Extracorporeal Membrane Oxygenation (ECMO) Training Program in A Pediatric Cardiac Intensive Care Unit: An 8-Year Single-Center Experience in Argentina.

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) for temporary cardiopulmonary support is one of the most intense and technologically complex therapies offered in medicine. It is a high-risk procedure that requires specific knowledge and technical skills to perform it with good results. OBJECTIVE: The main goal of this study is to describe our extracorporeal membrane oxygenation (ECMO) training program based on the study of specialized nurses and physicians of a simulation teaching experience, conducted in a pediatric cardiac intensive care unit. The program was developed as a theoretical-practical course with final exam and annual maintenance training sessions, caring for ECMO patients, its implementation and results. METHODS: A descriptive study for registered nurses, intensivists, and cardiac surgeons. A self-administered, anonymous, and voluntary survey was conducted to assess the long-term perception about the program. Demographic data to describe the population was required, and questions about satisfaction and confidence in acquired skills and competences were asked. A descriptive statistical analysis was performed; patient survival and complications were compared before and after ECMO program using chi-square test, and P<0.05 was considered statistically significant. RESULTS: Twenty-four training courses were performed for 68 professionals. More than 88% of the professionals considered the course components to be adequate and complete; and 94% felt trained to manage the ECMO circuit. Most valued activities were workshops and clinical cases. Since the implementation of the training program, 88 patients were assisted, with a survival rate at discharge of 58%, higher than in the previous period (P=0.03). CONCLUSION: More than 80% of the professionals considered the workshops and simulations as the most useful components. Reliance on the circuit care was higher than in training problem scenarios. Since 2013 we assisted 88 patients on ECMO, with a survival rate at discharge of 58%, within international standards results.

Extracorporeal Membrane Oxygenation (ECMO) Training Program in A Pediatric Cardiac Intensive Care Unit: An 8-Year Single-Center Experience in Argentina

ABSTRACT Introduction: Extracorporeal membrane oxygenation (ECMO) for temporary cardiopulmonary support is one of the most intense and technologically complex therapies offered in medicine. It is a high-risk procedure that requires specific knowledge and technical skills to perform it with good results. Objective: The main goal of this study is to describe our extracorporeal membrane oxygenation (ECMO) training program based on the study of specialized nurses and physicians of a simulation teaching experience, conducted in a pediatric cardiac intensive care unit. The program was developed as a theoretical-practical course with final exam and annual maintenance training sessions, caring for ECMO patients, its implementation and results. Methods: A descriptive study for registered nurses, intensivists, and cardiac surgeons. A self-administered, anonymous, and voluntary survey was conducted to assess the long-term perception about the program. Demographic data to describe the population was required, and questions about satisfaction and confidence in acquired skills and competences were asked. A descriptive statistical analysis was performed; patient survival and complications were compared before and after ECMO program using chi-square test, and P<0.05 was considered statistically significant. Results: Twenty-four training courses were performed for 68 professionals. More than 88% of the professionals considered the course components to be adequate and complete; and 94% felt trained to manage the ECMO circuit. Most valued activities were workshops and clinical cases. Since the implementation of the training program, 88 patients were assisted, with a survival rate at discharge of 58%, higher than in the previous period (P=0.03). Conclusion: More than 80% of the professionals considered the workshops and simulations as the most useful components. Reliance on the circuit care was higher than in training problem scenarios. Since 2013 we assisted 88 patients on ECMO, with a survival rate at discharge of 58%, within international standards results.

[Lumbar puncture training using simulation-based educational strategies: Experience in a clinical pediatric residency]. / Entrenamiento en punción lumbar utilizando estrategias educativas de simulación: Experiencia en una residencia de clínica pediátrica.

Pediatricians should acquire multiple skills during their professional training, including procedural skills. Skill acquisition requires knowledge on theoretical bases, direct observation and, lastly, supervised repetitive practice. Training using simulators allows to learn procedures in a controlled setting, ensuring patients' safety, integrating this as a learning stage prior to the actual contact with patients. Here we report on the teaching experience of a simulated lumbar puncture procedure. Training was provided to 112 first year pediatric residents who entered Hospital Prof. Dr. Juan P. Garrahan in the 2013-2014 period. Educational contents included communication with parents regarding the procedure, material preparation, compliance with biosafety standards, sepsis and general patient care, puncture and subsequent cerebrospinal fluid collection, and specimen collection. Strategies included, in a sequential order, the introduction of theoretical aspects using the bibliography and audiovisual resources available at the hospital's online campus and subsequent practice of lumbar puncture in a 3-month-old infant phantom on a lateral recumbent position that allowed to make a puncture and collect cerebrospinal fluid. At each training session, the level of confidence was measured before and after the procedure, and a checklist was developed to verify an adequate compliance with each step of the procedure. The simulated lumbar puncture training model has been introduced as an educational strategy of our Pediatric Residency Program.

Las competencias que debe adquirir un pediatra durante su formación profesional son múltiples; entre ellas, las destrezas en la realización de procedimientos. El proceso para la adquisición de estas destrezas requiere del conocimiento de bases teóricas, de la observación directa y, finalmente, de la práctica repetitiva bajo supervisión. El entrenamiento en simuladores permite aprender procedimientos en un marco controlado que protege la seguridad de los pacientes y que se integra como una instancia de aprendizaje previa a la realidad con el paciente. Reportamos la experiencia en el proceso de enseñanza del procedimiento de punción lumbar mediante simulación. Participaron del entrenamiento 112 residentes de Pediatría, de 1er año, que ingresaron al Hospital Prof. Dr. Juan P. Garrahan durante el ciclo 2013 y 2014. Los contenidos educativos abarcaron la comunicación a los padres sobre el procedimiento, la preparación del material, el cumplimiento de las normas de bioseguridad, asepsia y cuidados generales del paciente, la punción con obtención del líquido cefalorraquídeo y la recolección del material. La estrategia incluyó, en forma secuencial, la incorporación de aspectos teóricos mediante recursos bibliográficos y audiovisuales accesibles en el campus virtual del Hospital y la posterior práctica de la punción en un maniquí correspondiente a un lactante de 3 meses en posición acostado, que permitió la punción y obtención de líquido cefalorraquídeo. En cada entrenamiento se midió el nivel de confianza antes y después, y se elaboró una lista de cotejo para verificar el cumplimiento adecuado de cada paso del procedimiento. El módulo de entrenamiento en punción lumbar con simulación ha sido incorporado como estrategia educativa de nuestro Programa de Residencia en Pediatría