ECMO year in review: education & standardization

Fist obliged citation: the ECMOed Taskforce position paper, to describe the state of ECMO education worldwide, noting current limitations and challenges, & to put forth an educational agenda regarding opportunities for an international collaborative approach toward standardization.

Zakhary B, Shekar K, Diaz R, Badulak J, Johnston L, Roeleveld PP, Alinier G, Lai PCK, Ramanathan K, Moore E, Hassan I, Agerstrand C, Ngai WC, Salazar L, Raman L, Bembea MM, Davidson M, Gomez-Gutierrez RD, Mateo-Sidrón JAR, Kukutschka J, Antonini MV, Dickstein ML, Schmidt M, Abrams D, Ogino MT; ELSO ECMOed Taskforce.Position Paper on Global Extracorporeal Membrane Oxygenation Education and Educational Agenda for the Future: A Statement From the Extracorporeal Life Support Organization ECMOed Taskforce. Crit Care Med. 2019 Dec 11. link

ECMO education, in particular with regards to emergencies during a veno-arterial ECLS run, is challenging due to its intrinsic characteristics: a complex, high risk, often relatively low volume activity requiring dynamic decision making, multidisciplinary teamwork & communication, and rapid response. A simulation training focusing on CRM – Crisis Resource management and interprofessional communication could effectively address these educational needs. Institutional commitment to provide resources (both capital & human) is mandatory to the success of ECMO training programs. Read this full open access paper, Wallace Ngai of the ECMOed Workshops WG & Peter Lai of the Curriculum WG named among authors, congratulations!

Sin SWC, Ng PY, Ngai WCW, Lai PCK, Mok AYT, Chan RWK. Simulation training for crises during venoarterial extracorporeal membrane oxygenation. J Thorac Dis. 2019 May; 11(5): 2144–2152.
open access link

ECMO simulation-based training: a safe venue to practice complex interventions & learn how troubleshooting at best ECLS related complications through a well-coordinated teamwork. In this paper, Professor Guillaume Alinier, member of the ECMOed Curriculum & Research workgroups, and his colleagues of Qatar University & Hamad Medical Corporation in Doha, propose a novel SBT solution not based on real ECMO equipment but trying recreating problematic situations & emergencies scenarios with realism/high-fidelity and remote control, while avoiding costs related to extracorporeal support machine/circuits, enjoy!

Al Disi M, Alsalemi A, Alhomsi Y, Bensaali F, Amira A, Alinier G. Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution. Perfusion. 2019 Apr;34(3):183-194. link

Screen-based simulators as affordable & realistic alternative to replace conventional ECLS education?? Here, an evaluation of the efficacy of an open-source interactive & low-cost screen-based ECMO simulator, showing no significant dissimilarities between training through this simulator and didactic classroom-based teaching, in terms of learning outcomes, self-efficacy, learner performance (& both could be considered complementary to mannequin-based immersive #simulation training). ECMOed members Mark Ogino, President of the ELSO, and Guillaume Alinier cited between the authors.

Alsalemi A, Tanaka L, Ogino M, Disi MA, Alhomsi Y, Bensaali F, Amira A, Alinier G. A skills acquisition study on ECMOjo: a screen-based simulator for extracorporeal membrane oxygenation. Perfusion. 2019 Jul 13:267659119859120. link

ps here the link to ECMOjo simulator

A mandatory reading, with referral to standardization: another ELSO position paper, a consensus about nomenclature & abbreviations for extracorporeal life support to ensure accurate, concise communication.

Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, Di Nardo M, Belliato M, Bembea MM, Barbaro RP, Diaz R, Grazioli L, Pellegrino V, Mendonca MH, Brodie D1, Fan E, Bartlett RH, McMullan MM, Conrad SA. The ELSO Maastricht Treaty for ECLS Nomenclature: abbreviations for cannulation configuration in extracorporeal life support – a position paper of the Extracorporeal Life Support Organization. Crit Care. 2019 Feb 8;23(1):36. open access link

(& to get clear about ExtraCorporeal Life Support, do not forget previous one… even if it was published in 2018: extensive, consistent & unambiguous nomenclature for the description of the practice of ECLS & ECMO.

Conrad S, Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, Di Nardo M, Belliato M, Grazioli L, Barbaro RP, McMullan DM, Pellegrino V, Brodie D, Bembea MM, Fan E, Mendonca M, Diaz R, Bartlett RH. The Extracorporeal Life Support Organization Maastricht Treaty for Nomenclature in Extracorporeal Life Support. A Position Paper of the Extracorporeal Life Support Organization. Am J Respir Crit Care Med. 2018 Aug 15;198(4):447-451. link

And to conclude this first part of the year in review, let’s talk about the ELSO Registry: here, update and perspectives, with acknowledgement for the contribution of all centers & professionals who make up the ELSO community, for supporting this scientific initiative in the challenging ECLS field, and a thought to all the patients who were treated with ECMO support against critical illnesses and pending death.

Lorusso R, Alexander P, Rycus P, Barbaro R. The Extracorporeal Life Support Organization Registry: update and perspectives. Ann Cardiothorac Surg. 2019 Jan; 8(1): 93–98. open access link

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