Tag: simulation

Transcript of the first ELSO ECMO education twitter chat!

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!


@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

SWAAC ELSO @Swaacelso

Train The Trainers – ECMO

Train the Trainers: registrations are now open for this first-time ELSO course, run by an amazing faculty of experts from all of the five Chapters of the Extracorporeal Life Support Organization, March 17-19 2020 Vall d’Hebron Barcelona Hospital Campus: save the date!! The course will be followed by an optional one-day workshop on March 20, 2020 with simulation & boot camp.

The faculty

Bishoy Zakhary – Intensivist at OHSU – Oregon Health & Science Universityin Portland OR. His primary interests are respiratory failure and the emerging role of ECMO support. He currently serves as the ELSO Chair of Logistics and Education. Twitter handle: @bishoy_zakhary
Camilo Pizarro –  Director of the Adult Intensive Care Unit and co-director of the adult ECMO and ventricular Assist Device Unit of the Fundación Cardiovascular de Colombia – FCV, Professor of Anesthesiology at Universidad Industrial de Santander, coordinador del Postgraduate School of Critical Care Medicine and Intensive Care of the UDES-FCV.
Elizabeth Moore – Associate Director, University of Iowa Heart and Vascular Center, former ECMO Coordinator, serves as member of ELSO Education and Logistics Committee. Member of the Endorsement and of the Courses WG of ECMOed. Twitter handle: @MooreElizabethA
Ibrahim Fawzy Hassan – Critical Care Director and ECMO Program Director at Hamad Medical Corporation and A/Prof of Clinical Medicine at Weill Cornell Medical College, recently has been appointed as the Chair of SWAAC ELSO. Member of the Courses WG of ECMOed. Twitter handle: @IbrahimFawzyHa1
Jan Belohlavek – Cardiologist, intensivist in Prague, Czech Republic. Assoc. Prof. of Medicine, board certified in cardiology, angiology and critical care, licenced in invasive cardiology. In charge of cardiac intensive care, ECMO team coordinator. Main clinical and research focus on refractory cardiac arrest, ECMO reperfusion, microcirculation, different ECMO settings and reperfusion. Investigator of the Prague OHCA study comparing hyperinvasive approach – ECPR to standard therapy in refractory cardiac arrest. Participates also on ECMO-CS, cardiogenic shock study evaluating the role of ECMO in severe cardiogenic shock. Chair of the Czech Association of Acute Cardiology; he is the current President of EuroELSO. Twitter handle: @jan_belohlavek
Jenelle Badulak – Intensivist and emergency medicine physician, ECMO education director at the University of Washington & Harborview Medical Center, Seattle, WA. She is member of the Curriculum-Knowledge Workgroup and of the Online Education Workgroup of ECMOed. Twitter handle: @JenelleBadulak
Joan Balcells – Pediatrician dedicated to pediatric critical care, with an especial interest in pediatric cardiorespiratory failure, congenital heart disease and heart or lung transplantation in children, extracorporeal life support (ECMO and ventricular assist devices. Director of the Pediatric Critical Care Department since 2011 and of the Pediatric & Neonatal ECMO Program since 2007 at Vall d’Hebron Barcelona Hospital Campus.
Jordi Riera – Intensivist, Critical Care Department and ECMO team at Vall d’Hebron Barcelona Hospital Campus, his priority is to achieve excellence in three areas: patient care, research and training of residents; he is resident tutor and researcher in the area of ​​critical respiratory patients, especially in ECMO and lung transplant. Jordi is currently member of the EuroELSO Steering Committee. Twitter handle: @jrdelbrio
Leen Vercaemst – Currently working as a Nurse Specialist ECLS /Perfusionist in the University Hospital of Leuven (Belgium). Next to my clinical work as a perfusionist in a pediatric & adult cardiac surgery program, I’m involved in numerous educational projects such as coordinating the Leuven Perfusion School, leading national & international ECMO trainings as well as high fidelity simulation workshops related to ECMO/CPB. Currently member of the Board of EBCP and EuroELSO, as a liaison between the European perfusion society and EuroELSO, and member of the EuroELSO Steering Committee.
Mark Ogino – Chief Partnership Officer of the Nemours Children’s Health System at the Alfred – duPont Hospital for Children in Wilmington, Delaware, and Neonatology Chief, Nemours Delaware Valley. His academic appointment of Clinical Professor of Pediatrics is with the Sydney Kimmel Medical College at Thomas Jefferson University. Dr. Ogino is the current President of ELSO and served as the Chair of Logistics and Education from 2009 to 2015. His passion is helping clinical teams learn to deliver safe and quality ECLS care at the bedside. Twitter handle: @OginoMark
Mirko Belliato – Intensivist, Senior Consultant, Medical Director of the Advanced Respiratory ICU and leader of the multidisciplinary team for ECMO support at Foundation IRCCS Policlinico San Matteo, Italy. Adjunct Professor of Anesthesiology and Intensive Care at the University of Pavia, Member of the Steering Committee of EuroELSO, since 2016 he is involved in the ELSO activity as leader of the EuroELSO workgroup for “Innovation on ECMO and ECLS”, and as member of the ELSO adult ECMO and the EuroELSO workgroup for “Neuromonitoring on ECMO”. Twitter handle: @BelliatoMirko
Natalia Seguel – Critical Care Nurse and simulation coordinator in Clinica las Condes, Santiago, Chile.
Rodrigo Diaz – Cardiovascular Anesthesiologist, Master in Education, Master in Administration. Chief of the ECMO Unit in Clinica las Condes, Santiago, Chile. Former president of the Latin America Chapter of the Extracorporeal Life Support Organization, ELSO LATAM. Member of the Endorsement and of the Courses WG of ECMOed. Twitter handle: @EcmoDiaz
Simon Sin – Specialist in Critical Care Medicine, consultant of Department of Adult Intensive Care and ECMO program leader at Queen Mary Hospital (ELSO Center of Excellence – Gold level award), Hospital Authority, HK. Accredited fellowship in Critical Care Medicine (2008), Cardiology (2012), Advance Internal Medicine (2009) (Hong Kong College of Physicians). He is Education Co-Chair/member of the Steering Committee of ELSO Asia-Pacific Chapter (APELSO).
Velia Antonini – Critical Care Nurse for I° ICU/Procurement Team University Hospital of Parma, trained as ECMO specialist, Cardiovascular Perfusionist and Sonographer, is lecturer BS in Cardiocirculatory Physiopathology and Cardiovascular Perfusion at UNIMORE, Italy. Member of Online Education WG of the ECMOed and EuroELSO Steering Committee. Is ELSO Social Media Editor, & member of ASAIO Journal, ESIMC, IFAD SoMe Teams. Twitter handle: @foamecmo
Wallace Ngai – Critical Care Physician, Adult Intensive Care Unit, Queen Mary Hospital in Hong Kong. His special interests are ECMO Simulation Training and Cannulation Training. He’s the Co-Chairman of the ELSO Cannulation Workshop. Twitter handle: @wallacengai 

Adult learning model
Designing Effective Lecture
Crisis resource management
Learning objectives development
Simulation setups: Circuits, pumps
Design, set up, and perform simulations
Physiologic monitor set up and programming
Monitor and ECMO circuit manipulation practice
Scenario development & Debriefing techniques
Competency assessment ELSO ECMOed approach
Certification ELSO ECMOed approach
Endorsement Process ELSO ECMOed approach
Marketing and Social Media
Organization, finances and balances.

Additional details & practical info at  http://bit.ly/ECMOTTT2020