Page 68 - JSOM Winter 2024

for veno-arterial (VA) ECMO, but no training platforms have and met inclusion criteria were used. The study comparison
been developed for Role 2 surgical teams to offer VV ECMO groups were data from the 12 participants before and after
in operational environments or to provide sustainment of the course.
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knowledge and skills. To close this training gap and provide
increasingly available ECMO capabilities in a range of fu- The study was conducted in accordance with the regulations
ture conflict environments, a rapid and operationally relevant and guidelines of the Animal Welfare Act, the National Insti-
training course is required. We hypothesize that SOSTs can be tutes of Health Guide for the Care and Use of Laboratory An-
rapidly trained to safely and effectively cannulate and manage imals, and the American Association for the Accreditation of
VV ECMO patients. We also describe the use of a civilian-mil- Laboratory Animal Care. The animals were housed at the 81st
itary partnership to integrate operational military physicians MDG CRL, where the study was conducted. The study was
into a high-volume civilian ECMO center call schedule. funded by a 711th Human Performance Wing (HPW) Studies
and Analysis (S&A) grant.
Methods
ECMO Materials
Study Design The CARDIOHELP ECMO pump (Maquet Getinge Group
We developed a prospective controlled study evaluating the CARDIOHELP-I REF 70104-8012) and circuit (Maquet HLS
efficacy of a VV ECMO training course for SOST personnel. Set Advanced 7.0, HLS 7050 USA, 701052794) were used.
This study was reviewed by the University of Maryland and Cannulation was performed using Maquet 19-French venous
81st Medical Group (81st MDG) Institutional Review Boards cannulas (PVS 1938) and Medtronic Bio-Medicus 19-French
and approved as exempt. In addition, this study was approved venous cannulas (96670-019).
by the 81st MDG Clinical Research Laboratory (CRL) Institu-
tional Animal Care and Use Committee (IACUC). Course Materials
Educational materials were developed by subject matter ex-
Primary and Secondary Aims perts (SMEs) at the R Adams Cowley Shock Trauma Center
Our primary aim was to determine whether SOST person- (STC) at the University of Maryland Medical Center (UMMC),
nel could be rapidly trained to safely and effectively cannu- a high-volume ECMO institution. The STC has a quarterly
late and manage for VV ECMO in conditions that may be ECMO training course designed for physicians, advanced
encountered (white light and low light). Rapid training was practice providers, and nurses. This course was adapted to
defined as completion of the 2.5-day course. Previous studies include relevant operational topics. Lectures included: VV
on “rapid” courses on VV ECMO cannulation and its man- ECMO physiology, management, cannulation techniques and
agement involved training that had been completed in 3 days cannula selection, setting up the circuit, managing the circuit,
or less. 17,18 “Safe and effective” cannulation was defined as managing complications, indications and contraindications,
successful set-up of the circuit and cannulation during the val- and care of the patient during cannulation and while on VV
idation phase without technical complication. Technical com- ECMO. Skills stations with hands-on and mannequin train-
plications were determined by 2 independent, expert reviewers ing were developed by civilian and military ECMO SMEs, and
with ECMO cannulation credentials and clinical experience Center for the Sustainment of Trauma and Readiness Skills
in the procedure and management who applied standards of (C-STARS-Baltimore) cadre with expertise in ECMO. Skills
care and clinical competence to the validation phase of train- station topics included: assembly of the ECMO circuit, bifem-
ing. Criteria included: priming and setting up the circuit, ob- oral cannulation for VV ECMO, Role 2 VV ECMO case, and
taining ultrasound guidance, placement of cannulas, assessing managing complications. Performance at each skills station
placement of cannulas through ultrasound and measurement, took place with white lights on and in darkness. White light
connection of the cannulas to the ECMO circuit, initiating training simulated a hospital environment, and the procedures
VV ECMO, removing air from the circuit, simulated cannula performed in darkness were undertaken with headlamps (Fig-
dislodgement, titration of the circuit, and performance of ure 1). Step-by-step instructions were provided to all partic-
procedures and surgeries. These competencies were based on ipants: (1) bifemoral cannulation from an expert consensus
previous, established ECMO training. 18,19 survey performed prior to the course (Supplemental Table 1)
and (2) Maquet Cardiohelp-I set-up and priming instruction
Our secondary aim was to determine whether SOSTs could sheet. The course was divided into two phases: (1) didactic
then perform surgical and resuscitative procedures in under (training) phase and (2) validation (testing) phase (Supplemen-
2 hours on VV ECMO patients given that trauma patients tal Figure 1).
requiring VV ECMO commonly require other procedures in
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a time-sensitive manner. Participants’ confidence and knowl- Didactic (Training) Phase
edge were evaluated with a self-assessment and a multi-choice The didactic course phase took place at the STC simulation
knowledge questionnaire immediately before and after the VV center. In addition to the previously mentioned lecture and
ECMO training course. Pre-course participant demographics skills station topics listed, participants completed pre-course
were obtained through anonymous surveys. self- assessments (23 questions) rating their degree of confi-
dence with cognitive (9 questions), technical (11 questions),
Study Setting and Population and behavioral (3 questions) aspects of VV ECMO on a 5-point
Volunteers from Detachment 1 and Detachment 2, 720th Op- Likert scale. 20–22 This self-assessment was adapted from a pre-
erational Support Squadron (OSS/SOST) were solicited via viously published survey. Since this was a validation study,
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email. Personnel eligible for inclusion were (1) qualified SOST there was no absolute cutoff for adequacy of confidence im-
personnel who (2) had no previous formal ECMO training. Al- provement. Our goal was to demonstrate how our course im-
ternative qualified SOST Air Force Specialty Code personnel proved participants’ confidence. Participants also completed a
(AFSCs) that are acceptable substitutes for team composition pre- and post-course 25-question multiple-choice knowledge

66 | JSOM Volume 24, Edition 4 / Winter 2024