The Utility of High-Fidelity Simulation for Training Critical Care Fellows in the Management of Extracorporeal Membrane Oxygenation Emergencies

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.

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Assessment of Novice Learners in a Novel High-fidelity Simulation-Based Extracorporeal Membrane Oxygenation Education Program

10.21203/rs.3.rs-37920/v1 ◽

2020 ◽

Author(s):

Li TONG ◽

Wen-jie HU ◽

Yan-ping ZHU ◽

Lu CAO ◽

Ying-hui LI ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Likert Scale ◽

Performance Criteria ◽

High Fidelity ◽

High Fidelity Simulation ◽

Practical Test ◽

Novice Learners ◽

Membrane Oxygenation ◽

Simulation Based ◽

The Impact

Abstract Background: This study aimed to design a suitable integrated extracorporeal membrane oxygenation (ECMO) curriculum and assessed the impact of this a high-fidelity simulation-based education module on novice learners. Methods: An ECMO training curriculum was developed by well-trained and experienced ECMO experts that incorporated simulation modules to train multidisciplinary health care professionals. Pre- and post-participation questionnaires were used to determine the effects on the knowledge, ability, and confidence level of the participants. A five-point Likert scale was used to assess the participants regarding the ECMO practical test. Results: The study enrolled 37 participants (10 doctors, 27nurses). 67.6% (25/37) of trainees didn’t have ECMO experience. All two questionnaires were completed by 37 participants. A five-point Likert scale on practical test was finished by 4 ECMO experts. All participants passed the written and practical tests. All the responding participants thought the curriculum was useful in improving their perception of their overall knowledge and their ability to perform the required critical performance criteria on simulated ECMO. 91.9% (34/37) trainees thought that they invested more in active learning during the whole course; 60% (22/37) of them achieved a good level of technical evaluation. On the other hand, 67.6% (25/37) of the trainees have shown a good self-confidence in the priming course; however, 43.2% (16/27) trainees still needed to strengthen their overall competence in ECMO management. Conclusions: The integration of traditional teaching and high-fidelity simulation teaching can effectively improve the ECMO monitoring level and management skills of novice learners, but whether this training mode can be successfully transferred to the clinical field needs further research and confirmation.

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Assessment of Novice Learners in a Novel High-fidelity Simulation-Based Extracorporeal Membrane Oxygenation Education Program

10.21203/rs.3.rs-52219/v1 ◽

2020 ◽

Author(s):

Li TONG ◽

Wen-jie HU ◽

Yan-Ping ZHU ◽

Lu CAO ◽

Ying-Hui LI ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Likert Scale ◽

Performance Criteria ◽

High Fidelity ◽

High Fidelity Simulation ◽

Practical Test ◽

Novice Learners ◽

Membrane Oxygenation ◽

Simulation Based ◽

The Impact

Abstract Background: This study aimed to design a suitable integrated extracorporeal membrane oxygenation (ECMO) curriculum and assessed the impact of this a high-fidelity simulation-based education module on novice learners.Methods: An ECMO training curriculum was developed by well-trained and experienced ECMO experts that incorporated simulation modules to train multidisciplinary health care professionals. Pre- and post-participation questionnaires were used to determine the effects on the knowledge, ability, and confidence level of the participants. A five-point Likert scale was used to assess the participants regarding the ECMO practical test.Results: The study enrolled 37 participants (10 doctors, 27nurses). 67.6% (25/37) of trainees didn’t have ECMO experience. All two questionnaires were completed by 37 participants. A five-point Likert scale on practical test was finished by 4 ECMO experts. All participants passed the written and practical tests. All the responding participants thought the curriculum was useful in improving their perception of their overall knowledge and their ability to perform the required critical performance criteria on simulated ECMO. 91.9% (34/37) trainees thought that they invested more in active learning during the whole course; 60% (22/37) of them achieved a good level of technical evaluation. On the other hand, 67.6% (25/37) of the trainees have shown a good self-confidence in the priming course; however, 43.2% (16/27) trainees still needed to strengthen their overall competence in ECMO management. Conclusions: The integration of traditional teaching and high-fidelity simulation teaching can effectively improve the ECMO monitoring level and management skills of novice learners, but whether this training mode can be successfully transferred to the clinical field needs further research and confirmation.

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A Case Report of Combat Blast Injury Requiring Combat Casualty Care, Far-Forward ECMO, Air Transport, and All Levels of Military Critical Care

Military Medicine ◽

10.1093/milmed/usab354 ◽

2021 ◽

Author(s):

Lydia C Piper ◽

Jason J Nam ◽

John P Kuckelman ◽

Valerie G Sams ◽

Jeffry D DellaVolpe ◽

...

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Whole Blood ◽

Operative Management ◽

Blast Injury ◽

Esophageal Injury ◽

Resuscitative Thoracotomy ◽

Membrane Oxygenation ◽

Combat Casualty ◽

Cord Injury

ABSTRACT We describe a 34-year-old soldier who sustained a blast injury in Syria resulting in tracheal 5 cm tracheal loss, cervical spine and cord injury with tetraplegia, multiple bilateral rib fractures, esophageal injury, traumatic brain injury, globe evisceration, and multiple extremity soft tissue and musculoskeletal injuries including a left tibia fracture with compartment syndrome. An emergent intubation of the transected trachea was performed in the field, and the patient was resuscitated with whole blood prehospital. During transport to the Role 2, the patient required cardiopulmonary resuscitation for cardiac arrest. On arrival, he underwent a resuscitative thoracotomy and received a massive transfusion exclusively with whole blood. A specialized critical care team transported the patient to the Role 3 hospital in Baghdad, and the DoD extracorporeal membrane oxygenation (ECMO) team was activated secondary to his unstable airway and severe hypoxia secondary to pulmonary blast injury. The casualty was cannulated in Baghdad approximately 40 hours after injury with bifemoral cannulae in a venovenous configuration. He was transported from Iraq to the U.S. Army Institute of Surgical Research Burn Center in San Antonio without issue. Extracorporeal membrane oxygenation support was successfully weaned, and he was decannulated on ECMO day 4. The early and en route use of venovenous ECMO allowed for maintenance of respiratory support during transport and bridge to operative management and demonstrates the feasibility of prolonged ECMO transport in critically ill combat casualties.

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The Role and Impact of Extracorporeal Membrane Oxygenation in Critical Care

Methodist DeBakey Cardiovascular Journal ◽

10.14797/mdcj-14-2-110 ◽

2018 ◽

Vol 14 (2) ◽

pp. 110

Author(s):

Iqbal Ratnani ◽

Divina Tuazon ◽

Asma Zainab ◽

Faisal Uddin

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation

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928: INCLUSION OF HIGH-FIDELITY SIMULATION TRAINING IN A CRITICAL CARE NURSING INTERNSHIP

Critical Care Medicine ◽

10.1097/01.ccm.0000509604.68183.7f ◽

2016 ◽

Vol 44 (12) ◽

pp. 308-308 ◽

Cited By ~ 2

Author(s):

Bryan Boling ◽

Melanie Hardin-Pierce ◽

Lynne Jensen ◽

Zaki-Udin Hassan

Keyword(s):

Critical Care ◽

Simulation Training ◽

High Fidelity ◽

Critical Care Nursing ◽

High Fidelity Simulation ◽

Care Nursing

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Curriculum to Introduce Critical Care Nurses to Extracorporeal Membrane Oxygenation

American Journal of Critical Care ◽

10.4037/ajcc2020739 ◽

2020 ◽

Vol 29 (4) ◽

pp. 262-269

Author(s):

Whitney D. Gannon ◽

Lynne Craig ◽

Lindsey Netzel ◽

Carmen Mauldin ◽

Ashley Troutt ◽

...

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Reference Group ◽

High Volume ◽

Critical Care Nurses ◽

Care Nurse ◽

Membrane Oxygenation ◽

Written Examination ◽

Advanced User ◽

Before And After

Background Despite the growing use of extracorporeal membrane oxygenation (ECMO) in intensive care units (ICUs), no standardized ECMO training pathways are available for ECMO-naive critical care nurses. Objectives To evaluate a critical care nurse ECMO curriculum that may be reproducible across institutions. Methods An ECMO curriculum consisting of a basic safety course and an advanced user course was designed for critical care nurses. Courses incorporated didactic and simulation components, written knowledge examinations, and electronic modules. Differences in examination scores before and after each course for the overall cohort and for participants from each ICU type were analyzed with t tests or nonparametric equality-of-medians tests. Differences in postcourse scores across ICU types were examined with multiple linear regression. Results Critical care nurses new to ECMO (n = 301) from various ICU types participated in the basic safety course; 107 nurses also participated in the advanced user course. Examination scores improved after completion of both courses for overall cohorts (P < .001 in all analyses). Median (interquartile range) individual score improvements were 23.1% (15.4%-38.5%) for the basic safety course and 8.4% (0%-16.7%) for the advanced user course. Postcourse written examination scores stratified by ICU type, compared with the medical ICU/cardiovascular ICU group (reference group), differed only in the neurovascular ICU group for the basic safety course (percent score difference, −3.0; 95% CI, −5.3 to −0.8; P = .01). Conclusions Implementation of an ECMO curriculum for a high volume of critical care nurses is feasible and effective.

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Evolution of the United States Military Extracorporeal Membrane Oxygenation Transport Team

Military Medicine ◽

10.1093/milmed/usaa215 ◽

2020 ◽

Vol 185 (11-12) ◽

pp. e2055-e2060

Author(s):

Matthew D Read ◽

Jason J Nam ◽

Mauer Biscotti ◽

Lydia C Piper ◽

Sarah B Thomas ◽

...

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Demographic Data ◽

The United States ◽

Published Data ◽

Medical Treatment Facility ◽

Membrane Oxygenation ◽

Transport Distance ◽

Primary Indication ◽

The U.S

Abstract Introduction The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients. Materials and methods We conducted a single-center retrospective review of all patients transported by the sole U.S. military ECMO program from September 2012 to December 2019. We analyzed basic demographic data, ECMO indication, transport distance range, survival to decannulation and discharge, and programmatic growth. Results The U.S. military ECMO team conducted 110 ECMO transports. Of these, 88 patients (80%) were transported to our facility and 81 (73.6%) were cannulated for ECMO by our team prior to transport. The primary indication for ECMO was respiratory failure (76%). The range of transport distance was 6.5 to 8,451 miles (median air transport distance = 1,328 miles, median ground transport distance = 16 miles). In patients who were cannulated remotely, survival to decannulation was 76% and survival to discharge was 73.3%. Conclusions Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.

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