Page 45 - ANZCP Gazette MAY 2014

ECMO SIMULATION: RPH EXPERIENCE
Royal Perth Hospital (RPH) has supported 43 patients on Extracorporeal Membrane Oxygenation (ECMO) since 2005 (63% survival rate) with a total ECMO run of 367 days, the longest being 48 days.
ECMO is a classic low-volume, high-risk procedure. RPH averages 5 ECMOs per year. We have 4 Clinical Perfusionists and around 40 ECMO trained specialist nurses. We conduct in-house training: 2-day ECMO Foundation course bi-annually and an ECMO Refresher Course once a month. The ECMO simulation training was considered to be an integral component in delivering the curriculum, incorporating in-situ simulation modules to train multidisciplinary health care professionals involved in the management of ECMO patients. The recent purchase of our Orpheus Simulator has proved invaluable in the application of these simulation programs.
Mechanical emergencies on ECMO have an associated mortality of 25%.1 Clinical simulation facilitates the practice of emergency procedures, putting guidelines and algorithms into action in a real-time ‘realistic’ environment which is safe for both the
‘patient’ and the learner.2 On the day of simulation, teams were grouped in a similar pattern to that used routinely in ICU. A one-day course was conducted involving pre-course self-directed evaluations, 2 lectures and 4 simulation-scenarios.
So far 4 simulation courses have been completed and 2 more are scheduled in September. Pre and post course personal evaluation surveys have showed that the course greatly benefits the candidate and improves confidence within their abilities and as such provides an excellent training program.
References
1. Simulating Extracorporeal Membrane Oxygenation Emergencies to improve human performance. Part I: Methodologic and Technologic Innovations, Anderson JM, Murphy AA, et al. Simulation in Healthcare 2006; 1: 220-227.
2. Critical events simulation for neonatal and paediatric extracorporeal membrane oxygenation, GR Nimmo, G Wylie, J Scarth, J Simpson, E Gracie, I Torrance, M Liddell, C Davies, Volume 9, Number 1, April 2008 JICS
Viji Vincent, Brian Wright, Chris Allen and Luke Dix,
Royal Perth Hospital, Western Australia.
REPORT OF THE INTERNATIONAL CONSORTIUM
FOR EVIDENCE-BASED PERFUSION
Robert A. Baker, PhD, CCP (Aus), Cardiac Surgery Research and Perfusion,
Flinders University and Flinders Medical Centre, Adelaide, Australia, for the International Consortium for Evidence-Based Perfusion
The International Consortium for Evidence-Based Perfusion (ICEBP) has been working towards supporting its Mission and Vision.
4. Identify gaps between current and evidence-based clinical practice to promote the improvement in patient care.
We are now in a situation where we can report the following Mission progress:
The ICEBP is a partnership and collaboration between perfusion societies, medical societies, clinicians and industry to improve continuously the delivery of care and outcomes for our patients.
Vision of the ICEBP
To achieve this mission, we will:
1. Develop and support perfusion registries to evaluate clinical practices.
2. Develop and publish evidence based guidelines, and support their integration into clinical practice.
3. Identify gaps in the medical literature and empower investigation into areas where evidence is lacking.
1. Development of a Perfusion Registry (PerFORM) which currently has over 23 sites contributing perfusion data.
2. Revision of the Essentials and Guidelines of the American Society of Extracorporeal Technology.
3. Participation in the Perfusion Task Force established by the Society of Thoracic Surgeons (STS) and Society of Cardiovascular Anesthesia (SCVA) which is developing Clinical Practice Guidelines in Cardiopulmonary Bypass.
We are now in a situation where we can report the following progress on two of these topics: Temperature Management and Attenuating the Systemic Inflammatory Response.
MAY 2014 | www.anzcp.org
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