Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution

Disi, Mohammed Al; Alsalemi, Abdullah; Alhomsi, Yahya; Bensaali, Fayçal; Amira, Abbes; Alinier, Guillaume

doi:10.1177/0267659118802749

Cited by 22 publications

(16 citation statements)

References 54 publications

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“…Simulation is an important part of the process used to develop and maintain skills. 19 Finally, while PAH and GCUH have low ECMO case volumes, they treat high volumes of patients with cardiac and respiratory failure. Nearly 1700 patients were ventilated in the PAH ICU in 2019, more than any other ICU in Australia (unpublished data accessed from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database).…”

Section: Discussionmentioning

confidence: 99%

Low volume ECMO results study

Joyce¹,

Cook²,

Walsham³

et al. 2020

Critical Care and Resuscitation

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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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Section: Discussionmentioning

confidence: 99%

Low volume ECMO results study

Joyce¹,

Cook²,

Walsham³

et al. 2020

Critical Care and Resuscitation

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“…This workshop does not include the ECMO cannulation procedure as it is an aspect addressed in another workshop using a different patient simulator. 23 24 To maximize realism, the occurrence of the potential emergency varies and might be before, during, or after the ambulance transport phase. This is done in order to avoid having participants anticipating when something might happen.…”

Section: Candidate Selectionmentioning

confidence: 99%

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

Labib

Alinier

2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…With the exponential increase in ECMO use, there has been a parallel surge in ECMO educational programs worldwide re ecting recognition of the high cost, relatively low volume, intense resource utilization, and high risk nature of ECMO support, mandating that clinicians be properly trained [9,10].…”

Section: Introductionmentioning

confidence: 99%

Standardized Assessment of Simulation Based ECMO Educational Courses: A Pilot Study

Said

Cooley

Dı́az

et al. 2021

Preprint

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Background: The Extracorporeal Life Support Organization (ELSO) education taskforce (ELSOed) recently identified seven extracorporeal membrane oxygenation (ECMO) educational domains that would benefit from international collaborative efforts among which standardized assessments of ECMO courses was prioritized. We aimed to develop a standardized online assessment tool to evaluate the effectiveness of a comprehensive didactic and simulation-based ECMO course on participants’ gain in confidence, knowledge, and simulation-based skills.Methods: We performed a prospective multicenter observational study of five US adult ECMO courses. Standardized online assessment forms were developed and administered before and after courses, covering demographics, self-assessment regarding ECMO management, and knowledge exam (15 simple-recall multiple choice questions), while psychomotor skill assessment was performed during the course (time to complete pre-specified critical actions during simulation scenarios). Self-assessment covered cognitive, behavioral, and technical aspects of ECMO care.Results: Out of 211 participants, 107 completed both pre- and post-course forms (97 completed both pre and post-course knowledge forms). Physician-intensivists were the largest group (53%) and the majority practiced at academic hospitals (51%) and had less than 1-year of ECMO experience (50%). Post-course, participants reported significant increases in confidence across all domains (cognitive, technical, and behavioral; p<0.0001 CI:1.2-1.5, p<0.0001 CI:2.2-2.6, and p=0.002 CI:1.7-2.1, respectively) as well as an increase in knowledge scores (p<0.001, CI: 1.4-2.5). These findings were consistent for all specialties and prior ECMO experience. There were also significant reductions in the times to critical actions in 3 of the 4 scored simulation scenarios.Conclusions: We successfully developed and tested a comprehensive standardized ECMO course assessment tool, demonstrating participants’ self-reported benefit as well as improvement in both knowledge and psychomotor skill acquisition . Standardized course evaluation is feasible and potentially provides important information to improve ECMO courses. Future steps include national implementation, addition of questions targeting clinical decision making to further assess knowledge gain, and multi-language translation for implementation at international courses.

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Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution

Cited by 22 publications

References 54 publications

Low volume ECMO results study

Low volume ECMO results study

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

Standardized Assessment of Simulation Based ECMO Educational Courses: A Pilot Study

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