Building Qatar severe respiratory failure ECMO program

Transport and Retrieval on Extracorporeal Membrane Oxygenation (ECMO): Setup and Activities of an Immersive Transport and Retrieval on ECMO Workshop

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.

"Extracorporeal Membrane Oxygenation for Greater Poland" Program: How to Save Lives and Develop Organ Donation?

The "ECMO for Greater Poland" program takes full advantage of the extracorporeal membrane oxygenation (ECMO) perfusion therapy opportunities to promote the health of the 3.5 million inhabitants in the region. The main implementation areas are treatment of patients with hypothermia; severe reversible respiratory failure (RRF); critical states resulting in heart failure, that is, cardiac arrest, cardiogenic shock, or acute intoxication; and promotion of the donor after circulatory death (DCD) strategy in selected organ donor cases, after unsuccessful life-saving treatment, to achieve organ recovery. This organizational model is complex and expensive, so we used advanced high-fidelity medical simulation tests to prepare for real-life experience. Over the course of 4 months we performed scenarios including "ECMO for DCD," "ECMO for extended cardiopulmonary resuscitation," "ECMO for RRF," and "ECMO in hypothermia." Soon after these simulations, Maastricht category II DCD procedures were performed involving real patients and resulting in 2 successful double kidney transplantations for the first time in Poland. One month later we treated 2 hypothermia patients (7 adult patients with heart failure and 5 patients with reversible respiratory failure) with ECMO for the first time in the region. Fortunately, we have discovered an important new role of medical simulation. It can be used not only for skills testing but also as a tool to create non-existing procedures and unavailable algorithms. The result of these program activities will promote the care and treatment of patients in critical condition with ECMO therapy as well as increase the potential organ pool from DCDs in the Greater Poland region of Poland.