Abstract
Background
Despite advances in mechanical ventilation, severe acute respiratory distress syndrome
(ARDS) is associated with high morbidity and mortality rates ranging from 30% to 60%.
Extracorporeal Membrane Oxygenation (ECMO) can be used as a “bridge to recovery”.
ECMO is a complex network that provides oxygenation and ventilation and allows the
lungs to rest and recover from respiratory failure, while minimizing iatrogenic ventilator-induced
lung injury. In the critical care settings, ECMO is shown to improve survival rates
and outcomes in patients with severe ARDS. The primary objective was to present an
innovative approach for using high-fidelity medical simulation before setting ECMO
program for reversible respiratory failure (RRF) in Poland's first unique regional
program “ECMO for Greater Poland”, covering a total population of 3.5 million inhabitants
in the Greater Poland region (Wielkopolska).
Aim and methods
Because this organizational model is complex and expensive, we use advanced high-fidelity
medical simulation to prepare for the real-life implementation. The algorithm was
proposed for respiratory treatment by veno-venous (VV) Extracorporeal Membrane Oxygenation
(ECMO). The scenario includes all critical stages: hospital identification (Regional
Department of Intensive Care) - inclusion and exclusion criteria matching using an
authorship protocol; ECMO team transport; therapy confirmation; veno-venous cannulation
of mannequin's artificial vessels and implementation of perfusion therapy and transport
with ECMO to another hospital in a provincial city (Clinical Department of Intensive
Care), where the VV ECMO therapy was performed in the next 48 h, as training platform.
Results
The total time, by definition, means the time from the first contact with the mannequin
to the cannulation of artificial vessels and starting VV perfusion on ECMO, did not
exceed 3 h – including 75 min of transport (the total time of simulation with first
call from provincial hospital to admission to the Clinical Intensive Care department
was 5 h). The next 48 h for perfusion simulation “in situ” generated a specific learning
platform for intensive care personnel. Shortly after this simulation, we performed,
the first in the region: ECMO used for RRF treatment. The transport was successful
and exceeded 120 km. During first year of Program duration we performed 6 successful
ECMO transports (5 adult and 1 paediatric) with 60% of adult patient survival of ECMO
therapies. Three patients in good condition were discharged to home. Two years old
patient was successfully disconnected from ECMO and in stabile condition is treated
in Paediatric Department.
Conclusions
We discovered the important role of medical simulation, not only as an examination
for testing the medical professional's skills, but also as a mechanism for creating
non-existent procedures. During debriefing, it was found that the previous simulation-based
training allowed to build a successful procedural chain, to eliminate errors at the
stage of identification, notification, transportation and providing ECMO perfusion
therapy.
Abbreviations:
RRF (reversible respiratory failure), ARDS (acute respiratory distress syndrome), ECMO (Extracorporeal Membrane Oxygenation)Keywords
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Article Info
Publication History
Published online: April 18, 2018
Accepted:
April 17,
2018
Received in revised form:
March 22,
2018
Received:
February 14,
2018
Footnotes
☆This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
