Page 70 - JSOM Winter 2024

standard deviations (SDs). There were no missing data. The TABLE 1 Demographics of Course Participants
t test was used to assess differences with parametric continuous No. (%) of
data. All tests were two-tailed, and a P value of <.05 was used participants;
to define statistical significance. All tests were performed in n=12
Stata version 17 (StataCorp, College Station, TX) and Graph- Sex
Pad Prism 7.0 for Mac (GraphPad Software, La Jolla, CA). Male 8 (67)
Age, y
Given active duty SOST requirements, 12 qualified partici-
pants were the maximum number that could attend the train- 21–30 1 (8)
ing. A post-hoc power analysis was performed. The study was 31–40 10 (84)
found to be appropriately powered to detect a statistically sig- 41–50 1 (8)
nificant difference between knowledge assessments and self- AFSC
assessments before and after the course. 45S (General Surgeon) 2 (17)
44E (Emergency Physician) 1 (8)
Results 46M/45A (Nurse Anesthetist/Anesthesiologist) 4 (33)
46N (Critical Care Nurse) 2 (17)
Characteristics and Background of Course Participants ED 1 (50)
A total of 12 SOST-qualified personnel completed the course ICU 2 (100)
(Table 1). Most were male (67%) and between 31 and 40 years
of age (84%). All AFSCs were represented. When dividing into 4N (Surgical Technician) 1 (8)
6-person teams, each team had a general surgeon, critical care 4H (Respiratory Therapist) 2 (17)
nurse, and RT. A CRNA or anesthesiologist was used as a sub- Additional AFSC
stitute for emergency physician and ST roles on teams without 48R (Flight Surgeon) 1 (8)
these specialties. Over 50% of SOST personnel had ≥5 years of Total years in practice
clinical experience (counted as after residency completion for <5 5 (42)
physicians). The majority (67%) had been a qualified member ≥5 7 (58)
in SOST for 1–5 years. Four personnel had ECMO clinical ex- Time in current AFSC
posure; however, none had attended any formal ECMO course
or performed an ECMO cannulation. While 33% of SOST <1 year 5 (42)
personnel currently worked in an intensive care unit (ICU), the 1–5 years 5 (42)
majority (75%) had previous ICU clinical experience. Most >5–10 years 2 (17)
personnel had completed at least one advanced trauma or vas- >10 years 0 (0)
cular access/exposure course. Time in SOST
<1 year 0 (0)
Pre- and Post-Course Assessments 1–5 years 8 (67)
A 25-question multiple-choice knowledge assessment was >5–10 years 4 (33)
completed prior to the start of the course on arrival at the STC. >10 years 0 (0)
After didactic training was completed at STC and prior to trav-
eling to Keesler AFB, a post-course knowledge assessment was ECMO clinical exposure
also performed. The mean number of questions correct in each Yes 4 (33)
category increased significantly between assessments (Supple- No 8 (67)
mental Table 2). Total scores also significantly improved (12.5 Currently work in an ICU
vs. 20.6, P<.001) which corresponded to a 64% increase (95% Yes 4 (33)
CI 49%–83%). No participants answered ≥20 questions cor- No 8 (67)
rect on the pre-course knowledge assessment. Nine out of 12 Previous ICU experience
participants (75%) scored 80% or higher on the post-course Yes 9 (75)
knowledge assessment.
No 3 (25)
Training completion
Participants also completed self-assessment surveys prior to
the start of the course on arrival at the STC and again after Advanced trauma life support 9 (75)
testing at Keesler AFB (Figure 2). Ratings were performed on Advanced surgical skills for exposure in trauma 3 (25)
a 5-point Likert scale (5=extremely confident, 3=moderately BEST course (REBOA) 6 (50)
confident, 1=not at all confident). There was a significant in- ELSO ECMO cannulation course 0 (0)
crease after the course in all categories of self-reporting of at Institutional ECMO cannulation course 0 (0)
least moderate confidence (≥3): cognitive (2.8 personnel vs. Other vascular access course 0 (0)
11.3 personnel, P<.001), technical (1.2 personnel vs. 11.6 per- AFSC = Air Force Specialty Code; ECMO = extracorporeal membrane
sonnel, P<.001), and behavioral (2 personnel vs. 12 personnel, oxygenation; ED = emergency department; ICU = intensive care unit;
P<.001). Mean average rated scores for each category also in- SOST = Special Operations Surgical Team.
creased: cognitive (1.8 vs. 4, P<.001), technical (1.4 vs. 4.1,
P<.001), and behavioral (1.6 vs. 4.2, P<.001). with lights on and then in darkness (Table 2). Each team suc-
cessfully completed circuit set-up and priming in each envi-
Validation (Testing) ronment. Time from the start of the scenario to completion of
SOST participants were divided into two teams and completed priming ranged from 13 to 26 minutes, and the fastest time was
testing on cannulation and management of VV ECMO first accomplished in darkness conditions. Each team successfully

68 | JSOM Volume 24, Edition 4 / Winter 2024