The importance of the development of extracorporeal life support simulation centres for improving skills and knowledge during the COVID-19 pandemic.

Introduction: Despite increasing implementation of sophisticated and logistically challenging techniques to support patients in life-threatening conditions in the last years, there were no devoted education centres, especially in coronavirus pandemic. Aim: To assess the value of gaining evidence-based knowledge and improving the skills of physicians by means of simulation techniques in the safe use of extracorporeal technologies to support patients in the life-threatening conditions. Material and methods: In 2019, the National Education Centre for Artificial Life Support and Patient Safety and the frame program of the course of "Artificial Life Support with ECMO". was created. In years 2019-2023, we managed to organise 34 such courses for 405 physicians, which were additionally endorsed by ELSO (Extracorporeal Life Support Organisation). The physicians' cognitive, behavioural, and technical skills were evaluated before and after the courses. Results: The participants' gender was well balanced (54% men and 46% women). Most of them (mainly at the age between 31-40 years) presented more than 5 years of clinical experience, predominantly in anaesthesiology and intensive care (63%). Of note, 54% of them had no experience with ECMO application. In all detailed aspects of cognitive, behavioural, and technical assessment and knowledge scores, significant improvement was observed after the course. Conclusions: The development of a simulation-based education centre was found to be an invaluable achievement that enabled not only successful standardised training and testing of novel or previously accepted procedures, but also the upgrading of technical skills, even in the challenging COVID-19 pandemic period.

A Comparison of the bébé VieScope™ and Direct Laryngoscope for Use While Wearing PPE-AGP: A Randomized Crossover Simulation Trial.

This study aimed to compare the intubation effectiveness of the bébé Vie Scope™ (VieScope) and direct laryngoscopy for emergency intubation in a pediatric manikin model performed by paramedics with and without personal protective equipment for aerosol generating procedures (PPE-AGP). Participants performed endotracheal intubation using VieScope and standard Macintosh laryngoscope (MAC) in two research scenarios: (1) without PPE-AGP, and (2) with PPE-AGP. Fifty-one paramedics without any previous experience with the VieScope participated in this study. In the PPE-AGP scenario, in the VieScope group, the percentage of successful tracheal intubation on the first attempt was higher compared to the MAC group (94.1 vs. 78.4%, p = 0.031), intubation time was shorter (29.8 vs. 33.9 s, p < 0.001), and percentage of glottic opening (POGO) score was higher 91.0 vs 77.8 (p < 0.001). On the Cormack−Lehane scale, intubation with VieScope intubation was associated with higher scores rated at 1 (64.7 vs. 29.4%) than in the MAC group (p = 0.001). For intubation in the non-PPE scenario, there were no statistically significant differences between VieScope and MAC in relation to above parameters. Summarize, the bébé VieScope™ under PPE-AGP wearing conditions has proven to be a useful device for airway management in children providing better visualization of the larynx, better intubation conditions, and a higher success rate of tracheal intubation on the first attempt and reduced intubation time compared to the standard Macintosh laryngoscope.

Comprehensive assessment of a nationwide simulation-based course for artificial life support.

BACKGROUND: Successful implementation of medical technologies applied in life-threatening conditions, including extracorporeal membrane oxygenation (ECMO) requires appropriate preparation and training of medical personnel. The pandemic has accelerated the creation of new ECMO centers and has highlighted continuous training in adapting to new pandemic standards. To reach high standards of patients' care, we created the first of its kind, National Education Centre for Artificial Life Support (NEC-ALS) in 40 million inhabitants' country in the Central and Eastern Europe (CEE). The role of the Center is to test and promote the novel or commonly used procedures as well as to develop staff skills on management of patients needing ECMO. METHOD: In 2020, nine approved and endorsed by ELSO courses of "Artificial Life Support with ECMO" were organized. Physicians participated in the three-day high-fidelity simulation-based training that was adapted to abide by the social distancing norms of the COVID-19 pandemic. Knowledge as well as crucial cognitive, behavioral and technical aspects (on a 5-point Likert scale) of management on ECMO were assessed before and after course completion. Moreover, the results of training in mechanical chest compression were also evaluated. RESULTS: There were 115 participants (60% men) predominantly in the age of 30-40 years. Majority of them (63%) were anesthesiologists or intensivists with more than 5-year clinical experience, but 54% had no previous ECMO experience. There was significant improvement after the course in all cognitive, behavioral, and technical self-assessments. Among aspects of management with ECMO that all increased significantly following the course, the most pronounced was related to the technical one (from approximately 1.0 to more 4.0 points). Knowledge scores significantly increased post-course from 11.4 ± SD to 13 ± SD (out of 15 points). The quality of manual chest compression relatively poor before course improved significantly after training. CONCLUSIONS: Our course confirmed that simulation as an educational approach is invaluable not only in training and testing of novel or commonly used procedures, skills upgrading, but also in practicing very rare cases. The implementation of the education program during COVID-19 pandemic may be helpful in founding specialized Advanced Life Support centers and teams including mobile ones. The dedicated R&D Innovation Ecosystem established in the "ECMO for Greater Poland" program, with developed National Education Center can play a crucial role in the knowledge and know-how transfer but future research is needed.

Managing patients on extracorporeal membrane oxygenation support during the COVID-19 pandemic - a proposal for a nursing standard operating procedure.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is effective in a selected critically ill patient population with promising results in refractory hypoxemia related to the novel coronavirus disease (COVID-19). However, it requires specialized clinicians and resources in advanced technology. Moreover, the COVID-19 remains an ongoing global emergency, and there is no evidence-based practice in preparedness. This article proposes an innovative and optimized nursing care protocol, the Standard Operating Procedure (SOP), that regulates safety and efficiency in using personal protective equipment (PPE) during ECMO-relevant procedures while providing ECMO therapy for patients with COVID-19. METHODS: After performing a narrative literature search, we developed a high-fidelity translational simulation scenario. It included practicing appropriate donning and doffing PPE during work organization, ECMO-related procedures, and routine daily nursing care and management of ECMO over nine hours. In addition, we held supplementary constructive debrief meetings to consult international expert in the field. RESULTS: A proposal for nursing standardized operating procedures was created, divided into categories. They included work organization, workload references, competences, infrastructural conditions, cannulation equipment, daily routine nursing care, and procedures during ECMO. CONCLUSIONS: High-fidelity medical simulation can play an important role in staff training, improvement in previously gained proficiency, and development of optimal SOP for nursing care and management during ECMO in patients with COVID-19. Optimal SOPs may further guide multidisciplinary teams, including intensive care units and interventional departments.

How should we teach cardiopulmonary resuscitation? Randomized multi-center study.

BACKGROUND: A 2017 update of the resuscitation guideline indicated the use of cardiopulmonary resuscitation (CPR) feedback devices as a resuscitation teaching method. The aim of the study was to compare the influence of two techniques of CPR teaching on the quality of resuscitation performed by medical students. METHODS: The study was designed as a prospective, randomized, simulation study and involved 115 first year students of medicine. The participants underwent a basic life support (BLS) course based on the American Heart Association guidelines, with the first group (experimental group) performing chest compressions to observe, in real-time, chest compression parameters indicated by software included in the simulator, and the second group (control group) performing compressions without this possibility. After a 10-minute resuscitation, the participants had a 30-minute break and then a 2-minute cycle of CPR. One month after the training, study participants performed CPR, without the possibility of observing real-time measurements regarding quality of chest compression. RESULTS: One month after the training, depth of chest compressions in the experimental and control group was 50 mm (IQR 46-54) vs. 39 mm (IQR 35-42; p = 0.001), compression rate 116 CPM (IQR 102-125) vs. 124 CPM (IQR 116-134; p = 0.034), chest relaxation 86% (IQR 68-89) vs. 74% (IQR 47-80; p = 0.031) respectively. CONCLUSIONS: Observing real-time chest compression quality parameters during BLS training may improve the quality of chest compression one month after the training including correct hand positioning, compressions depth and rate compliance.

Annual Observation of Changes in the Angle of Trunk Rotation. Trunk Asymmetry Predictors. A Study from a Scoliosis Screening in School Adolescents.

Adolescent forms of idiopathic scoliosis are commonly encountered deformities of the thoracic and lumbar spine. They affect a significant number of adolescents, yet their cause is still unknown. The presented research is a cross-sectional analysis of 3933 volunteers (2131 girls and 1802 boys). The participants were primary school students aged 9 to 13 years old. This study determined a relationship between predictors such as: body mass, body height and body mass index (BMI) (independent variables) and angle of trunk rotation (ATR) value (dependent variable). Moreover, a stepwise multiple regression with backward selection was conducted to determine to what extent the dependent variable is explained by body mass, body height and BMI. In the group of 11,12,13-year-old girls, the analyzed results of multiple stepwise regression were statistically significant. Among the all studied predictors, it has been shown that body mass in the 11-year-old girls and body height in 12- and 13-year-old girls are major correlates of a 1-year ATR increase in proximal and main thoracic spine levels.

Do Years of Running Experience Influence the Motivations of Amateur Marathon Athletes?

The aim of the study was to investigate if years of running experience influence the motivations of marathon athletes. An empirical study was conducted during the last (20th) PKO Poznan Marathon, one of the largest and most popular mass running events in Poland, which was held in Poznan (Poland) in October 2019. A total of 493 marathon runners (29% of whom were female, and 71% of whom were male) took part in the cross-sectional study, which used the diagnostic survey method. The questionnaire employed the division of motives from the motivation of marathoners scale (MOMS) by Masters et al., adapted to the Polish language by Dybala. Running motivations have already been analysed for variables such as age, gender and place of residence, but there is a research gap regarding existing research, as the relationship between motivations and running experience has not yet been studied. One-way analysis of variance for independent samples was used to verify statistical hypotheses. Prior to making the relevant calculations, the assumption of homogeneity of variance was checked via Levene's test. Variances were assessed with an F-test, and if they were unequal, Welch's correction was applied. Eta squared (η2) was used as a measure of effect size. The calculations carried out showed that running experience was not a statistically significant factor in the motivations of runners taking part in a marathon.

The Impact of Modern Ultramarathons on Shaping the Social Identity of Runners. The Case Study of Karkonosze Winter Ultramarathon.

Despite the growing interest in extreme sports around the world, researchers have rarely investigated the complex factors that have led to a developed commitment to extreme sports in recent years. Precisely, the social identity of ultramarathoners remains a research niche. The aim of the article is to analyze the impact of a sports event on shaping social identity of ultramarathon runners on the example of Karkonosze Winter Ultramarathon (held in Poland). The qualitative method used in the article-interviews with runners-made it possible to examine the factors that create social identity, among which the motives for participation, sports subculture, and the authenticity of the experience play a key role. The first part of the article describes the theoretical aspects of social identity in sport. The second, empirical part presents the research results supplemented by the statements of the contestants. In this case, the subject of analysis is the motives for participation in a winter ultramarathon and their characteristics. Lastly, the article analyzes the subculture of ultramarathoners and the experience of contestants' authenticity. The investigated winter ultramarathon created the perfect space for creation, deepening and celebrating the social identity of ultramarathoners assessed as a value in itself. The article enriches the present knowledge about the motivation of ultramarathoners because, unlike the results of quantitative research, it presents in-depth responses of runners who were not always concerned by existing research questionnaires.

An innovative panel to assess endothelial integrity of pedicled and skeletonized internal thoracic artery used as aortocoronary bypass graft: a randomized comparative histologic and immunohistochemical study.

BACKGROUND: Optimal preservation of endothelial integrity of the vessels used as aortocoronary grafts is a crucial determinant of long-term clinical success of coronary artery bypass grafting (CABG). The purpose of this study was to evaluate an impact of two common techniques to harvest left internal thoracic artery (LITA) on endothelial integrity. METHODS: One hundred twenty consecutive patients (84 males and 36 females) with a mean age of 64.9±8.8 years undergoing CABG were randomized to receive pedicled (group P; n=60) or skeletonized (group S; n=60) LITA grafts. During surgery LITA was harvested by the same experienced cardiac surgeon. The most peripheral surplus segments of LITA were obtained and then analysed histologically under light microscope. Additionally, endothelial expression of CD31, CD34, CD133 and nitric oxide synthase (eNOS) were evaluated by means of immunohistochemistry. RESULTS: In both groups, no cases of major arterial wall damage such as disruption, dissection, thrombosis or subadventitial hematoma were noted on LITA cross sections. Immunohistochemical assessment of protein expression revealed no differences in endothelial expression of CD133, CD34 antigens (markers of regeneration potential) and eNOS (indicating preserved functional integrity) between studied groups. Contrary to them, endothelial immunoreactivity of CD31, a marker of the morphological integrity of the endothelium, was revealed to be stronger in group P. CONCLUSIONS: The skeletonized method of LITA harvesting may be associated with worse preservation of morphological integrity of endothelium but without compromising functional integrity and potential for tissue regeneration.

Prototype of extracorporeal membrane oxygenation (ECMO) therapy simulator used in regional ECMO program.

BACKGROUND: Simulation is widely accepted as an important tool in training and educating healthcare providers. The first regional polish extracorporeal membrane oxygenation (ECMO) program called "ECMO for Greater Poland" was recently started. METHODS: We present a prototype for ECMO prepared for high-fidelity medical simulation in extracorporeal life support. ECMO therapy is a complex, difficult and expensive therapy in patient care. We have constructed an advanced ECMO simulation prototype, which can be used as a training tool in scenarios that prepare for real-life experiences. The "ECMO for Greater Poland" program uses high-fidelity simulation as a superior tool to simulate several complex clinical scenarios, and consequently train healthcare providers in rare, complicated and expensive procedures. The training course is standardized and allows repeatable training, improvement of skills, and an objective verification of trained skills. RESULTS: The ECMO simulation prototype is designed to replicate the physiological circulatory system and simulate several scenarios (i.e., bleeding, low pressure, occlusion, reaction for proper and incorrect pharmacological treatment). The electronic core control unit (CCU) with silicone tubes, artificial vessels (modified polyethylene) and analog components can be connected to an ECMO machine to emulate the human body during an ECMO simulation. If necessary, damaged and used parts can easily be replaced. The total cost of the simulator is approximately 450 and 50 USD for disposable parts. CONCLUSIONS: This newly developed advanced ECMO simulation prototype was recently introduced into education and regularly training of healthcare providers of the "ECMO for Greater Poland" program. The simulation based training program is financially affordable and enables clinical teaching in a wider range of clinical scenarios. The ECMO simulation prototype consequently improves level of expertise of the healthcare providers and finally improves quality in patient care.

BEST Life-"Bringing ECMO Simulation To Life"-How Medical Simulation Improved a Regional ECMO Program.

The implemented "ECMO for Greater Poland" program takes full advantage of the ECMO (extracorporeal membrane oxygenation) perfusion therapy to promote health for 3.5 million inhabitants in the region. The predominant subjects of implementation are patients with hypothermia, with severe reversible respiratory failure (RRF), and treatment of other critical states leading to heart failure such as sudden cardiac arrest, cardiogenic shock or acute intoxication. Finally, it promotes donation after circulatory death (DCD) strategy in selected organ donor cases. ECMO enables recovery of organs' function after unsuccessful lifesaving treatment. Because this organizational model is complex and expensive, we use advanced high-fidelity medical simulation to prepare for real-life implementation. During the first four months, we performed scenarios mimicking "ECMO for DCD," "ECMO for ECPR (extended cardiopulmonary resuscitation)," "ECMO for RRF" and "ECMO in hypothermia." It helped to create algorithms for aforementioned program arms. In the following months, three ECMO courses for five departments in Poznan (capitol city of Greater Poland) were organized and standardized operating procedures for road ECMO transportation within Medical Emergency System were created. Soon after simulation program, 38 procedures with ECMO perfusion therapy including five road transportations on ECMO were performed. The Maastricht category II DCD procedures were done four times on real patients and in two cases double successful kidney transplantations were carried out for the first time in Poland. ECMO was applied in two patients with hypothermia, nine adult patients with heart failure, and five with RRF, for the first time in the region. In the pediatric group, ECMO was applied in four patients with RRF and 14 with heart failure after cardiac surgery procedures. Additionally, one child was treated successfully following 200 km-long road transport on ECMO. We achieved good and promising results especially in VV ECMO therapy. Simulation-based training enabled us to build a successful procedural chain, and to eliminate errors at the stage of identification, notification, transportation, and providing ECMO perfusion therapy. We discovered the important role of medical simulation, not only to test the medical professional's skills, but also to promote ECMO therapy in patients with critical/life-threatening states. Moreover, it also resulted in increase of the potential organ pool from DCD in the Greater Poland region.

Evaluation of tourniquet application in a simulated tactical environment.

BACKGROUND: Application of a tourniquet in a tactical environment is implemented in two ways: the so-called self-aid, which is the application of a tourniquet by the injured, and the so-called buddy aid, which is the application of a tourniquet by the person provide aid. This study aimed to test the quality of tourniquet use in a simulated situation, close quarter battle. METHODS: The study involved 24 injured operators and 72 operators in the whole simulation, implying 12 sections of six individuals. To validate the application of tourniquets, the recommendations of the Committee of Tactical Combat Care of the Injured were used, and ultrasound with Doppler function was employed to assess the hemodynamic effect of applying tourniquets. RESULTS: Native flow was observed in 15 operators; in three people, a trace flow was noticed, whereas in six people, a full flow was observed. No significant difference was found between the qualities of tourniquet application by the operators themselves compared with those of tourniquet application by another person. The median distance of tourniquet application from the armpit was 9.5 cm for self-aid and buddy aid. In 16 participants the outer arrangement of tourniquets was observed, and in only eight participants tourniquets were correctly located on the internal part of the arm. In 18 participants, tourniquets were not correctly prepared for use in the tactical environment, whereas in only six participants, they were correctly prepared. Most operators with a negative ultrasound flow revealed negative distal observed pulse (DOP). Positive DOP occurred in the majority of operators with full ultrasound flow. CONCLUSION: The application of tourniquets poses a challenge even in case of specialized units; therefore, there is a need to provide regular training for implementing that procedure.

Automated external defibrillator use in public places: a study of acquisition time.

BACKGROUND: Sudden cardiac arrest (SCA) is a frequent cause of death in the developed world. Early defibrillation, preferably within the first minutes of the incident, significantly increases survival rates. Accessible automated external defibrillators (AED) in public areas have been promoted for many years, and several locations are equipped with these devices. AIM: The aim of the study was to assess the real-life availability of AEDs and assess possible sources of delay. METHODS: The study took place in the academic towns of Poznan, Lodz, and Warsaw, Poland. The researchers who were not aware of the exact location of the AED in the selected public locations had to deliver AED therapy in simulated SCA scenarios. For the purpose of the trial, we assumed that the SCA takes place at the main entrance to the public areas equipped with an AED. RESULTS: From approximately 200 locations that have AEDs, 78 sites were analysed. In most places, the AED was located on the ground floor and the median distance from the site of SCA to the nearest AED point was 15 m (interquartile range [IQR] 7-24; range: 2-163 m). The total time required to deliver the device was 96 s (IQR 52-144 s). The average time for discussion with the person responsible for the AED (security officer, staff, etc.) was 16 s (IQR 0-49). The AED was located in open access cabinets for unrestricted collection in 29 locations; in 10 cases an AED was delivered by the personnel, and in 29 cases AED utilisation required continuous personnel assistance. The mode of accessing the AED device was related to the longer discussion time (p < 0.001); however, this did not cause any significant delay in therapy (p = 0.132). The AED was clearly visible in 34 (43.6%) sites. The visibility of AED did not influence the total time of simulated AED implementation. CONCLUSIONS: We conclude that the access to AED is relatively fast in public places. In the majority of assessed locations, it meets the recommended time to early defibrillation of under 3 min from the onset of the cardiac arrest; however, there are several causes for possible delays. The AED signs indicating the location of the device should be larger. AEDs should also be displayed in unrestricted areas for easy access rather than being kept under staff care or in cabinets.

The role of extracorporeal membrane oxygenation in patients after irreversible cardiac arrest as potential organ donors.

The number of people waiting for a kidney or liver transplant is growing systematically. Due to the latest advances in transplantation, persons after irreversible cardiac arrest and confirmation of death have become potential organ donors. It is estimated that they may increase the number of donations by more than 40%. However, without good organization and communication between pre-hospital care providers, emergency departments, intensive care units and transplantation units, it is almost impossible to save the organs of potential donors in good condition. Various systems, including extracorporeal membrane oxygenation (ECMO), supporting perfusion of organs for transplantation play a key role. In 2016 the "ECMO for Greater Poland" program was established. Although its main goal is to improve the survival rate of patients suffering from life-threatening cardiopulmonary conditions, one of its branches aims to increase the donation rate in patients with irreversible cardiac arrest. In this review, the role of ECMO in the latter group as the potential organ donors is presented.

[Medical simulation as a professional tool which affect the safety of the patient used in the learning process]. / Symulacja medyczna jako profesjonalne narzedzie wplywajace na bezpieczenstwo pacjenta wykorzystywane w procesie nauczania.

Simulation is the methodology of teaching, learning process using educational equipment from simple simulators, designed to study individual tasks, through advanced mannequins called human patient stimulators faithfully mimic the human and its parameters. The medical simulation's main task is education and improvement patients' safety. Advanced human simulators can realistically cough, vomit with artificial chyme and bleed with artificial blood causing a real stress of medical personnel and the need for immediate action. Medical simulation gives the opportunity to prepare medical personnel to the profession more effectively, in less time than traditional education and also clearly affects the patients' safety.