The Extracorporeal Life Support Organization, ELSO, is the global nonprofit organization for ExtraCorporeal Membrane Oxygenation (ECMO) and Extracorporeal Life Support (ECLS). We are working with our partners across the globe on the response to COVID-19 as it relates to the use of ECMO for supporting patients infected with the virus. We are relying on the same sources as others for accurate information related to the rapidly evolving COVID-19 virus epidemiology. Specifically, we will continue to rely on the World Health Organization, the Centers for Disease Control, as well as, local health officials and governments as the situation evolves. We remain a real-time authoritative resource because of ELSO’s global member centers which provide up-to-date information and data to allow our physicians and scientists to continually edit our recommendations. COVID-19 can cause respiratory distress in some patients. ECMO has proven to be an effective option to support selective patients with severe respiratory distress, some of which are COVID-19 patients. We are tracking this information globally, including as part of our registry. In addition, we are launching new studies and data sharing agreements with our partners across the globe. As an example, our Asia Pacific ELSO Chapter is coordinating efforts across the Asia Pacific region and globally to study ECMO in the treatment of patients with COVID-19. The group’s trial, ExtraCorporeal Membrane Oxygenation for Coronavirus 19 Acute Respiratory Distress (ECMOCARD) will study the clinical data of COVID-19 patients where ECMO treatment was provided in more than 50 hospitals across 4 continents and 19 countries. This study has been endorsed by the World Health Organization and the international ECMO research group, ECMONet. As new studies and results emerge, we will share relevant information on our website. We will be updating this information with the urgency that this situation requires. We will have a link from our homepage: http://www.elso.org, social media sites on Twitter, Facebook, LinkedIn, and our ELSO ECMOed blog on COVID 19. Twitter Facebook Linkedin ELSO ECMOed blog We are committed to coordinating with our ECLS centers across the globe and sharing updated information as this situation warrants. Thank you, and stay healthy.
To date, there is limited worldwide experience with using ECMO in COVID-19 patients. The ELSO – Extracorporeal Life Support Organization continues to collect data through our member centers, and will provide recommendations as additional information becomes available. Moreover, to support the ECMO providers community, we are going to host a series of webinars to answer main questions related to Coronavirus outbreak and induced disease COVID-19 & the use of ECMO, involving leaders in the field of intensive care medicine and extracorporeal support ECLS. Any question, doubt or concern? Any particular topic you would like our expert to address? Send all questions to email@example.com or through DM & stay tuned, info on date/timing coming soon!
Optimal site for providing extracorporeal cardio-pulmonary resuscitation ECPR in out-of-hospital cardiac arrest? maybe in the hospital, in the cath-lab better! here notes from the talk given by Jan Belohlavek, EuroELSO president, at EuroELSO2019 meeting: not ECLS alone, but a comprehensive approach including ECMO, with high quality bystander CPR/high quality ACLS, may have an impact on logistics for OHCA patients; we have technology but we still need to define proper patients & optimize logistics: randomized studies are absolutely necessary. Everything else is just an emotional bias. Visual abstract by @foamecmo See you at EuroELSO2020 Congress, next May 6-8 2020 in London! register here
Perfect prime for ECMO circuit?? We take care for neonates, pediatrics, growing number of adult patients… there is no gold standard that defines ideal prime, as no prime is going to fit all these populations, and sometimes is a race against time! here some notes freely based on the talk by Christine Franciscovich at 2019 ELSO Conference: clear & blood priming, and factors to be considered when choosing dilutional hematocrit calculation additives options: calcium, albumin, heparin, NaHcO3… lab/ABG on prime graphics by Velia Marta Antonini @foamecmo
About the ExtraCorporeal Membrane Oxygenation for 2019 novel Coronavirus Acute Respiratory Disease ECMOCARD study, Professor Robert Bartlett, writes:”… our most important weapon in this crisis is data to predict and plan – on a global scale… a global problem needs global collaboration”. Here some words by Professor John Fraser, President of the Asia Pacific ELSO Chapter APELSO, introducing the study. “Colleagues As President of the Asia Pacific ELSO, I write to express my gratitude for all the work and collaboration from our brothers and sisters during this time of pandemic. At times of global crisis, this is where teams show their strength. We have now more than. 50 centres in 20+ countries. over 4 continents that have signed up for the ECMOCARD study. Each night more centres are contacting us to join to work together; innovators and trailblazers that have come before us have given us the skills to hopefully be able to help the most critically unwell. It is in this environment that I am delighted that the father of #ECMO, Prof. Bob Bartlett has written to congratulate the ECMOCARD on the global collaboration we have created. Because a global crisis needs global collaboration for a global solution. With Best wishes and thanks” John Attached, full text of Professor Bartlett letter.
ExtraCorporeal Membrane Oxygenation for 2019 novel Coronavirus Acute Respiratory Disease ECMOCARD study is an multi-centre International study, conducted in all collaborating hospitals/ICU-based research networks in Asia, Australia & New Zealand (APELSO in collaboration with centres within the SPRINT-SARI and ISARIC Networks), and Europe, in COVID-19 patients requiringadmission to to ICU, Mechanical Ventilation &/or ECMO, to characterize: incidence of ICU admission, need for non-invasive/invasive MV and ECMO risk factors, clinical features and severity of respiratory failure ECMO technical characteristics & duration of the run complications and ICU/Hospital survival requirements/time for approvals in participating network regions.
Aim is to recruit all eligible patients at each study location; patients will be studied specifically focusing on collecting data on MV, ECMO, main therapies (includinvasoactives, hypoxaemia rescue therapies, RRT), antibiotics/antivirals, adjunctive therapies, ie immunomodulators, corticosteroids, short-term outcomes.
Laboratory-confirmed COVID-19 infection by real-time PCR and/or next-generation sequencing Admission to an ICU
MV for other concomitant causes ECMO for other concomitant causes
Family of RNA viruses which may infect mammals and birds, with 6 species known to cause human disease; 2 strains, the severe acute respiratory syndrome coronavirus SARS-CoV and Middle East respiratory syndrome coronavirus MERS-CoV have caused more serious, sometimes fatal, respiratory illnesses (reported mortality respectively 10% & 37%).
SARS-CoV-2 & COVID-19
In late December, 2019, in Wuhan, Hubei, China, new respiratory syndrome emerged with clinical signs resembling viral pneumonia and person-to-person transmission; analysis from lower respiratory tract samples corroborated emergence of novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 SARS–CoV-2, causing COrona VIrus Disease 2019 (COVID-19).
Recommendations on Extracorporeal Life Support for critically ill patients with Coronavirus Disease 2019 (COVID-19) pneumonia from the Chinese Society of Extracorporeal Life Support. Along with the sharp increase in confirmed cases of novel Coronavirus infection, some of the most critically ills will require ExtraCorporeal Membrane Oxygenation (ECMO) support. Based on the clinical data related to COVID-19, as well as on the data from previous clinical studies and on the recommendations from the Extracorporeal Life Support Organization (ELSO), the Committee Board of the Chinese Society of Extracorporeal Life Support (CSECLS) drafted a series of recommendations to guide implementation of extracorporeal support in patients with confirmed infection developing refractory respiratory or cardio-respiratory failure: here a summary, attached the full original version.
Acute Respiratory Distress Syndrome (ARDS) is one of the most common indications for extracorporeal support in respiratory failure. While providing extracorporeal gas exchange, respiratory ECMO enables lung protective mechanical ventilation settings, allowing the lung to rest, and eventually to recover. In majority of the patients infected with novel Coronavirus, pneumonia were mild and reversible. However, some of these patients became critically ill, with most of them developing dyspnea and/or hypoxemia in 1 week from the onset. Most severe cases rapidly developed ARDS, deteriorating to multiple organ failure. Some patients presented with concurrent cardiac involvement, eventually evolving in circulatory dysfunction in sickest patients. When cardiogenic shock or cardiac arrest occurs, veno-arterial configuration (VA-ECMO) needs to be considered.
Timing for ECMO support
ECMO could be implemented in patients with ARDS if hypoxemia does not improve despite conventional management strategies, with maximal mechanical ventilation settings (FiO2≥ 0.8, tidal volume 6 ml/kg, PEEP ≥ 10 cmH2O), if no contraindication are present, and when at least one of the following conditions is met: – PaO2/ FiO2 < 80 mmHg for more than 6 hours – FiO2 = 1.0，PaO2/FiO2 < 100 mmHg. – arterial pH < 7.25, PaCO2 > 60 mmHg for more than 6 hours, and respiratory rate > 35 breaths per minute – respiratory rate > 35 breaths per minute, and arterial pH < 7.2 with plateau pressure > 30 cmH2O – coexisting cardiogenic shock or cardiac arrest.
Relative or absolute contraindications for ECMO
combination of irreversible disease, severe damage of central nervous system or advanced stage of malignant tumor.
Mechanical Ventilation at high settings (FiO2> 0.9, plateau pressure > 30 cmH2O) lasting 7 days or longer;
advanced age in not actually considered a contraindication, it is associated to an increased risk of death;
severe multiple organ failure;
moderate to severe aortic regurgitation and acute aortic dissection could be considered contraindications to VA ECMO support;
no vascular access available for ECMO cannulation due to anatomy alterations or pathological changes involving target vessels.
COVID-19 patients usually present with a normal cardiac function at the early stage, so veno-venous ECMO to support respiratory function has been the preferential configuration; however, right heart function should be closely monitored during the rung. If cardiogenic shock or cardiac arrest occurs, configuration could be shift to veno-arterial. If differently hypoxemia develops on VA-ECMO, establishing a VAV configuration could be considered.
Clinical characteristics of patients with 2019nCoV (now properly defined by World Health Organization (WHO) Covid-19) in these 3 papers.
Data extraction on 1,099 patients with laboratory-confirmed #Covid-19 from 552 hospitals in 31 provinces/provincial municipalities through January 29th, 2020. Authors reported 5% of patients admitted to #ICU, 2.18% requiring invasive ventilation, and 1.36% death rate. Extracorporeal membrane oxygenation implemented in 5 severe cases (0.5%). Read additional data (detailed clinical characteristics, radiographic & laboratory findings, complications, treatment & outcome, distribution of patients across China), open access text. Note article is a preprint/not peer-reviewed.
Data from 138 hospitalized patients infected with 2019 novel coronavirus in Wuhan, China also published on JAMA, reporting 26.1% of cases transferred to the intensive care unit, 47.2% received invasive ventilation, 4 patients were switched to #ECMO support; overall mortality 4.3%. Open access text
Clinical characteristics of 137 2019-nCoV-infected patients from tertiary hospitals in Hubei Province, reporting no extracorporeal support (authors relate this finding to the fact that they reported about cases admitted to respiratory departments, with data from ICUs/other departments missing). Open access on Chinese Medical Journal.
The WHO is distributing an Interim Guidance document for the “Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected.” The medical community is closely monitoring the outbreak. The WHO guidance document includes a statement to “consider referral patients with refractory hypoxemia despite lung-protective ventilation. . . in settings with access to expertise in ECLS.” Where ECLS expertise is available, extracorporeal support should be considered according to the standard management algorithm for ARDS in supporting patients with viral lower respiratory tract infection. However, clearly at this time, there is little worldwide experience with using ECMO to support nCOV-infected patients. ELSO will continue to collect data through our member centers and provide recommendations as additional information becomes available. Dr. Mark Ogino, ELSO – Extracorporeal Life Support Organization President.
The World Health Organization (WHO) Interim Guidance full text open access.
In this first report published on The Lancet, available data (to date) about the recent cluster of pneumonia cases caused by a novel betacoronavirus in Wuhan, China, with the epidemiological, clinical, laboratory, radiological characteristics of these patients, including treatment (n=2, 5% of all reported cases, 15% of the patients requiring ICU care, supported with ECMO) and clinical outcomes. Open access text
A second study on the same journal includes all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data, with outcomes followed up until Jan 25, 2020; 23% admitted to ICU, 17% developed ARDS, 3% treated with extracorporeal support, 11% worsened in a short period of time and died of multiple organ failure. Open access text
On The Lancet also a study reporting epidemiological, clinical, laboratory, radiological, and microbiological findings of 5 patients in a family cluster who presented with unexplained pneumonia after returning to Shenzhen, Guangdong province, China, after a visit to Wuhan, and an additional family member who did not travel to Wuhan, with findings consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions. Open access text … and some interesting comments: About novel coronavirus outbreak of global health concern Open access text on data sharing and outbreaks: best practice exemplified Open access text … and emerging understandings of 2019-nCoV. Open access text
Consider reading this report on The New England Journal of Medicine, about 3 adult patients presented with severe pneumonia admitted to a hospital in Wuhan at the end of December, with details on detection, isolation and characterization of the Novel Coronavirus. Abstract NEJM has also published an editorial, focusing on this zoonotic coronavirus, which (third time in 3 decades, after evere acute respiratory syndrome coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus [MERS-CoV]) has crossed species to infect human populations. Open access text Moreover, on same journal, a viewpoint on key questions for impact assessment of this new emerging Coronavirus. Open access text
NEJM published data on the first 425 confirmed cases of novel coronavirus infected pneumonia (NCIP) in Wuhan, reporting informations collected on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases by January 22, 2020, with estimation of key epidemiologic time-delay distributions. Open access text
The report of a case of importation and human-to-human transmission of nCoV in Vietnam ia also available. Open access link
Moreover, a dedicated page has been created on New England Journal of Medicine, and a special set of practices that will be applied to all submitted manuscripts describing the 2019-nCoV outbreak, has been announced in this editorial, to promote fast publishing.
JAMA published another viewpoint highlighting the perpetual challenge of emerging infectious human diseases caused by pathogens from viral families (formerly thought to be relatively benign) and the importance of sustained preparedness. Open access text Moreover, another editorial refers about control measures in China, and control measures by governments worldwide, nonpharmaceutical interventions, and role of WHO. Open access text
A dedicated page is available on Centers for Disease Control and Prevention (CDC) website, with outbreak of respiratory illness caused by the novel coronavirus reporting: – situation news & summary; – informations/interim guidance for healthcare professionals, including criteria to guide evaluation of patients under investigation (PUI) for 2019-nCoV; recommendations for reporting, testing, and specimen collection; healthcare infection prevention and control recommendations for PUI for 2019-nCoV, and checklists for HCPs/hospitals; – interim guidance for laboratory professionals working with specimens from PUI for human infections with 2019-nCoV.
An online dashboard for tracking worldwide spread of novel Coronavirus has been built & is regularly updated by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University; the map is freely available! link
But how setting up an ICU to cope with novel Coronavirus infection? read about this experience from Sichuan region, China: equipment preparation education & training of staff protection of the staff early recognition/classification of disease severity restriction of patient contact full text open access on ICM
The ELSO – Extracorporeal Life Support Organization will persist in publishing additional evidence and advices, as available, on all our social media channels and on our website, in order to actively contribute to the updating of our community about this topic.
Need to improve your cannulation skills?? Want to act faster & safer next time you need to implement extracorporeal support? Join the ELSO Cannulation Workshop! This focused course, taught by a ELSO ECMOed Education Committee using realistic cannulation models, will train physicians to safely perform percutaneous #ECLS cannulation. All attendees will learn all aspects of cannulation in a small-group hands-on format; specific content includes: equipment selection, #POCUS vessel assessment, #ultrasound-guided vascular access, serial dilation, catheter placement and securement. Instructors will emphasize the value of imaging & address complication troubleshooting. At the conclusion of the course participants will be prepared to perform percutaneous veno-venous, veno-arterial, and bi-caval ECMO cannulations at their institution. Save the date! September 21st or 22nd, 2020 Hilton Waikoloa Village Big Island of Hawai’i… Registration opening soon!!& do not forget, same venue, following the workshop, #ELSO2020 the 31st Annual ELSO – Extracorporeal Life Support Organization Conference: a special event at a special place, September 23-26, 2020! https://www.elso.org/Education/2020Hawaii.aspx
The first ELSO ECMOed ECMO education twitter chat has been held few hours ago, involving participants from all Continents: Lots of interesting comments, questions, idea and suggestions have been shared, focused on the target to standardize ECMO education making it globally available & properly train/certify providers. Here, nearly (as feasible) complete transcript of the chat… some hints: implement the ELSO ECMO education dedicated guidelines focus on (a partially) online education strategy to improve worldwide accessibility, to be integrated with high fidelity #simulation/practice increasing availability of free open access resources ie dedicated webinars, conference talks organize a social media based platform to discuss interesting ECMO cases (with a proper management of sensitive data)… Improving cost and sustainability of education & training, particularly in low income Countries and for low income HCPs, without negatively impact on quality seems an important issue! investing in ECMO team education/updating is an investment towards patients/program outcome improvements. mandatory certifications? using something like ACLS/ALS model or not?
to view original posts, reply & comment search for #ECMOedPP hashtag on twitter, enjoy!
About ELSO ECMOed
@EcmoDiaz The goal of this Taskforce is to take further what ELSO has done in education: standarization in curriculum, evaluation, simulations and education research with the best team work: international collaboration. @kshekar01 There is so much variation in ECMO practice and outcomes that high quality education can have a huge impact on all aspects of ECMO care – huge gains to be made with education as things stand. @HerxxAU The ECMOed framework is a great start and builds the framework for future structures. National and regional solutions are next. @bishoy_zakhary. We hope the global framework will help guide organization at the national levels. @EcmoDiaz Exactly! collaboration is the first step to get the framework @slthomps12 Need to standardize the expectations, medical knowledge, technical knowledge, and troubleshooting of ECMO. Having a standard to meet in order to care for ECMO patients is needed that is comparable across all centers. @JenelleBadulak Agree that this will also be essential for unifying ECMO practice better enabling meaningful clinical research: if we do it similarly in multiple institutions, we can study it across multiple institutions. @ecmocare I fully agree to fact that ECMO education should be standardised and supported. The ECMOedPP chat is a right initiative, but we need to further structure the initiative. @kshekar01 Agree – ongoing educational research will help optimise/calibrate educational content and delivery both and to measure impact over time. With representation from all ELSO chapters, ECMOed can enable every chapter to build capacity in terms of both endorsed courses and trainers; all the suggested options for affordability etc sound good. @KrKrramanathan That would ensure quality education for sure. Basic standards are needed not just for learners but also for trainers and on how training it is imparted. @g_alinier The collective experience & wiseness of ELSO ECMOed taskforce is impressive! Really honoured to have been invited to be part of this. All together we can really have an impact, and improve ECMO patient care through better education
How to provide highly accessible, high quality ECMO education?is online ECMO education the answer??
@EcmoNinja How do you ensure that everyone has equal access to education, not just those at big ECMO centers that have resources to send people to meetings? @JenelleBadulaK web-based didactic education will help extend the reach of standardized education and make in-person simulation sessions able to be shorter (and cheaper!) focusing on hands-on skills. @jkukutschka Online education is a great option for this and will definitely have a greater outreach at a lower cost in a blended training model or for CME. @FOAMecmo How to match free open spreading of ECMO education resources, to make these globally available, with high content quality and economical sustainability? Think the use of (partly) online strategy by ELSO ECMOed experts could be really effective to support spread of standardized high quality/highly accessible also meaning low cost ECMO education. @g_alinier So true that cost is often a barrier to education & training but that is often a false economy! ignorant unskilled uninformed unprepared workforce cost money (in hospital beds through extended patient stays, additional treatment/procedures) & in patients’ lives. Online education needs to be followed up by hands-on face to face activities as ECMO relies also so much on good technical & communication skills to provide optimal care. ELSO and ELSO ECMOed are the key coordinating channels for dissemination! @kshekar01 Agree – the non-technical skills are so important too – other big area is for providers to open up their minds to idea of shared decision making and team work that’s so critical for ECMO. @jkukutschka Absolutely! A blended (online + onsite) model for training ECMO practitioners. @bishoy_zakhary this is a very important challenge without easy solutions. Widespread ELSO endorsement can be a helpful step but ultimately Online Education may be a viable option. @KrKrramanathan Great question. The answer may not be straightforward. Basic ECMO knowledge can be streamlined online or via e-learning; we are striving towards that. However the skill component would be tricky- you can achieve that with experience or only with high fidelity simulation. @kshekar01 We need to change thinking; access to ECMO = access to ECMO for patients + access to ECMO education for providers. What are your thoughts to help to make this happen? @EcmoNinja It will have to be multi-modal. Heavy use of online content that is controlled. Using the hub center to train the spokes/referring centers has generally worked well in my practice. @kshekar01 Great question – the hub and spoke model for ecmo service delivery should also work for education, hope we can use qualitative research tools to study these models of education over time! @ecmocare More webinars. The ELSO courses to be available online, the conference proceedings to be available live as webcast: free up knowledge, involve more participants! @bishoy_zakhary Yes webinars have a great potential for reach and exposure!
@HerxxAU As supposed to ALS – ECMO delivery has regional differences and something which works in Seattle is not practical in Japan @kshekar01 Agree: standardising what we can may provide a good starting point for local providers to work with – we are organising focus groups across all Chapters to understand the local expectations and challenges. @bishoy_zakhary This is true but at the sample time there is a minimal competency level that is across chapters and applicable to all ECMO practitioners. @EcmoNinja Agree: different indications, different patient populations, different technologies. All important factors to consider. What doesn’t work is other mandatory certifications (think ACLS or ATLS) – the training is mandatory for those that need it the least and often doesn’t reach the true target audience. @mamoon Accredited & well thought in situ simulation program development should be a priority, as you tend to miss latent threats in your own working environment. @JenelleBadulaK A certification from an organization like @ELSOOrg may help set a certain standard but content needs to evolve and change with the technology and integrate continued curricular evaluation & meet the needs of the learner. Otherwise risk content stagnation! @kshekar01 Certification is one area where we need a lot of feed back as there are so many models of ecmo care and multidisciplinary provider @bishoy_zakhary The challenge we are facing is the explosive growth in the number of ECMO centers that often outpaces the capability of courses to provide training!
@precordialthump Mastery learning should be a feature of a standardized approach to ECMO education (suggested reading: Cheng A et al. Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2018 open access link https://www.ahajournals.org/doi/10.1161/CIR.0000000000000583). Also, while a standardized ALS type entry course is important, so is ongoing spaced practice to guard against deskilling. Likely to need 6 monthly refreshers. In situ simulation for team training is likely even more important than courses though! Finally, I’d like to see “after action reviews” standardized after ECMO events (clinical debriefing) to maximize learning from real world events and contribute to a culture of learning. @foamecmo Important points! doing ECMO course once is not enough! certification matters but re-certification too… the less you practice/the lowest your ECLS volume, the most you need to run (simulation based/whole team) training & do no forget (online FOAMed?) updates in a moving so fast field. @succenyl impressive work by ELSO ECMOed: thanks for supporting ECMO community. I suggest adding another hashtag for weekly case presentation for open discussion from different aspects and controversies raised! @FOAMecmo Discussing interesting ECMO cases on Socia Media? could be effective to look for expert support/offer alternative viewpoints/diffuse ECMO centers results, providing every precaution is taken to protect patient’s privacy/confidentiality of personal information and image; what about consent? needed/feasible? @KrKrramanathan Difficult cases get discussed at the ELSO ECMOed blog!
@ArpanCh21458537 The help from industry should be there. They have their own mannequins/ simulators. We can take support of that. Guidelines should include the industry participation also. @ECMONinja Industry is limited what they can do in the US because most products used for ECMO don’t carry that FDA designation- they are used off label. @kshekar01 A low cost sim can be locally developed; maybe we need to make this knowledge accessible and support centres with their basic sim program – a sim should hopefully be incorporated into any ECMO program along with wet drills etc. @ecmocare Need support and knowhow to develop a low cost sim. @MooreElizabethA Would there be interest in creating an ECMO simulation “know how” session to a future ELSO conference? @ecmocare There should be definitive guidelines for the trainers as well. The ELSO need to publish more clinical guidelines too. @jkukutschka ELSO provides Train the Trainers courses… Next one will be this march in Barcelona @FOAMecmo Considered to attend to the ELSO ECMOed Train the Trainers course to learn how to educate and train in the ECMO field… experts from all ELSO chapters will be involved! @kshekar01 Every ECMO centre ideally should have one or two trainers who have done the train the trainer course who can then champion local education- it is easy to set up basic simulation and organise basic in-house training @ecmocare Totally agree The train the trainers courses should be more frequent, should be more accessible and affordable. Can ELSO subsidize registration or offer travel grants or any other programme to encourage young minds?
@ecmocare The cost of the ELSO ECMOed courses in each Country or region to vary. Can’t keep same fee structure everywhere. Remember a huge number of participants are perfusionists and nurses. @KrKrramanathan Good suggestion. It is a daunting task as cost of resources vary from country to country @kshekar01 cost and sustainability are important issues – we will have to enable local providers to provide education tailored to local flavour while maintaining quality of education.
About ELSO ECMOed endorsement for ECMO educational initiatives
@ecmocare More centers should be endorsed to conduct the courses. At least one center in every country needs to be endorsed. Larger countries need to have multiple centers. @JenelleBadulak Completely agree! Creating a standardized curriculum that we can distribute and utilize train the trainer courses will enable us to make this standardized curriculum available worldwide. Also essential to this will be web-based didactics #ECMOedPP@kshekar01 I think the process for endorsement is in place and is an important area for ECMOed. @bishoy_zakhary Agree! There is a need for ELSO endorsement of ECMO courses across all the chapters so ECMO practitioners can have easy access to standardized material. @HajiJumana to standardise training, and streamline the ELSO endorsement process, would help if ELSO puts up some pre-endorsement guidelines and prerequisites for newer centres to model their training on the website. @HajiJumana It would help if ELSO puts up some pre endorsement guidelines and prerequisites for newer centres to model their training on the website. This would help to standardise training and streamline the endorsement process. @KrKrramanathan certainly some thing to ponder about! @FOAMecmo Seems ELSO ECMOed advices needed for “young” ECMO centers to adapt/organize ECLS education! meanwhile , consider checking the ELSO ECMO specialists education & training guidelines, open access and the the ELSO guidelines for ECMO centers, open access. @ECMOed For all centers/groups interested in or willing to ask for ELSO ECMOed endorsement, to ensure potential learners ELSO standard is met for your ECMO courses, simulation-based courses, workshops, check our dedicated post
Learning from other ECMO education experiences
@ArpanCh21458537 We have to think for the awareness educations to the General practitioners. They should be properly educated also regarding the timing of referral. They are the backbones of Indian Healthcare system. Short courses on ECMO can be designed for them also. @bishoy_zakhary This is an important suggestion that can have a significant impact on ECMO outcomes. ECMO Workshops targeting the Non-ECMO Practitioner is a great idea. Do you have this? @ArpanCh21458537 I am doing regular awareness campaigns to the various suburbs and districts. A gathering of local practitioners are interacting with us. Basic discussions on ECMO and its success stories are shared with them for early referrals. Sometimes We are engaging survivors. @bishoy_zakhary This is a good effort – especially with involvement from prior patients and families! @MooreElizabethA this could be an excellent idea to engage survivors. We have much to learn of their experiences post ECMO! @gracebichara My previous program in Brasil has a 1 day course for pediatric intensivist 2-3 times a year. We have amazing feedback! We focus on indications, #ECMO basics, outcomes, etc. @ecmocare At ECMO Kolkata we conduct awareness programmes for GPs, do basic training of residents, fellows and attendings at Med schools of the region. They participate more in case based discussion. Interested young minds come over to witness live cases. ECMO isn’t part of basic clinical curriculum in Med Schools yet. We can make basic #ECMO knowledge compulsory in undergrads and basic proficiency in ECMO in Residencies and fellowships (pediatrics, anesthesia, medicine, pulmonology, critical care, cardiac surgery). I fully agree to fact that ECMO education should be standardised and supported. The ECMOedPP is the right initiative. But we need to further structure the initiative. @bishoy_zakhary How would you envision structuring the initiative? @ecmocare The ESOI ECMO Society of India fellowship structure can be followed. There online webinars, log books, thesis, compulsary attendance of one comprehensive #ECMO workshop and a conference, 15 days training in an ECMO center, live case videos and discussions @kshekar01 This can be well embedded in a hub abs spoke model @ecmocare Can we have a definitine course like the ACLS/BLS model as well have the same literature circulated in every #ECMO workshop? @kshekar01 One possible model as it’s a lot of effort to design and run courses and it’s wasted energy , time and money for everyone to write their own content @bishoy_zakhary We are trying to implement something similar to the BLS/ACLS model by using ELSO Course Endorsement to increase the reach and impact of the ECMO curriculum worldwide. What are your thought on the effectiveness? @kshekar01 This is something we can test in the research domain. @KrKrramanathan interesting thought. We are trying streamlining this aspect at ELSO ECMOed. What should be the content of the course, duration of the course, how to assess participants and how to certify? We are getting there.
@HajiJumana I’m sharing the results of an ongoing survey I am conducting in India. Lack of training, lack of physician and patient awareness about ECMO as treatment option pretty in India, and lack of ELSO-registered centers, observed. @kshekar01 Great work: there is huge opportunity here for ELSO ECMOed, SWAAC ELSO, APELSO to collaborate with the ECMO community in India and work on many of these identified areas.
(Most) active participants & their twitter handles(alphabetical order)
Ahmed Rabie @succenyl Arpan Chakraborty @ArpanCh21458537 Bishoy Zakhary @bishoy_zakhary Chris Nickson @precordialthump Dipanjan Chatterjee @ecmocare Elizabeth A. Moore @mooreelizabetha Grace Bichara @Gracebichara Guillaume Alinier @g_alinier Hergen Buscher @HerxxAU Jeannie Kukutschka @jkukutschka Jenelle Badulak @JenelleBadulak Jumana Haji @HajiJumana Kiran Shekar @kshekar01 Mamoon @mamoon Ramanathan KR @KrKrramanathan Rodrigo Diaz @EcmoDiaz Shaun Thompson @slthomps12 Velia Antonini @FOAMecmo