Enhancing Clinical Learning Through an Innovative Instructor Application for ECMO Patient Simulators

© 2018 The Authors. Reprinted by permission of SAGE PublicationsBackground. Simulation-based learning (SBL) employs the synergy between technology and people to immerse learners in highly-realistic situations in order to achieve quality clinical education. Due to the ever-increasing popularity of extracorporeal membrane oxygenation (ECMO) SBL, there is a pressing need for a proper technological infrastructure that enables high-fidelity simulation to better train ECMO specialists to deal with related emergencies. In this article, we tackle the control aspect of the infrastructure by presenting and evaluating an innovative cloud-based instructor, simulator controller, and simulation operations specialist application that enables real-time remote control of fullscale immersive ECMO simulation experiences for ECMO specialists as well as creating custom simulation scenarios for standardized training of individual healthcare professionals or clinical teams. Aim. This article evaluates the intuitiveness, responsiveness, and convenience of the ECMO instructor application as a viable ECMO simulator control interface. Method. A questionnaire-based usability study was conducted following institutional ethical approval. Nineteen ECMO practitioners were given a live demonstration of the instructor application in the context of an ECMO simulator demonstration during which they also had the opportunity to interact with it. Participants then filled in a questionnaire to evaluate the ECMO instructor application as per intuitiveness, responsiveness, and convenience. Results. The collected feedback data confirmed that the presented application has an intuitive, responsive, and convenient ECMO simulator control interface. Conclusion. The present study provided evidence signifying that the ECMO instructor application is a viable ECMO simulator control interface. Next steps will comprise a pilot study evaluating the educational efficacy of the instructor application in the clinical context with further technical enhancements as per participants’ feedback.Peer reviewedFinal Accepted Versio

Chinese Expert Consensus on Critical Care Ultrasound Applications at COVID-19 Pandemic

The spread of new coronavirus (SARS-Cov-2) follows a different pattern than previous respiratory viruses, posing a serious public health risk worldwide. World Health Organization (WHO) named the disease as COVID-19 and declared it a pandemic. COVID-19 is characterized by highly contagious nature, rapid transmission, swift clinical course, profound worldwide impact, and high mortality among critically ill patients. Chest X-ray, computerized tomography (CT), and ultrasound are commonly used imaging modalities. Among them, ultrasound, due to its portability and non-invasiveness, can be easily moved to the bedside for examination at any time. In addition, with use of 4G or 5G networks, remote ultrasound consultation can also be performed, which allows ultrasound to be used in isolated medial areas. Besides, the contact surface of ultrasound probe with patients is small and easy to be disinfected. Therefore, ultrasound has gotten lots of positive feedbacks from the frontline healthcare workers, and it has played an indispensable role in the course of COVID-19 diagnosis and follow up

Introducing ECMO/ECLS in sub-Saharan Africa – prospects and perspectives

Background: The introduction of modern medical technologies reduced mortality in adults and increased survival in infants less than five years old. Cardiac and respiratory failure can be managed through mechanical circulatory support devices such as ECMO/ECLS (Extracorporeal Membrane Oxygenation/ Extracorporeal Life Support).Main Findings: We evaluate the importance and potential impact of using ECMO/ECLS in improving health care in sub-Saharan Africa. The intention of this recommendation is to introduce this concept as a feasible rescue method for clinicians in the region. The potential use of ECMO/ECLS will be discussed with focus on infrastructure for the retrieval services from the referring hospitals to designated ECMO centres.Conclusion: ECLS resources and time that should be committed to training of staff and on-going education should not be underestimated. ECLS should only be commenced, maintained and weaned in the hands of trained, experienced and knowledgeable medical personnel cognisant that the results will be benchmarked by ELSO (Extracorporeal Life Support Organization) and available for consumption in the public domain. Partnership models are key to the ECLS success with well-defined roles and responsibilities for each party. The possible way for ECMO/ECLS in Africa should be combining with a two-pronged education programme: Improving critical care services in themselves, and once they get to an acceptable level in this department then is to manage ECLS patients for a few hours. To upgrade critical care services, this is vital for Africa, and only then to introduce ECMO/ECLS

Neurologic Issues in Patients Receiving Extracorporeal Membrane Oxygenation Support

Extracorporeal membrane oxygenation (ECMO) is a well-established therapy for patients experiencing acute severe cardiac and/or respiratory failure. Unfortunately, despite noteworthy improvements in patient selection, technology, and multidisciplinary team management, significant complications are still common. The most dramatic and potentially severe complications are neurologic. However, the incidence of neurologic complications (i.e. embolic stroke, intracerebral hemorrhage, seizures, and anoxic injuries) has not been completely defined. Unfortunately, brain death and neurologic injuries are significant causes of morbidity and mortality for patients requiring an ECMO support. Critical to the management of patients requiring ECMO is a broader understanding of neurologic monitoring along with the clinical assessment and management of neurologic events. It is important to evaluate and potentially intervene early in the event of a neurologic problem to minimize its clinical significance. Hopefully, with a better understanding of the pathophysiology, diagnostic and therapeutic tools, and prevention strategies, the true incidence of neurologic complications can be understood and minimized

Interactions between extracorporeal support and the cardiopulmonary system.

This review describes the intricate physiological interactions involved in the application of extracorporeal therapy, with specific focus on cardiopulmonary relationships. Extracorporeal therapy significantly influences cardiovascular and pulmonary physiology, highlighting the necessity for clinicians to understand these interactions for improved patient care. Veno-arterial extracorporeal membrane oxygenation (veno-arterial ECMO) unloads the right ventricle and increases left ventricular (LV) afterload, potentially exacerbating LV failure and pulmonary edema. Veno-venous (VV) ECMO presents different challenges, where optimal device and ventilator settings remain unknown. Influences on right heart function and native gas exchange as well as end-expiratory lung volumes are important concepts that should be incorporated into daily practice. Future studies should not be limited to large clinical trials focused on mortality but rather address physiological questions to advance the understanding of extracorporeal therapies. This includes exploring optimal device and ventilator settings in VV ECMO, standardizing cardiopulmonary function monitoring strategies, and developing better strategies for device management throughout their use. In this regard, small human or animal studies and computational physiological modeling may contribute valuable insights into optimizing the management of extracorporeal therapies

ECG Signal Reconstruction on the IoT-Gateway and Efficacy of Compressive Sensing Under Real-time Constraints

Remote health monitoring is becoming indispensable, though, Internet of Things (IoTs)-based solutions have many implementation challenges, including energy consumption at the sensing node, and delay and instability due to cloud computing. Compressive sensing (CS) has been explored as a method to extend the battery lifetime of medical wearable devices. However, it is usually associated with computational complexity at the decoding end, increasing the latency of the system. Meanwhile, mobile processors are becoming computationally stronger and more efficient. Heterogeneous multicore platforms (HMPs) offer a local processing solution that can alleviate the limitations of remote signal processing. This paper demonstrates the real-time performance of compressed ECG reconstruction on ARM's big.LITTLE HMP and the advantages they provide as the primary processing unit of the IoT architecture. It also investigates the efficacy of CS in minimizing power consumption of a wearable device under real-time and hardware constraints. Results show that both the orthogonal matching pursuit and subspace pursuit reconstruction algorithms can be executed on the platform in real time and yield optimum performance on a single A15 core at minimum frequency. The CS extends the battery life of wearable medical devices up to 15.4% considering ECGs suitable for wellness applications and up to 6.6% for clinical grade ECGs. Energy consumption at the gateway is largely due to an active internet connection; hence, processing the signals locally both mitigates system's latency and improves gateway's battery life. Many remote health solutions can benefit from an architecture centered around the use of HMPs, a step toward better remote health monitoring systems.Peer reviewedFinal Published versio