Extracorporeal Membrane Oxygenation Education Research Articles

202: Current State of Extracorporeal Membrane Oxygenation Education in Neonatal and Pediatric Critical Care Fellowship Training

202: Current State of Extracorporeal Membrane Oxygenation Education in Neonatal and Pediatric Critical Care Fellowship Training

An International Survey of Extracorporeal Membrane Oxygenation Education and Credentialing Practices.

The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly over the past decades because of evolving indications, advances in circuit technology, and encouraging results from modern trials. Because ECMO is a complex and highly invasive therapy that requires a multidisciplinary team, optimal education, training, and credentialing remain a challenge. The primary objectives of this study were to investigate the prevalence and application of ECMO education and ECMO practitioner credentialing at ECMO centers globally. In addition, we explored differences among education and credentialing practices in relation to various ECMO center characteristics. We conducted an observational study of ECMO centers worldwide using a survey querying participants in two major domains: ECMO education and ECMO practitioner credentialing. Of note, the questionnaire included ECMO program characteristics, such as type and size of hospital and ECMO experience and volume, to explore the association with the two domains. A total of 241 (32%) of the 732 identified ECMO centers responded to the survey, representing 41 countries across the globe. ECMO education was offered at 221 (92%) of the 241 centers. ECMO education was offered at 105 (98.0%) high-ECMO volume centers compared with 136 (87.5%) low-ECMO volume centers (P = 0.005). Credentialing was established at 101 (42%) of the 241 centers. Credentialing processes existed at 52 (49.5%) high-ECMO volume centers compared with 51 (37.5%) low-ECMO volume centers (P = 0.08) and 101 (49.3%) Extracorporeal Life Support Organization centers compared with 1 (2.7%) non-Extracorporeal Life Support Organization center (P < 0.001). We found significant variability in whether ECMO educational curricula are offered at ECMO centers. We also found fewer than half of the ECMO centers surveyed had established credentialing programs for ECMO practitioners. Future studies that assess variability in outcomes among centers with and without standardized educational and credentialing practices are needed.

Prior Extracorporeal Membrane Oxygenation (ECMO) Experience and Performance in High-Fidelity Simulation Scenarios.

BackgroundExtracorporeal Membrane Oxygenation (ECMO) provides a heart-lung bypass for patients with life-threatening cardiorespiratory failure. It is a classic low-volume, a high-risk procedure that requires specialized training to develop and maintain competence. Therefore, our ability to train efficiently and effectively is essential. The purpose of this study is to determine if specific participant training or experience leads to better performance in emergency ECMO scenarios during high-fidelity simulation training.MethodsFifty-one physicians, nurses, and respiratory/medical technicians participated in a study comparing an animal model vs. simulation-based ECMO education. All completed a multiple-choice questionnaire about prior ECMO experience and other demographics, as well as a four-hour pre-lab didactic session. They completed individual ECMO scenarios with both modalities during two sessions, and task completion times (minutes) and scores (percentage) were measured using a validated ECMO skills assessment tool. The scores of the 19 participants who completed the simulation-based scenarios during their first session were further analyzed in the context of their self-reported ECMO experience, and participants were divided into a novice group and an experienced group. Statistical testing included the Mann-Whitney U test (times) and Fisher’s exact test (scores).ResultsData from the 19 participants who completed the simulation-based ECMO training on the first session showed no statistically significant differences in the task completion time or scores among those in the novice group vs. the experienced group in the years of ECMO experience category (28 vs. 34 minutes; p=0.66 and 61% vs. 62%; p=0.54), a number of cannulations category (30 vs. 25 minutes; p=0.11 and 59% vs. 62%; p=0.82) or the number of ECMO patients cared for category (28 vs. 34 minutes; p=0.30 and 57% vs. 62%; p=0.54). Findings were similar for both the lecture-based training and simulation-based training categories, respectively (33 vs. 28 minutes; p=0.71 and 62% vs. 60%; p=0.91 and 34 vs. 28 minutes; p=0.74 and 63% vs. 58%; p=0.12).ConclusionAmong this small subset of participants, we observed no statistically significant differences in performance based on participant experience during simulation-based ECMO scenarios. The didactic/review sessions preceding the training may have contributed to an effective form of training for participants with no prior ECMO experience. Due to the small sample size of this study, further studies are needed to better elucidate what factors lead to better performance in emergency ECMO scenarios.

A Scoping Review and Appraisal of Extracorporeal Membrane Oxygenation Education Literature.

BackgroundDespite a recent rise in publications describing extracorporeal membrane oxygenation (ECMO) education, the scope and quality of ECMO educational research and curricular assessments have not previously been evaluated.ObjectiveThe purposes of this study are 1) to categorize published ECMO educational scholarship according to Bloom’s educational domains, learner groups, and content delivery methods; 2) to assess ECMO educational scholarship quality; and 3) to identify areas of focus for future curricular development and educational research.MethodsA multidisciplinary research team conducted a scoping review of ECMO literature published between January 2009 and October 2021 using established frameworks. The Medical Education Research Study Quality Instrument (MERSQI) was applied to assess quality.ResultsA total of 1,028 references were retrieved; 36 were selected for review. ECMO education studies frequently targeted the cognitive domain (78%), with 17% of studies targeting the psychomotor domain alone and 33% of studies targeting combinations of the cognitive, psychomotor, and affective domains. Thirty-three studies qualified for MERSQI scoring, with a median score of 11 (interquartile range, 4; possible range, 5–18). Simulation-based training was used in 97%, with 50% of studies targeting physicians and one other discipline.ConclusionECMO education frequently incorporates simulation and spans all domains of Bloom’s taxonomy. Overall, MERSQI scores for ECMO education studies are similar to those for other simulation-based medical education studies. However, developing assessment tools with multisource validity evidence and conducting multienvironment studies would strengthen future work. The creation of a collaborative ECMO educational network would increase standardization and reproducibility in ECMO training, ultimately improving patient outcomes.

ECMO simulation training during a worldwide pandemic: The role of ECMO telesimulation.

Extracorporeal membrane oxygenation (ECMO) is a supportive therapy used in the most severe forms of acute respiratory distress syndrome. Due to its intrinsic complexity and relatively low annual volume, simulation is essential for efficient and appropriate ECMO management. COVID-19 has limited the opportunities for high-fidelity in-person simulation training when many hospitals are looking to expand their ECMO services to battle the ongoing pandemic. To meet this demand, the National Cardiovascular Center Harapan Kita, Jakarta, Indonesia, conducted a 3-day ECMO course entailing online didactic lectures (adult and paediatric stream), water drills and telesimulation. The purpose of the study is to report the evaluation result of this novel model of education during COVID-19 outbreak. Participants were given an ECMO knowledge pre-course and post-course test and a telesimulation evaluation survey at the conclusion and these data were collected. The course was attended by 104 physicians, critical care nurses and perfusionists. Pre-course and post-course assessments showed a significant improvement in ECMO knowledge (60.0% vs 73.3%, respectively). Overall, the participants rated the telesimulation positively, and most found it acceptable to in-person simulation training considering the pandemic restrictions. Despite the complexities of ECMO, our recent experience demonstrates ECMO education and simulation delivered online is feasible, welcomed and supportive of a change in ECMO training course format. As we incorporate more innovative digital technologies, telesimulation may further enhance the quality of future ECMO training.

Characteristics of Extracorporeal Membrane Oxygenation Education Vary in Entry-Level Doctor of Physical Therapy Programs

Background/Purpose: Extracorporeal membrane oxygenation (ECMO) with high risks of mismanagement is being used more frequently in critical care for cardiorespiratory failure. The safety and feasibility of physical therapy (PT) for patients on ECMO have been established. Little is known about ECMO education and training for entry-level physical therapist students. The purpose of this study is to determine the characteristics of ECMO education in entry-level doctor of physical therapy (DPT) educational programs and examine any correlations among these characteristics. Methods: A survey was developed on the basis of a literature search and author experience. The anonymous survey was disseminated electronically to directors of all Commission on Accreditation in Physical Therapy Education (CAPTE)–accredited DPT programs in the United States. Results: Faculty from 31 (12.8%) programs responded. Some level of ECMO-related education was included in 25 (80.65%) programs. Content of didactic education varied across programs. Other modes of ECMO education included case study discussions, simulation training, and hands-on experience. Statistically significant relationships were identified among university affiliation with an academic medical center and the presence of case studies (n = 6, P &lt; .05) and hands-on experience (n = 8, P = .001), as well as between instructor cardiovascular and pulmonary specialist credentials and the presence of hands-on experience (n = 12, P &lt; .001). Discussion/Conclusion: The extent and characteristics of ECMO-related education vary among entry-level DPT programs. Programs affiliated with academic medical centers and specialty-certified instructors may provide exposure to broader critical care content, such as ECMO. Formalized curricular guidelines may be necessary to help adequately prepare students for clinical practice. Entry-level clinicians should advocate for advanced training when appropriate.

증강현실을 활용한 체외막산화장치 준비교육이 임상간호사의 수행능력, 수행자신감 및 교육만족도에 미치는 효과

Purpose: This study aimed to understand the effect of extra-corporeal membrane oxygenation (ECMO) preparation education implemented with smart glasses in augmented reality on the performance ability, performance confidence, and educational satisfaction of clinical nurses. Method: The participants were clinical nurses at B hospital—27 in the experimental group and 25 in the control group. The measurement tools were performance ability (24 items), performance confidence (11 items), and educational satisfaction (9 items). The experimental group intervention used augmented reality with smart glasses, and the control group used video resources. The collected data were analyzed by t-test, x2-test, and ANCOVA using the SPSS Statistics for Windows, version 25.0. Results: The performance was significantly higher in the experimental group than in the control group (F = 104.83, p < .001). Performance confidence was considerably higher in the experimental group than in the control group (F = 2.09, p = .041). Finally, educational satisfaction was significantly higher in the experimental group than in the control group (F = 4.52, p < .001). Conclusion: It was confirmed that ECMO education implementing augmented reality with smart glasses is an effective method for improving performance ability, performance confidence, and educational satisfaction among clinical nurses.

Acute Care Nurse Practitioner-Led Extracorporeal Membrane Oxygenation Simulation Training.

Acute Care Nurse Practitioner-Led Extracorporeal Membrane Oxygenation Simulation Training.

The Effectiveness of Three Different Curricular Models to Teach Fundamental ECMO Specialist Skills to Entry Level Perfusionists

The dramatic increase in the use of extracorporeal membrane oxygenation (ECMO) over the last decade with the concomitant need for ECMO competent perfusionists has raised questions of how well perfusion education programs are preparing entry-level perfusionists to participate in ECMO. While all perfusion schools teach ECMO principles, there is no standardized or systematic approach to the delivery of didactic knowledge and clinical skills in ECMO. Given this variability of ECMO education across and within perfusion schools, the CES-A exam may provide a metric for comparing curricular approaches. The purpose of this study is to examine three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We examined three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We hypothesized that there would be no difference in CES-A pass rate, exam score, Rasch measure, and item category scores between SUNY Cardiovascular Perfusion Program (CVP) graduates who completed SUNY’s ECMO Capstone experience (Group III) and CVP graduates who did not select the ECMO Capstone experience (Group II). Further, we studied the performance of a third group of new graduates from an external program that does not offer formal ECMO courses or an ECMO Capstone experience (Group I). Every perfusion graduate in all groups passed the adult ECMO specialist exam. The graduates who as students completed an ECMO Capstone experience (Group III) scored higher on the exam and significantly higher on four exam categories: coagulation and hemostasis (p = .058), lab analysis point of care (p = .035), and monitor patient and circuit (p = .073), and the safety and failure modes (p = .017). Overall the median graduate Rasch measures ranked with Group III demonstrating the highest measure to Group I the lowest measures (not significant atp = .085). There is a positive educational effect due to CVP graduates completion of the ECMO Capstone experience compared to the program standard ECMO-related curricula in the two perfusion programs participating in this study. From this observation a structured ECMO simulation-based program appears to be equally effective as a traditional, typical lecture-only, clinical perfusion preceptorship, while demonstrating a more satisfactory experience with a higher reported case experience. In this study the standard perfusionist education curriculum prepared the new graduate to be successful on the CES-A exam. The three curricular approaches appear to prepare perfusionist graduates to be successful on the Adult ECMO Specialist exam.

The Effectiveness of Three Different Curricular Models to Teach Fundamental ECMO Specialist Skills to Entry Level Perfusionists.

The dramatic increase in the use of extracorporeal membrane oxygenation (ECMO) over the last decade with the concomitant need for ECMO competent perfusionists has raised questions of how well perfusion education programs are preparing entry-level perfusionists to participate in ECMO. While all perfusion schools teach ECMO principles, there is no standardized or systematic approach to the delivery of didactic knowledge and clinical skills in ECMO. Given this variability of ECMO education across and within perfusion schools, the CES-A exam may provide a metric for comparing curricular approaches. The purpose of this study is to examine three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We examined three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We hypothesized that there would be no difference in CES-A pass rate, exam score, Rasch measure, and item category scores between SUNY Cardiovascular Perfusion Program (CVP) graduates who completed SUNY's ECMO Capstone experience (Group III) and CVP graduates who did not select the ECMO Capstone experience (Group II). Further, we studied the performance of a third group of new graduates from an external program that does not offer formal ECMO courses or an ECMO Capstone experience (Group I). Every perfusion graduate in all groups passed the adult ECMO specialist exam. The graduates who as students completed an ECMO Capstone experience (Group III) scored higher on the exam and significantly higher on four exam categories: coagulation and hemostasis (p = .058), lab analysis point of care (p = .035), and monitor patient and circuit (p = .073), and the safety and failure modes (p = .017). Overall the median graduate Rasch measures ranked with Group III demonstrating the highest measure to Group I the lowest measures (not significant at p = .085). There is a positive educational effect due to CVP graduates completion of the ECMO Capstone experience compared to the program standard ECMO-related curricula in the two perfusion programs participating in this study. From this observation a structured ECMO simulation-based program appears to be equally effective as a traditional, typical lecture-only, clinical perfusion preceptorship, while demonstrating a more satisfactory experience with a higher reported case experience. In this study the standard perfusionist education curriculum prepared the new graduate to be successful on the CES-A exam. The three curricular approaches appear to prepare perfusionist graduates to be successful on the Adult ECMO Specialist exam.

Simulation Versus Interactive Mobile Learning for Teaching Extracorporeal Membrane Oxygenation to Clinicians: A Randomized Trial.

Extracorporeal membrane oxygenation has become integral to critical care. Data informing optimal extracorporeal membrane oxygenation education modalities are lacking. We aimed to compare the effect of high-fidelity simulation versus interactive mobile learning on extracorporeal membrane oxygenation knowledge acquisition and retention among clinicians. Observer-blinded, randomized controlled trial. A single academic medical center. Forty-four critical care clinicians with limited extracorporeal membrane oxygenation experience. Participants were randomized to receive: 1) simulation: three high-fidelity training scenarios, 2) QuizTime: 15 total multiple-choice questions delivered over 3 weeks via mobile device, or 3) experiential: no formal training. Participants completed a survey, written knowledge examination, and simulation assessment prior to randomization, immediately following the intervention, and 4 month postintervention. The primary outcome was knowledge about extracorporeal membrane oxygenation assessed by score on the immediate postintervention written examination. Secondary outcomes included performance in extracorporeal membrane oxygenation simulation postintervention and 4 months later assessed by a rater blinded to group assignment. Clinicians randomized to simulation (n = 15), QuizTime (n = 14), and experiential (n = 15) had similar baseline characteristics. Adjusting for baseline knowledge, postintervention examination scores were higher in the simulation group (90.0%; interquartile range, 85.0-90.0%) than the QuizTime group (70.0%; interquartile range, 65.0-80.0%; p = 0.0003) and the experiential group (75.0%; interquartile range, 65.0-80.0%; p = 0.001). Scores did not differ between the groups at 4 months (p > 0.05 in all analyses). In postintervention extracorporeal membrane oxygenation simulations, the simulation group demonstrated shorter time to critical action compared with QuizTime (80.0 s [interquartile range, 54.0-111.0 s] vs 300.0 s [interquartile range 85.0-300.0 s]; p = 0.02) and compared with both QuizTime (45.0 s [interquartile range, 34.0-92.5 s] vs 255.5 s [interquartile range, 102.0-300.0 s]; p = 0.008) and experiential (300.0 s [interquartile range, 58.0-300.0 s]; p = 0.009) at 4 months. Simulation was superior to QuizTime and experiential learning with regard to extracorporeal membrane oxygenation knowledge acquisition. Further studies are needed to ascertain the effect of these interventions on knowledge retention, clinical performance, and patient outcomes.

Interprofessional ECMO telerounding: a novel approach to neonatal ECMO clinical participation and education.

ObjectiveDetermine the feasibility, strengths, and barriers of offering extracorporeal membrane oxygenation (ECMO) telerounding to neonatal intensive care unit (NICU) care providers.Study designNICU providers were invited to join ECMO rounds by teleconference. Data were collected on telerounding participation and ECMO concepts discussed. A survey was sent to all providers.ResultsFrom March 2018 to February 2020, telerounding on 24 neonatal ECMO patients (168 ECMO days) was performed in a Level IV NICU. A mean of four providers joined telerounds per ECMO day with an increase from 3 to 6 providers over the study period. Nearly all respondents felt telerounding lowered barriers to attending ECMO rounds (94%), promoted engagement (89%), and improved continuity of care (78%). Barriers to ECMO telerounding were suboptimal audio connections and limited ability to participate in the clinical discussion.ConclusionECMO telerounding is well-received by NICU providers. It can improve provider participation, complement existing in-person ECMO rounds, and ECMO education.

Position Paper on Global Extracorporeal Membrane Oxygenation Education and Educational Agenda for the Future: A Statement From the Extracorporeal Life Support Organization ECMOed Taskforce.

The purpose of this position paper is two-fold: first, to describe the state of extracorporeal membrane oxygenation education worldwide, noting current limitations and challenges; and second, to put forth an educational agenda regarding opportunities for an international collaborative approach toward standardization. Relevant medical literature was reviewed through literature search, and materials from national organizations were accessed through the Internet. Taskforce members generated a consensus statement using an iterative consensus process through teleconferences and electronic communication. In 2018, the Extracorporeal Life Support Organization convened the ECMOed Taskforce at two structured, face-to-face meetings of 40 healthcare practitioners and educators with expertise in caring for the extracorporeal membrane oxygenation patient and in extracorporeal membrane oxygenation education. None. None. The ECMOed Taskforce identified seven educational domains that would benefit from international collaborative efforts. Of primary importance, the Taskforce outlined actionable items regarding 1) the creation of a standardized extracorporeal membrane oxygenation curriculum; 2) defining criteria for an extracorporeal membrane oxygenation course as a vehicle for delivering the curriculum; 3) outlining a mechanism for evaluating the quality of educational offerings; 4) utilizing validated assessment tools in the development of extracorporeal membrane oxygenation practitioner certification; and 5) promoting high-quality educational research to guide ongoing educational and competency assessment development. Significant variability and limitations in global extracorporeal membrane oxygenation education exist. In this position paper, we outline a road map for standardizing international extracorporeal membrane oxygenation education and practitioner certification. Ongoing high-quality educational research is needed to evaluate the impact of these initiatives.

The introduction of a high-fidelity simulation program for training pediatric critical care personnel reduces the times to manage extracorporeal membrane oxygenation emergencies and improves teamwork.

Extracorporeal membrane oxygenation (ECMO) is used to support patients with severe respiratory and/or cardiac failure unresponsive to conventional treatments. Despite being one of the most complex supportive therapy used in intensive care unit, there is a still a lack of training programs dedicated to improve both clinical and nonclinical skills. The aim of the current study was to evaluate if the introduction of an ECMO high-fidelity simulation curriculum among personnel reduces the times to manage bedside emergencies and improves the behavioral skills. This retrospective study was performed from 2011 to 2016 in a 6-beds general pediatric intensive care unit (PICU) of a tertiary children's hospital. The study population was the PICU personnel. From the beginning of 2011 to the end of 2013, ECMO education was provided without a simulation program. A high-fidelity simulation program instead, was provided from December 2013. Times to manage the most common ECMO emergencies (pump failure, oxygenator change and air embolism management) as well as the behavioral skills of the personnel were evaluated before and after the simulation intervention only in novice learners to reduce the bias related to the natural improvement associated with the bedside practice. There were a total of 30 ECMO runs and 27 ECMO emergencies over the study period. Ten ECMO emergencies occurred during the pre-simulation period and 17 in the post-simulation period. The median time to change an oxygenator in case of failure was 5.3 (4.80-6.02) min during the pre-simulation period vs. 3.9 (3.50-4.15) min in the post-simulation period (P=0.02). The median time to manage an air embolism emergency was 22 (20.00-23.50) min during the pre-simulation period vs. 15 (13.75-16.50) min in the post-simulation period (P=0.048). Only one episode of pump failure occurred in either the pre-simulation and post-simulation periods. In the pre-simulation period the median cumulative behavioral score was 40 (35.00-44.75) whereas it was 48 (44.5-49.00) in the post-simulation period (P<0.01). The introduction of a high-fidelity simulation program for pediatric ECMO improved both the times to effective interventions and behavioral skills.

The evolving role of ECMO simulation

The utilization of extracorporeal membrane oxygenation (ECMO) to support patients with respiratory and/or cardiac failure continues to increase annually, with growth primarily in the adult population. 1 The life-saving therapy requires a multidisciplinary team to deliver the highly technical treatment with clinical competency in three areas: cognitive knowledge, technical skills, and behavioral skills. The use of traditional methods of education in which knowledge is transmitted through lectures and reading materials results in limited retention and ability to apply learned information in the clinical setting. 2 Adult education theory promotes alternative methods of learning, which organizes abstract information through association with previous experiences and leads to mastery of knowledge through functional application. 3 The educational tool which supports this approach to learning is simulation. Multiple forms of simulation have been used to enhance ECMO education. These include task trainers, virtual...

ECMO nurse specialist: Qatar experience

As part of the National Health Strategy in the State of Qatar to improve the healthcare sector, the Critical Care Service in Hamad General Hospital (HGH) sets up an extracorporeal membrane oxygenation (ECMO) service within the Medical Intensive Care Unit (MICU) to enhance the care provided to critically ill patients. The new service demands a new technology and specific staff training in order to maintain high standards and safe care. Therefore, our initial investment was in training the team following ELSO guidelines and the purchase of ECMO equipment, especially for the adult population in our case. In the State of Qatar, the first use of ECMO treatment as respiratory support was in May 2014. Our experience supports other research that this technique requires expert knowledge and skills to deliver best and safe practice.1 We believe that this can be developed through regular practice and interaction at the bedside with patients and the ECMO technical equipment. Moreover, planning a robust ECMO education programme for the team is central to improving the quality of care and safety that we provide to these vulnerable patients. As part of our preparation process, in November 2013, six ICU nurses attended the ECMO specialist training course in London (UK). Since then, continuing educational programme has been established to train all the whole MICU nursing team focused on ECMO patient care. Several in-house training workshops and external re-training programmes were provided to nurses to develop their theoretical knowledge and technical skills with other members of the clinical team. In addition, we have performed simulation training that focused on multidisciplinary team, emphasising that teamwork is important and necessary for the care of such patients. The ECMO specialised nurse who takes care of these patients is educated to provide specialised assessment, appropriate monitoring, and clinical reasoning interventions. In addition to manipulating the ECMO machine, understanding ventilation requirements and the patient's medical treatment is crucial to help the ECMO nurses detect the signs of deterioration early and intervene immediately. Therefore, naturally, the role of the ECMO nurse has expanded and tends to be developed with theoretical and technological developments.2 The primary roles being close monitoring of alterations in blood flow and observation and maintenance of the circuit, and also an ability to assess the risks and assist with patient care. We also compared the role of the ECMO specialist nurse versus the role of the perfusionist. We believe in the importance of both roles; however, we argue that when the ECMO nurse works alongside the ICU bedside nurse, the bedside care becomes more effective. Both nurses and perfusionists are able to understand the patient's overall condition and needs during the ECMO run, and have better interpretation regarding observed changes.3 The partnership promotes the continuity of patient care and allows better communication and support of the family as an aspect of care. This also increases the opportunity of bedside training and education and allows developing other nurses under supervision. Overall, with proper planning, education, and structuring of ECMO care, we were able to obtain outcomes that are similar to those reported internationally. We aim to further improve patient outcome, especially regarding post-ICU discharge as part of holistic nursing care.

Use of ECMO in the Management of Severe Acute Respiratory Distress Syndrome: A Survey of Academic Medical Centers in the United States.

Mortality of severe acute respiratory distress syndrome (ARDS) remains high. Once conventional mechanical ventilation fails, alternative modes of therapy are used; most of which have limited evidence to support their use. No definitive guidelines exist for the management of these patients with alternate modalities of treatment. We conducted a cross-sectional national survey of 302 adult critical care training programs in the United States to understand the current preferences of intensivists regarding the use of different therapies for severe ARDS, including the use of extracorporeal membrane oxygenation (ECMO). A total of 381 responses were received: 203 critical care faculty and 174 critical care trainees. Airway pressure release ventilation was the initial choice of treatment reported by most when conventional mechanical ventilation strategy failed followed by inhaled nitric oxide and prone positioning. Extracorporeal membrane oxygenation availability was reported by 80% of the respondents at their institutions. Most respondents (83%) would consider ECMO in patients who fail optimal mechanical ventilation strategies, and the majority (60%) believed that ECMO use can facilitate lung protective ventilation, but few favored its use as a first-line modality. The majority of respondents reported limited knowledge of ECMO and desired specific ECMO education during training.

ABSTRACT 572

Background and aims: Extracorporeal membrane oxygenation is a high-risk and low-volume procedure whose management requires quick and decisive application of knowledge as well as technical and behavioral prowess to solve multiple problems. A variety of simulation modalities can facilitate the learning of procedural skills and promote evidence-based practice guidelines. Aims: 1) To establish a nurse led simulation-based extracorporeal membrane oxygenation education program for CTSD PICU nurses; 2) To evaluate the competency of nursing care for paediatric patients with ECMO therapy. Methods: From September 2012 to December 2013, our department initiated a nurse led simulation-based ECMO education program which was a 1-day in-service training and development. We recruited 45 nurses who were working in CTSD PICU. The program included a pre-test and post-test, ECMO demonstration, return demonstration, case discussion and simulation scenarios. Debriefing introduced after post-test. Evaluation was completed at the end of the program. Results: 45 CTSD PICU nurses were recruited to participate in the program. Pre-test was finished and found that they were lacking knowledge in looking after critically ill paediatric patients with ECMO therapy. In the pre-test, all nurses achieved an average of 47.5% whereas 90% in the post-test. Of 45 nurses who joined the program, 87% enjoyed the program, 88% found it useful, 92% facilitated their professional development and 95% enjoyed the team work with instructors. Conclusions: Nurse led simulation-based ECMO education program proved to be effective and provided a safer clinical ECMO service to enhance better patient outcomes. All nursing staff attained good competency with simulated clinical ECMO management.