scarce resources and supplies available after the COVID-19 pandemic. METHODS To address this challenge, we examined the current state-of-the-art medical simulators and collaborated closely with Hamad Medical Corporation (HMC), the primary healthcare provider in Qatar, to establish criteria for advancing the cutting-edge ECMO simulation. This article presents a comprehensive ambulatory high-realism and cost-effective ECMO simulator. RESULTS Over the past 3 years, we have surveyed relevant literature, gathered data, and continuously developed a prototype of the system modules and the accompanying tablet application. By doing so, we have successfully addressed the issue of cost and fidelity in ECMO simulation, providing an effective tool for medical professionals to improve their understanding and treatment of patients requiring ECMO support. CONCLUSIONS This paper will focus on presenting an overall ambulatory ECMO simulator, detailing the various sub-systems and emphasizing the modular casing of the physical components and the simulated patient monitor.
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Affiliation(s)
- Aya N Sayed
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | | | - Yahya Alhomsi
- Department of Electrical Engineering, Qatar University, Doha, Qatar
| | - 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
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Loza-Avalos S, DeAtkine E, Cox J, Lussier B, Leveno M, Dultz LA, Hackmann A, Park C. ECMO simulation: How much, who to train, and a review of cost, fidelity and performance. Perfusion 2023:2676591231200988. [PMID: 37684100 DOI: 10.1177/02676591231200988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Extracorporeal Membrane Oxygenation (ECMO) is a high-risk, low-volume procedure requiring repetition, skill and multiple disciplines with fidelity of communication. Yet many barriers exist to maintain proficiency and skills with variable cost and fidelity. We designed and implemented a low-cost monthly ECMO simulation and hypothesized providers would have increased familiarity and improved teamwork. We also review some key elements of cost, fidelity and evaluation of effectiveness. METHODS A structured, 1-hour ECMO simulation was performed on a customized mannikin on a monthly basis in 2022. Qualitative surveys were administered to each member post-simulation. Answers were categorized by theme, including satisfaction of patient care, evaluation of self and team dynamics, and areas for improvement. RESULTS Most participants were satisfied with their ability to take care of the patient, with common themes of communication and coordination of roles. Identified areas of improvement were mostly limited to technical skills, and soft skills such as communication and teamwork. CONCLUSIONS We designed and implemented a low-cost, monthly and multi-disciplinary ECMO simulation program with overall positive feedback and identified areas for improvement. There remains variability in cost, fidelity and evaluation of performance and retention. There may be a need to create guidelines for ECMO simulation training that can be applied at all institutions utilizing ECMO for patient care.
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Affiliation(s)
- Sandra Loza-Avalos
- Department of Surgery, Division of Burns, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth DeAtkine
- Department of Surgery, Division of Burns, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Julie Cox
- Cardiovascular and ECMO Program, Parkland Memorial Hospital, Dallas, TX, USA
| | - Bethany Lussier
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthew Leveno
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda A Dultz
- Department of Surgery, Division of Burns, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amy Hackmann
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caroline Park
- Department of Surgery, Division of Burns, Trauma and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Nater M, Nelson-McMillan K, Elzein C, Boone A, Urbas C. Development of pediatric multidisciplinary extracorporeal membrane oxygenation simulations: A novel educational program to enhance team communication and emergency preparedness. Perfusion 2023; 38:1142-1152. [PMID: 35613946 DOI: 10.1177/02676591221105408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pediatric extracorporeal membrane oxygenation (ECMO) is a high risk, low-volume technology. Infrequency of this technology and associated complications may translate to unfamiliarity of identification and management of potentially life-threatening events, which may require knowledge and procedural skills to be performed quickly. Providers involved in managing ECMO must be able to promptly identify and initiate management for such events, particularly when surgical colleagues are not readily available. METHODS A multidisciplinary ECMO simulation program was implemented in a tertiary children's hospital. Over 18 months, a prospective, observational study was conducted evaluating simulations involving circuit and patient emergencies, teamwork and communication behaviors and technical skills. An on-line survey was sent to participants following sessions to evaluate post-simulation confidence, lessons learned and potential barriers to implementation of necessary skills and behaviors. RESULTS Ten simulation sessions occurred during implementation. Mean participants per session was 7 (range: 5-11). Eight Pediatric Cardiac Intensive Care Unit attendings, four Advance Practice Nurses, 54 pediatric intensive care unit registered nurses, and 55 pediatric respiratory therapists attended. Tasks with highest self-reported increase in confidence were related to (1) diagnosis (tension pneumothorax, oxygenator failure, and ventricular tachycardia), (2) fluid administration and (3) early and efficient mobilization for ECPR, with less reported confidence increase with technical skills More than 90% of participants provided a task or behavior they would implement if a specific emergency was encountered in real-life following simulation training. Real-life application occurred following simulations with participants reporting direct impact of training on their ability to perform the skill efficiently and correctly. CONCLUSIONS Implementation of ECMO multidisciplinary simulations provides structured opportunities for the team to learn and practice ECMO skills together in scenarios they may encounter without surgical presence. Ensuring competency of providers through implementation of such a program may improve patient safety through enhanced team communication, knowledge, and hands-on experience.
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Affiliation(s)
- Melissa Nater
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Kristen Nelson-McMillan
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatrics, Division of Critical Care, University of Chicago, Chicago, IL, USA
| | - Chawki Elzein
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Alison Boone
- Advocate Christ Medical Center Simulation Center, Oak Lawn, IL, USA
| | - Cynthia Urbas
- Department of Surgery, Advocate Children's Hospital, Oak Lawn, IL, USA
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McIntyre A, Schroder G, Amadi A, Jimenez M, Marflak J, Dell'Aiera L, Fitzgerald D. A quality improvement initiative to increase adult ECMO decision-making abilities in a perfusion education program: The use of 3D ECMO simulation. Perfusion 2023:2676591231177903. [PMID: 37227090 DOI: 10.1177/02676591231177903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Adult and pediatric ECMO procedures have been increasingly established as conventional life-saving modalities in critical care services across the world. Since 2017, a multidisciplinary team of program advisors for our perfusion education program have aimed to increase cardiovascular perfusion (CVP) student ECMO exposure and improve clinical decision-making. In this QI intervention, the use of 3D computer-based simulation was assessed in establishing a standardized process to improve the diagnosis and treatment of adult ECMO complications among first year CVP students. METHODS The Califia 3D Patient Simulator was incorporated into the curriculum for first year CVP students (n = 26) along with traditional lecture for the adult ECMO complication laboratory session. Pre-class knowledge assessments using de-identified polling software were compared to post-class assessments following the first assigned learning activity. Assessments from students that received simulation before lecture (SIM, n = 15) were compared to students receiving lecture before simulation (LEC, n = 11). User experience questionnaires (UEQ) consisting of 26 questions for six scales of simulation instruction were administered to measure the comprehensive impression of the student experience. RESULTS Overall median [IQR] pre- and -post knowledge assessment scores were 74% [11] and 84% [11], respectively (p = 0.01). There were no significant differences in pre-class assessment scores between the SIM and LEC groups (74.0% and 74.0%, respectively, p = 0.959). The LEC group achieved higher median post-assessment scores than the SIM group (84% vs 79%, p = 0.032). Among the 26 UEQ survey scales, 23 were positively evaluated (>0.8), and three were a neutral evaluation (-0.8 to 0.8). Cronbach Alpha-Coefficients of >0.78 were measured for attractiveness, perspicuity, efficacy, and stimulation. The coefficient for dependability was 0.37. 25 (96.2%) students indicated that 3D simulation was beneficial to improving ECMO clinical decision-making. CONCLUSIONS In this QI intervention, the implementation of computer-based 3D simulation following lecture was perceived by learners to help improve the diagnosis and treatment of ECMO-related complications.
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Affiliation(s)
- Angela McIntyre
- Division of Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Garrett Schroder
- Division of Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Adannaya Amadi
- Division of Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Michael Jimenez
- Division of Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - John Marflak
- Division of Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Laura Dell'Aiera
- Division of Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - David Fitzgerald
- Division of Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Jing Y, Yuan Z, Zhou W, Han X, Qi Q, Song K, Xing J. A phased intervention bundle to decrease the mortality of patients with extracorporeal membrane oxygenation in intensive care unit. Front Med (Lausanne) 2022; 9:1005162. [PMID: 36325385 PMCID: PMC9618597 DOI: 10.3389/fmed.2022.1005162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
Abstract
Aim To evaluate whether a phased multidimensional intervention bundle would decrease the mortality of patients with extracorporeal membrane oxygenation (ECMO) and the complication incidence. Materials and methods We conducted a prospective observational study in comparison with a retrospective control group in six intensive care units (ICUs) in China. Patients older than 18 years supported with ECMO between March 2018 to March 2022 were included in the study. A phased intervention bundle to improve the outcome of patients with ECMO was developed and implemented. Multivariable logistic regression modeling was used to compare the mortality of patients with ECMO and the complication incidence before, during, and up to 18 months after implementation of the intervention bundle. Results The cohort included 297 patients in 6 ICUs, mostly VA ECMO (68.7%) with a median (25th–75th percentile) duration in ECMO of 9.0 (4.0–15.0) days. The mean (SD) APECHII score was 24.1 (7.5). Overall, the mortality of ECMO decreased from 57.1% at baseline to 21.8% at 13–18 months after implementation of the study intervention (P < 0.001). In multivariable analysis, even after excluding the confounding factors, such as age, APECHII score, pre-ECMO lactate, and incidence of CRRT during ECMO, the intervention bundle still can decrease the mortality independently, which also remained true in the statistical analysis of V-V and V-A ECMO separately. Among all the ECMO-related complications, the incidence of bloodstream infection and bleeding decreased significantly at 13–18 months after implementation compared with the baseline. The CUSUM analysis revealed a typical learning curve with a point of inflection during the implementation of the bundle. Conclusion A phased multidimensional intervention bundle resulted in a large and sustained reduction in the mortality of ECMO that was maintained throughout the 18-month study period. Clinical trial registration [ClinicalTrials.gov], identifier [NCT05024786].
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Affiliation(s)
- Yajun Jing
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Zhiyong Yuan
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Weigui Zhou
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Xiaoning Han
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Qi Qi
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Kai Song
- School of Mathematics and Statistics, Qingdao University, Qingdao, China
| | - Jinyan Xing
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- *Correspondence: Jinyan Xing,
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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.
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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
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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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Alinier G, Oriot D. Simulation-based education: deceiving learners with good intent. Adv Simul (Lond) 2022; 7:8. [PMID: 35303963 PMCID: PMC8932061 DOI: 10.1186/s41077-022-00206-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
The level of performance of every clinician and of the overall multiprofessional team relies on the skills and expertise they have individually and collectively acquired through education, training, self-directed learning, and reflection. Simulation-based education (SBE) is playing an increasingly important role in that respect, and it is sometimes said that it is an art to facilitate. Many explanations can justify this assertion. Although there is generally an emphasis on making everything as realistic or "high-fidelity" as possible, it is often futile and this is where the art of simulation comes into play with an element of modulation of realism linked to the intended learning objectives. The atmosphere created by the educators; how the learners are made to engage and interact; how physical, technical, and contextual elements are simulated or represented; and what type of technology is used need to be appropriately adapted to contribute to the immersiveness of any SBE activity. Although it inevitably carries a negative connotation, some form of "deception" is more commonly used than one may think for the benefit of learners during SBE. High levels of realism are sometimes achieved by making learners believe something works or reacts as would be expected in real life, whereas it is achieved in a totally different manner. Learners do not need to know, see, or understand these "tricks of the trade", shortcuts, or artistic or technological aspects, and this can be considered a form of benevolent deception. Similarly, information may be withheld to recreate a realistic situation and push learners to demonstrate specific learning outcomes, but it needs to be practised with caution and be justifiable. These forms of "positive" deception are part of most SBE activities and are used to help learners bridge the reality gap so they can suspend disbelief more easily, exercise critical thinking, and treat the simulation more realistically without damaging the trust they place in their educators. This article will discuss how aspects of SBE activities are often manipulated, modified, or hidden from learners to facilitate the learning experience and present a simulation fidelity model encompassing the environmental, patient, semantical, and phenomenal dimensions.
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Affiliation(s)
- Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, Doha Qatar
- School of Allied Health Professions, Midwifery and Social Work, University of Hertfordshire, College Lane, Hatfield, AL10 9AB UK
- Weill Cornell Medicine – Qatar, Education City, Doha Qatar
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Denis Oriot
- Paediatric Emergency Department, University Hospital of Poitiers, Poitiers, France
- ABS Lab, Simulation Laboratory, Faculty of Medicine, University of Poitiers, Poitiers, France
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Labib A, Alinier G. Transport and Retrieval on Extracorporeal Membrane Oxygenation (ECMO): Setup and Activities of an Immersive Transport and Retrieval on ECMO Workshop. J Cardiothorac Vasc Anesth 2020; 35:1603-1610. [PMID: 33431274 DOI: 10.1053/j.jvca.2020.11.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 11/11/2022]
Abstract
Extracorporeal life support and extracorporeal membrane oxygenation (ECMO) are widely used for acute severe refractory cardiac and respiratory failure. An increasing number of patients are treated with ECMO worldwide. This can be attributed to technical and technologic advancements, easier access to modern equipment, and more regular and accessible training opportunities for practitioners to maintain current skills and develop new ones. Typically, ECMO is provided at tertiary or regional centers that often are university- affiliated. In a significant number of patients, ECMO may be initiated at a peripheral hospital before they are transported to a tertiary facility by a specialized multiprofessional ECMO team. The transport phase is, however, fraught with challenges and untoward events are not uncommon during ECMO transportation, so a robust education and training program is critical to ensure patient safety and optimum outcome. This article describes the authors' experience of developing and running a simulation-based ECMO Transport and Retrieval workshop, with multiple immersive scenarios and opportunities for participants to familiarize themselves with the process and the ambulance equipment and environment. Preparation is a key element to successfully run scenarios that are technically challenging to facilitate due to the environment and equipment involved. To date, 136 multidisciplinary ECMO providers have attended the workshop and no incidents have been reported by the authors' teams during actual transfers and retrieval missions with patients on ECMO.
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Affiliation(s)
- Ahmed Labib
- Medical Intensive Care Unit, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar.
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar; School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom; Northumbria University, Newcastle upon Tyne, United Kingdom
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Joyce CJ, Cook DA, Walsham J, Krishnan A, Lo W, Samaan J, Semark AJ, Pearson DC, Stroebel A, Provenzano S, McKeague R, Winearls JR. Low volume ECMO results study. CRIT CARE RESUSC 2020; 22:327-334. [PMID: 38046879 PMCID: PMC10692512 DOI: 10.51893/2020.4.oa5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To report extracorporeal membrane oxygenation (ECMO) experience at Princess Alexandra and Gold Coast University hospitals and compare mortality with benchmarks. Design: Case series of patients treated with ECMO. Setting: Two adult tertiary Australian intensive care units with low ECMO case volumes. Participants: Patients treated with ECMO, aged > 18 years. Main outcome measures: Patients were categorised into respiratory, cardiac, and extracorporeal cardiopulmonary resuscitation (eCPR) groups. Observed mortality was compared with mortality predicted using individual risk of death predictions from the Survival after Veno-arterial ECMO (SAVE) and Respiratory ECMO Survival Prediction (RESP) scores; mortality predicted when mortality predictions of the SAVE score were modified to be consistent with the validation cohort in the SAVE study (Alfred Hospital); and with mortality predicted when eCPR patients were all assigned a risk of death equal to Extracorporeal Life Support Organization (ELSO) Registry eCPR mortality. Results: Over 10 years, 86 patients were treated with ECMO. Eight deaths were observed in 49 patients with respiratory failure, below the 95% CI (13-24) for the deaths predicted by the RESP score (P < 0.001). Nine deaths were observed in 27 patients with cardiac failure, below the 95% CI (14-23) for the deaths predicted by the SAVE score (P < 0.001), but within the 95% CI (9-17) for the deaths predicted by the SAVE score modified to be consistent with the Alfred Hospital cohort (P > 0.05). Seven deaths were observed in the ten eCPR patients, within the 95% CI (4-10) predicted using the risk of death derived from the ELSO Registry. Conclusions: Mortality in two low volume ECMO centres was not inferior to benchmarks.
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Affiliation(s)
- Christopher J. Joyce
- Intensive Care, Princess Alexandra Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - David A. Cook
- Intensive Care, Princess Alexandra Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
| | - James Walsham
- Intensive Care, Princess Alexandra Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Anand Krishnan
- Intensive Care, Princess Alexandra Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Wingchi Lo
- University of Queensland, Brisbane, QLD, Australia
- Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - John Samaan
- University of Queensland, Brisbane, QLD, Australia
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Andrew J. Semark
- University of Queensland, Brisbane, QLD, Australia
- Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - David C. Pearson
- Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Andrie Stroebel
- Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Sylvio Provenzano
- Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Ronan McKeague
- Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - James R. Winearls
- University of Queensland, Brisbane, QLD, Australia
- Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia
- Intensive Care, St Andrew’s War Hospital, Brisbane, QLD, Australia
- Monash University, Melbourne, VIC, Australia
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The ECMO specialist’s role in troubleshooting ECMO emergencies. EGYPTIAN JOURNAL OF CRITICAL CARE MEDICINE 2018. [DOI: 10.1016/j.ejccm.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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