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

Using thermochromic ink for medical simulations

© 2017 Alsalemi, Aldisi, Alhomsi, Ahmed, Bensaali, Alinier, Amira, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. Alsalemi A, Aldisi M, Alhomsi Y, Ahmed I, Bensaali F, Alinier G, Amira A., 'Using thermochromic ink for medical simulations', Qatar Medical Journal, 4th Annual ELSO-SWAC Conference Proceedings 2017:63 http://dx.doi.org/10.5339/qmj.2017.swacelso.63Background: In medical simulation and training, blood is used to exhibit its different behaviors in context. In some cases, blood color differential is an imperative visual effect to ensure high-fidelity training and practical understanding. High simulation realism is usually achieved by using animal or artificial blood (which mimics some biological features of blood), which has high cost, requires disposable equipment such as oxygenators, and entails contamination or infection risks. Methods: A novel method for blood simulation is introduced. Using the thermal properties of thermochromic ink, its color can be altered by adjustment of temperature. 1 The unique red color of blood can be mimicked to a high fidelity using a custom hue of thermochromic ink. Then, by adjusting its temperature, realistic dark and bright red can be employed to simulate the low and high oxygen concentrations of blood, respectively. Although thermochromic ink currently does not imitate other blood properties such as viscosity and clotting, it has superior merits when color change simulation is a paramount priority. The major advantages of the proposed solution are reusability and cost. Thermochromic ink can be used for multiple simulations without any noticeable change in quality. It also costs significantly less than using actual or artificial blood. Results: Testing results of the proposed solution in extracorporeal membrane oxygenation (ECMO) simulation has proven its efficacy as a practical solution for medical simulations (see Figure 1). To prevent membrane occlusion because of the thermochromic ink, the latter needs to be pierced. In addition to ECMO simulation, other medical applications are being considered. Conclusions: The use of thermochromic ink in medical training provides reproducible color change simulation features of blood while maintaining significantly lower equipment costs and contamination risks as all circuit components can be reused.Peer reviewedFinal Published versio

Design and implementation of a modular ECMO simulator

© 2017 The Authors, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided theoriginal work is properly cited. Aldisi M, Alsalemi A, Alhomsi Y, Ahmed I, Bensaali F, Alinier G, Amira A., 'Design and implementation of a modular ECMO simulator', Qatar Medical Journal, 4th Annual ELSO-SWAC Conference Proceedings 2017:62 http://dx.doi.org/10.5339/qmj.2017.swacelso.62Extracorporeal membrane oxygenation (ECMO) is a high-complexity life-saving procedure riddled with mechanical complications that can place the patient in a critical state where fast and coordinated actions are required to avoid mortality. Thus, patients on ECMO are supervised round the clock by highly trained nurses and perfusionists. Currently, ECMO training programs include patient emergency simulations performed with different levels of success. Some training facilities use mannequins that have computer-controlled physiological parameters such as heart rate and oxygen saturation. The circuit parameters such as pressure are manually adjusted per scenario; air and artificial blood are manually injected to indicate problems such as air embolism, and hypovolemia. 1 Despite being realistic, using an actual ECMO circuit for simulation training purposes has disadvantages such as the use of expensive disposable equipment (oxygenation membrane), lack of oxygenation color differentials, and manual circuit adjustments and injections.Peer reviewedFinal Published versio

A High-Realism and Cost-Effective Training Simulator for Extracorporeal Membrane Oxygenation

Medical simulators, employed in extracorporeal membrane oxygenation (ECMO), are burdened with costly equipment and low-fidelity methodologies. This dichotomy necessitated a new approach that eliminates high-costs and integrates with the critical care environment. This is especially applicable after the Coronavirus pandemic, where resources and supplies are evermore scarce. After examining the state-of-the-art and establishing a close collaboration with Hamad Medical Corporation (HMC), the main healthcare provider in Qatar, several criteria were identified to advance the cutting-edge. In this article, a high-realism, cost-effective ECMO simulator is presented. It runs on a novel blood simulation technology along with simulation modules. An instructor tablet application enables instructors to orchestrate the training experience wirelessly with real-time performance. It also includes a novel scenario designer for implementing consistent simulation curricula. A product-level simulator with high-fidelity casings is in the final integration phases. Current results include developing and testing the simulated blood circuit, simulation modules for hemorrhaging, line chattering, air bubbles noise, and a replicated console along with an integrated communications system. Nineteen specialists rated the fidelity of the system as highly realistic during a questionnaire-based study. It is expected to run a second study to evaluate the educational efficacy of the simulator as a first-of-its-kind in the region. 2013 IEEE.This work was supported by the Qatar University under Grant M-CTP-CENG-2020-1.Scopu

Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution

Introduction: Patients under the error-prone and complication-burdened extracorporeal membrane oxygenation (ECMO) are looked after by a highly trained, multidisciplinary team. Simulation-based training (SBT) affords ECMO centers the opportunity to equip practitioners with the technical dexterity required to manage emergencies. The aim of this article is to review ECMO SBT activities and technology followed by a novel solution to current challenges. ECMO simulation: The commonly-used simulation approach is easy-to-build as it requires a functioning ECMO machine and an altered circuit. Complications are simulated through manual circuit manipulations. However, scenario diversity is limited and often lacks physiological and/or mechanical authenticity. It is also expensive to continuously operate due to the consumption of highly specialized equipment. Technological aid: Commercial extensions can be added to enable remote control and to automate circuit manipulation, but do not improve on the realism or cost-effectiveness. A modular ECMO simulator: To address those drawbacks, we are developing a standalone modular ECMO simulator that employs affordable technology for high-fidelity simulation.Peer reviewe

Addressing the challenges of ECMO simulation

This document is the Accepted Manuscript. The final, definitive version of this paper has been published in Perfusion, May 2018, published by SAGE Publishing, All rights reserved.Introduction/Aim: The patient’s condition and high-risk nature of extracorporeal membrane oxygenation (ECMO) therapy force clinical services to ensure clinicians are properly trained and always ready to deal effectively with critical situations. Simulation-based education (SBE), from the simplest approaches to the most immersive modalities, helps promote optimum individual and team performance. The risks of SBE are negative learning, inauthenticity in learning and over-reliance on the participants’ suspension of disbelief. This is especially relevant to ECMO SBE as circuit/patient interactions are difficult to fully simulate without confusing circuit alterations. Methods: Our efforts concentrate on making ECMO simulation easier and more realistic in order to reduce the current gap there is between SBE and real ECMO patient care. Issues to be overcome include controlling the circuit pressures, system failures, patient issues, blood colour and cost factors. Key to our developments are the hospital-university collaboration and research funding. Results: A prototype ECMO simulator has been developed that allows for realistic ECMO SBE. The system emulates the ECMO machine interface with remotely controllable pressure parameters, haemorrhaging, line chattering, air bubble noise and simulated blood colour change. Conclusion: The prototype simulator allows the simulation of common ECMO emergencies through innovative solutions that enhance the fidelity of ECMO SBE and reduce the requirement for suspension of disbelief from participants. Future developments will encompass the patient cannulation aspect.Peer reviewe

Assessing Learning Outcomes in Extracorporeal Membrane Oxygenation Simulations with a Novel Simulator and Instructor Application

Simulation plays an important part in enhancing the outcomes of clinical training worldwide. In particular, extracorporeal membrane oxygenation (ECMO) is a life-saving procedure that utilizes a cardiopulmonary bypass circuit to offer short or mid-term respiratory and circulatory assistance to seriously ill patients. After the current Coronavirus (COVID-19) pandemic hit the world, in-person simulations became quite challenging to organize, due to the precautionary physical distancing practices. Due to ECMO's reliance on hands-on training, there is a need for a physical distancing-compatible solution that does not compromise on learning fidelity. Consequently, an assessment application has been developed to assist ECMO centers in carrying out simulations while being assessed by ECMO educators remotely. In this article, we conceptually introduce a revolutionary tablet-based assessment application for convenient, yet sophisticated and structured assessment of ECMO learners as a companion to an ECMO simulator and instructor application. The proposed application allows real-time assessment of the ECMO simulation experience and creates standardized simulation assessment curricula synced with a high-realism ECMO simulator. Initial app prototype showcases basic functionality, low communication latency, and a prototype simulation system that can simulate various ECMO emergencies. 2008-2011 IEEE.This work was supported by Qatar University under internal Grant M-CTP-CENG-2020-1.Scopu

IoT-based mock oxygenator for extracorporeal membrane oxygenation simulator

Background: Training is an essential aspect of providing high-quality treatment and ensuring patient safety in any medical practice. Because extracorporeal membrane oxygenation (ECMO) is a complicated operation with various elements, variables, and irregular situations, doctors must be experienced and knowledgeable about all conventional protocols and emergency procedures. The conventional simulation approach has a number of limitations. The approach is intrinsically costly since it relies on disposable medical equipment (i.e., oxygenators, heat exchangers, and pumps) that must be replaced regularly due to the damage caused by the liquid used to simulate blood. The oxygenator, which oxygenates the blood through a tailored membrane in ECMO, acts as a replacement for the patient's natural lung. For the context of simulation-based training (SBT) oxygenators are often expensive and cannot be recycled owing to contamination issues. Methods: Consequently, it is advised that the training process include a simulated version of oxygenators to optimize reusability and decrease training expenses. Toward this goal, this article demonstrates a mock oxygenator for ECMO SBT, designed to precisely replicate the real machine structure and operation. Results: The initial model was reproduced using 3D modeling and printing. Additionally, the mock oxygenator could mimic frequent events such as pump noise and clotting. Furthermore, the oxygenator is integrated with the modular ECMO simulator using cloud-based communication technology that goes in hand with the internet of things technology to provide remote control via an instructor tablet application. Conclusions: The final 3D modeled oxygenator body was tested and integrated with the other simulation modules at Hamad Medical Corporation with several participants to evaluate the effectiveness of the training session. 2022 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.This article was supported by the Qatar University Internal Grant No. M-CTP-CENG-2020-1. The findings achieved herein are solely the responsibility of the authors. Open Access funding provided by the Qatar National Library.Scopu

CouchDB Based Real-Time Wireless Communication System for Clinical Simulation

Medical simulators are advancing in technology and complexity to enhance realism and hence implementing a real-time communication system for such simulators is a challenge that engineers face. This paper follows up on the Firebase communication system solution that was employed for the modular extracorporeal membrane oxygenation (ECMO) simulator and addresses its challenges and limitations by presenting an alternative CouchDB based communication system. Testing results shows that CouchDB overcomes Firebase limitations in terms of latency, compatibility, and ongoing maintenance costs. The new approach features automatic application program interfaces (APIs), extremely low latency, and long term reliability.This paper was supported by Qatar university Internal Grant No. QUCG-CENG-2018-1. The findings achieved herein are solely the responsibility of the authors.Scopu

Revolutionizing ECMO simulation with affordable yet high-Fidelity technology

This document is the Accepted Manuscript version of the following article: Mohammed Al Disi, Abdullah Alsalemi, Yahya Alhomsi, Fayçal Bensaali, Abbes Amira, and Guillaume Alinier, ‘Revolutionizing ECMO simulation with affordable yet high-Fidelity technology’, The American Journal of Emergency Medicine, Vol. 36 (7): 1310-1312, July 2018. Under embargo until 15 November 2018. The final, definitive version is available online via doi: https://doi.org/10.1016/j.ajem.2017.11.036.Simulation-based training (SBT) is becoming a necessity in educating healthcare professionals who work in high-risk environments, such as the intensive care unit (ICU). This applies to extracorporeal membrane oxygenation (ECMO), a complication-burdened life support ICU modality employed to treat patients with circulatory and/or respiratory failure. Additionally, ECMO can quickly restore perfusion, and hence, used in the pre-hospital or emergency setting as an extracorporeal cardiopulmonary resuscitation (E-CPR) strategy or to maintain donors’ organs after circulatory death. Different ECMO simulation models have been reported in the literature. It ranges from simple mannequin and circuit modification with manual control, to hydraulically capable, remotely controlled mannequins, and high-fidelity simulators. However, the common factor in the incumbent practices is the reliance on a functioning ECMO console and circuit components, which introduces a colossal cost barrier and requires active spending to replace ECMO consumables. Reliance of such specialized and potentially scarce pieces of equipment also significantly reduces training opportunities. Furthermore, attempts to improve the simulation paradigm are faced with ever-increasing technical difficulties. For example, basic objectives such as controlling the displayed circuit pressures requires creating a sophisticated hydraulic model. It becomes even more problematic when considering higher level objectives such as simulating blood oxygenation color differentials, or remotely controlling blood gas parameters, displayed on in-line monitors. Hence, there is a need for lower cost, high-fidelity simulation systems with more customization capabilities that meet the expectations and increasing demand for ECMO therapy.Peer reviewedFinal Accepted Versio