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Introduction: Over 200,000 patients survive an intensive care admission each year in the United Kingdom (UK). For patients, survival is frequently beset by a range of chronic disabilities. Approximately 50% must navigate an often complex convalescence, while suffering serious and persistent symptoms of post-traumatic stress disorder (PTSD), anxiety and/or depression.1 Eye-movement desensitisation and reprocessing (EMDR) is a trauma-focussed psychological therapy, recommended for treating PTSD by the International Society for Traumatic Stress Studies2 and NICE.3 However, EMDR has never been systematically investigated for patient benefit following intensive care admission. Objective(s): CovEMERALD4 evaluated the feasibility of delivering a randomised controlled trial (RCT), testing the effect of EMDR on the psychological health of intensive care survivors, following COVID-19 related critical illness. We also provide preliminary evidence of the effect on clinically relevant outcomes. Findings will inform the design of a subsequent fully-powered RCT. Method(s): This feasibility RCT was conducted at a single-centre, teaching hospital in the UK (University Hospital Southampton). Patients were eligible if they were admitted to intensive care for over 24-hours with confirmed COVID-19, were above 18 years of age, were recruited within 3-months of hospital discharge, and had no cognitive impairment or pre-existing psychotic diagnosis. Participants were randomised (1:1) to receive either up to 8 sessions of remotely-delivered EMDR (Recent traumatic events protocol) or standard care alone as the control group (CG). Psychometric evaluation was undertaken at Baseline and 6-months after hospital discharge. Result(s): Seventy-five consecutive patients were screened at hospital discharge, from October 2020 to April 2021. 51 eligible patients approached. 26 (51%) provided consent. Reasons for declining participation were;no psychological distress (n=16), no internet access (n=7) and being physically unready (n=2). Demographic variables were balanced between groups. Of the 13 patients randomised to EMDR, one withdrew prior to intervention: the remaining attended all sessions recommended by the psychological therapists (mean of 3-4 sessions per patient), giving an overall adherence of 93%. One patient from each group declined the 6-month follow-up evaluation, so trial completion was possible in 23 of 26 (88%) participants. No reasons for trial withdrawal were given. There were no attributable adverse events. Mean change in PTSD score (PTSD Checklist-Civilian) from Baseline to 6-months, was -8 (SD=10.49) in the EMDR group vs. +0.75 (SD=15.17) in CG (p=0.126). Mean change in anxiety (Hospital Anxiety and Depression Scale-Anxiety) was -0.45 (SD=2.3) following EMDR vs. -0.83 (SD=4.0) in the CG (p=0.787), and median change in depression (HADS-D) was -2(IQR:-3.0,1.0) following EMDR vs. +1(IQR-1.5,2.0) in the CG (p=0.263). Figure 1. Box-plot of change in PTSD symptoms (PCL-C) from baseline to 6-months post-hospital discharge for control group and EMDR intervention group. Conclusion(s): EMDR can improve psychological recovery following an intensive care admission for COVID-19, and appeared feasible and safe. Although not powered to determine clinical effectiveness, this single-centre feasibility study returned a positive signal, in reducing PTSD and depressive symptoms. A full results manuscript will be submitted prior to congress. CovEMERALD has supported a successful NIHR doctoral fellowship application, during which protocol refinements will be tested, within existing, and recommended rehabilitation pathways. Trial activity and progression will be consistent with the Medical Research Council framework for developing and evaluating complex healthcare interventions.5.
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Background: The COVID-19 pandemic has affected the world in every aspect. Many universities and education centres adapted their teaching to online education1. Virtual simulation has been endorsed by stakeholders not only for teaching healthcare students and workers, but also to be counted as practice hours for students2. We propose an approach to facilitate simulation-based education (SBE) online in an interactive manner for multiple participants. Methods: Visually enhanced mental simulation (VEMS) is a low fidelity yet very immersive and engaging educational activity used for participants to practise non-technical skills such as decisionmaking and communication while others observe3. Unlike ordinary mental simulation, participants can engage in VEMS as in a full-scale scenario-based simulation session, while being observed by peers. It is supported with visual elements such as a patient poster and laminated equipment cards for participants to illustrate the actions performed. Actions and patient parameters are also recorded with the timing by a facilitator on a white board. The scenario is followed by a debriefing involving all participants and observers. Recommendations: VEMS can be adapted to the online environment and be facilitated through platforms such as Microsoft Teams, Skype, Zoom, GoToMeeting, or Cisco WebEx easily using a shared screen with Microsoft PowerPoint and their associated chat function or the facilitator's web camera facing a noticeboard. A patient pictogram and transparent background equipment images can be used in PowerPoint to illustrate the actions verbalised by the participants. The facilitator can speak as the patient and illustrate and write down everything in PowerPoint as the participants engage in the scenario, so all the other session attendees can observe. Everyone can then attend the scenario debriefing online. Conclusion: Online VEMS offers an opportunity for participants to practise non-technical and communication skills. It is a low fidelity and low-cost approach to facilitating SBE that still needs to be tested with actual learners for ease of use, acceptability, and educational effectiveness.