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Ecmo simulation

Lindsay Johnston, Gary Oldenburg
Extracorporeal membrane oxygenation (ECMO) is a highly technical and complex method of life support. Patient and circuit emergencies on ECMO are rare, but in these cases, prompt and correct actions to address the crisis are needed to prevent morbidity and mortality. ECMO simulation programs have gained popularity in recent years, as they provide a standardized educational experience for all members of the inter-professional care team. In addition to providing a context in which to solidify knowledge of ECMO support, participants are also able to focus on vital technical and behavioral skills that are not highlighted in other training methodologies...
October 13, 2016: Seminars in Perinatology
Julie Autmizguine, Christoph P Hornik, Daniel K Benjamin, Kim L R Brouwer, Susan R Hupp, Michael Cohen-Wolkowiez, Kevin M Watt
BACKGROUND: Candida is a leading cause of infection in infants on extracorporeal membrane oxygenation (ECMO). Optimal micafungin dosing is unknown in this population because ECMO can alter drug pharmacokinetics (PK). METHODS: To characterize micafungin PK and safety in infants on ECMO, we conducted an open label PK trial. Infants on ECMO either received IV micafungin 4 mg/kg/day for invasive candidiasis prophylaxis, or 8 mg/kg/day when a fungal infection was suspected or confirmed...
June 16, 2016: Pediatric Infectious Disease Journal
James J Fehr, Mark Shepard, Mary E McBride, Mary Mehegan, Kavya Reddy, David J Murray, John R Boulet
OBJECTIVE: The aims of the study were (1) to create multiple scenarios that simulate a range of urgent and emergent extracorporeal membrane oxygenation (ECMO) events and (2) to determine whether these scenarios can provide reliable and valid measures of a specialist's advanced skill in managing ECMO emergencies. DESIGN: Multiscenario simulation-based performance assessment was performed. SETTING: The study was conducted in the Saigh Pediatric Simulation Center at St...
June 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
Mattias Lindfors, Björn Frenckner, Ulrik Sartipy, Anna Bjällmark, Michael Broomé
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is indicated in reversible life-threatening circulatory failure with or without respiratory failure. Arterial desaturation in the upper body is frequently seen in patients with peripheral arterial cannulation and severe respiratory failure. The importance of venous cannula positioning was explored in a computer simulation model and a clinical case was described. A closed-loop real-time simulation model has been developed including vascular segments, the heart with valves and pericardium...
April 18, 2016: Artificial Organs
Sydne Muratore, Greg Beilman, Ranjit John, Melissa Brunsvold
BACKGROUND: No guidelines exist for credentialing extracorporeal membrane oxygenation (ECMO) physicians despite variable training backgrounds. We aim to identify national patterns of institutional credentialing for ECMO physicians. METHODS: Program directors from 173 US ECMO centers were surveyed regarding credentialing, recertification, training elements, and barriers. RESULTS: Response rate was 42% (73/173). ECMO credentialing for physicians was required in 66% of responding ECMO centers...
October 2015: American Journal of Surgery
Robert J Gajarski, Kurtis Smitko, Renee Despres, Jeff Meden, David W Hutton
OBJECTIVES: Using survival and neurologic outcome as endpoints , this study explored the incremental cost effectiveness of three mutually exclusive cooling strategies employed after resuscitated out-of-hospital cardiac arrests. DESIGN: Economic analysis based on retrospective data collection and Markov modeling. SETTING: Modeling based on patients housed in a tertiary ICU setting. PATIENTS: Patients >18 years following resuscitation from out-of-hospital cardiac arrest...
2015: SpringerPlus
Kristine Estensen, Kiran Shekar, Elissa Robins, Charles McDonald, Adrian G Barnett, John F Fraser
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) circuits have been shown to sequester circulating blood compounds such as drugs based on their physicochemical properties. This study aimed to describe the disposition of macro- and micronutrients in simulated ECMO circuits. METHODS: Following baseline sampling, known quantities of macro- and micronutrients were injected post oxygenator into ex vivo ECMO circuits primed with the fresh human whole blood and maintained under standard physiologic conditions...
December 2014: Intensive Care Medicine Experimental
Elmi Messai, Abdesselam Bouguerra, Guy Harmelin, Gabriella Di Lascio, Manuela Bonizzoli, Massimo Bonacchi
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an important tool in the management of most severe forms of acute respiratory failure. The determinants and management of oxygen delivery in patients treated with VV-ECMO is a complex topic. The physiological principles of oxygenation on VV-ECMO are reviewed in many textbooks. However a numerical model is an additional instrument to be used in understanding and exploring this intricate subject matter. We present a numerical model of blood oxygenation during VV-ECMO...
June 2016: Journal of Clinical Monitoring and Computing
Michael J Harvey, Michael G Gaies, Lisa A Prosser
CONTEXT: The in-hospital costs of extracorporeal membrane oxygenation (ECMO) have not been well established. OBJECTIVE: To evaluate the in-hospital costs of ECMO technology in both US and non-US settings for all patient types. DATA SOURCES: Systematic review of English-language articles, using the PubMed, Embase, Web of Science and EconLit databases. Searches consisted of the terms 'ECMO' AND 'health expenditures' or 'resource use' or 'costs' or 'cost analysis' or 'cost(-)effectiveness' or 'cost(-)benefit' or 'cost(-)utility' or 'economic(-)evaluation' or 'economic' or 'QALY' or 'cost per quality-adjusted life year'...
August 2015: Applied Health Economics and Health Policy
Roberta Brum, Ronak Rajani, Elton Gelandt, Lisa Morgan, Nira Raguseelan, Salman Butt, David Nelmes, Georg Auzinger, Simon Broughton
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a complex treatment. Despite this, there are a lack of training programs designed to develop relevant clinical and nonclinical skills required for ECMO specialists. The aim of the current study was to describe the design, implementation and evaluation of a 1-day simulation course for delivering training in ECMO. METHODS: A 1-day simulation course was developed with educational and intensive care experts. First, the delegates received a lecture on the principles of simulation training and the importance of human factors...
April 2015: Annals of Cardiac Anaesthesia
Kazuo Sakamoto, Keita Saku, Takuya Kishi, Takamori Kakino, Atsushi Tanaka, Takafumi Sakamoto, Tomomi Ide, Kenji Sunagawa
Although venoarterial extracorporeal membrane oxygenation (ECMO) was developed to rescue patients with cardiogenic shock, the impact of ECMO on hemodynamics is often unpredictable and can lead to hemodynamic collapse. In this study, we developed a framework in which we incorporated ECMO into the extended Guyton's model of circulatory equilibrium and predicted hemodynamic changes in response to ECMO. We first determined the cardiac output (CO) curves of left and right heart (to generate the integrated CO curve) without ECMO in eight normal and seven dogs with left ventricular dysfunction...
April 15, 2015: American Journal of Physiology. Heart and Circulatory Physiology
Kiran Shekar, John F Fraser, Fabio Silvio Taccone, Susan Welch, Steven C Wallis, Daniel V Mullany, Jeffrey Lipman, Jason A Roberts
INTRODUCTION: The scope of extracorporeal membrane oxygenation (ECMO) is expanding; however, optimal drug prescription during ECMO remains a developing science. Currently, there are no clear guidelines for antibiotic dosing during ECMO. This open-label, descriptive, matched-cohort pharmacokinetics (PK) study aimed to compare the PK of meropenem in ECMO patients to critically ill patients with sepsis not receiving ECMO (controls). METHODS: Eleven adult patients on ECMO (venovenous (VV) ECMO, n = 6; venoarterial (VA) ECMO, n = 5) receiving intravenous (IV) meropenem were included...
2014: Critical Care: the Official Journal of the Critical Care Forum
Mikael Broman, Björn Frenckner, Anna Bjällmark, Michael Broomé
PURPOSE: Veno-venous ECMO is indicated in reversible life-threatening respiratory failure without life-threatening circulatory failure. Recirculation of oxygenated blood in the ECMO circuit decreases efficiency of patient oxygen delivery but is difficult to measure. We seek to identify and quantify some of the factors responsible for recirculation in a simulation model and compare with clinical data. METHODS: A closed-loop real-time simulation model of the cardiovascular system has been developed...
January 2015: International Journal of Artificial Organs
Andrew D Meyer, Jonathan A L Gelfond, Andrew A Wiles, Robert J Freishtat, Khoydar Rais-Bahrami
Current anticoagulation strategies do not eliminate thromboembolic stroke or limb loss during neonatal extracorporeal membrane oxygenation (ECMO), a form of cardiopulmonary bypass (CPB). In adults, CPB surgery generates prothrombotic platelet-derived microparticles (PMPs), submicron membrane vesicles released from activated platelets. However, information on PMP generation in neonatal ECMO systems is lacking. The objective of this study was to compare PMP generation in five different neonatal ECMO systems, using a simulated circuit with swine blood at 300 ml/min for 4 hours...
January 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Marcelo Park, Pedro Vitale Mendes, Fernando Godinho Zampieri, Luciano Cesar Pontes Azevedo, Eduardo Leite Vieira Costa, Fernando Antoniali, Gustavo Calado de Aguiar Ribeiro, Luiz Fernando Caneo, Luiz Monteiro da Cruz Neto, Carlos Roberto Ribeiro Carvalho, Evelinda Marramon Trindade
OBJECTIVE: To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil. METHODS: A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation...
July 2014: Revista Brasileira de Terapia Intensiva
Jess L Thompson, Lisa M Grisham, Jeanne Scott, Chris Mogan, Hannes Prescher, David Biffar, John Jarred, Robyn J Meyer, Allan J Hamilton
Initiation of extracorporeal membrane oxygenation (ECMO) is stressful, especially for inexperienced extracorporeal life support providers. The main objective of this study was to create a novel, reusable mannequin for high-fidelity simulation of ECMO initiation. We modified a Laerdal neonatal mannequin (SimNewB; Stavanger, Norway) so that it could be used to simulate an ECMO initiation. A simulation of a neonatal patient suffering from meconium aspiration was performed in the pediatric intensive care unit, and participants included new extracorporeal life support specialists in addition to the composition of the clinical ECMO team...
April 2014: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Stepan Havranek, Jan Belohlavek, Mikulas Mlcek, Michal Huptych, Tomas Boucek, Tomas Svoboda, Jaromir Fichtl, Matej Hrachovina, Ales Linhart, Otomar Kittnar
BACKGROUND: The aim of our study was to analyze, in a pig model of prolonged ventricular fibrillation (VF) treated by veno-arterial extracorporeal membrane oxygenation (ECMO), the time dependent changes of VF wavelet frequency obtained from intracardial signals and its relations to return of spontaneous circulation (ROSC). METHODS: 11 female pigs (50.3 ± 3.4 kg) under general anesthesia had undergone 15 min of VF with ECMO flow of 5 to 10 ml/kg per min simulating "untreated" VF followed by continued VF with full ECMO flow of 100 ml/kg per min...
January 2014: International Journal of Artificial Organs
Iryna Atamanyuk, Olivier Ghez, Imran Saeed, Mary Lane, Judith Hall, Tim Jackson, Ajay Desai, Margarita Burmester
OBJECTIVES: To develop an affordable realistic open-chest extracorporeal membrane oxygenation (ECMO) model for embedded in situ interprofessional crisis resource management training in emergency management of a post-cardiac surgery child. METHODS: An innovative attachment to a high-fidelity mannequin (Laerdal Simbaby) was used to enable a cardiac tamponade/ECMO standstill scenario. Two saline bags with blood dye were placed over the mannequin's chest. A 'heart' bag with venous and arterial outlets was connected to the corresponding tubes of the ECMO circuit...
January 2014: Interactive Cardiovascular and Thoracic Surgery
Catherine K Allan, Frank Pigula, Emile A Bacha, Sitaram Emani, Francis Fynn-Thompson, Ravi R Thiagarajan, Annette Imprescia, Gavin Hayes, Peter Weinstock
INTRODUCTION: American Heart Association guidelines recommend timely extracorporeal membrane oxygenation (ECMO) cannulation during cardiopulmonary resuscitation for pediatric cardiac arrest refractory to conventional resuscitation. Traditional cannulation training relies on the apprenticeship model. We hypothesized that a simulation-based ECMO cannulation curriculum featuring a novel integrated skills trainer would improve ECMO cannulation during cardiopulmonary resuscitation performance by cardiothoracic surgery trainees...
August 2013: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
William Lansdowne, David Machin, David J Grant
Despite its life-sustaining potential, extracorporeal membrane oxygenation (ECMO) remains a complex treatment modality for which close teamwork is imperative with a high risk of adverse events leading to significant morbidity and mortality. The provision of adequate training and continuing education is key in mitigating these risks. Traditional training for ECMO has relied predominantly on didactic education and hands-on water drills. These methods may overemphasize cognitive skills while underemphasizing technical skills and completely ignoring team and human factor skills...
December 2012: Journal of Extra-corporeal Technology
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