[TJS2-3] Initiating ECMO training program in Thailand
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ライブ配信】
Extracorporeal membrane oxygenator (ECMO) is a mechanical cardiovascular and respiratory support device that is used in patients who suffered from severe cardiovascular and respiratory failure. ELSO guidelines for training and continuing education of ECMO specialists recommend that ECMO center must develop their institution specific guidelines and policies for training ECMO specialists. In the first period, ECMO was done in the intensive care unit (ICU) of cardiovascular and thoracic (CVT) surgery under taking care by cardiac surgeon and perfusionist. After increasing number of ECMO cases, ECMO team has been initiated as an ECMO specialist. Then in-house ECMO training programs have been established for critical care doctor, ICU nurse and others.
First ECMO case in Ramathibodi hospital, one of the ECMO centers in Bangkok, Thailand, is a near drowning pediatric patient occurred in 2003, 15 years ago. Veno-arterial ECMO was used in this patient who was intensive cared in CVT-ICU with the cooperation between cardiovascular surgeon, pediatrician and perfusionist. During the first 10 year, there was only 15 cases. All of them was veno-arterial ECMO cases and pediatric patient or post-operative cardiac surgery. ECMO Survival rate is about 20%. At that time, there was no ECMO training program in Thailand.
In 2013, there was the first ECMO case in pediatric ICU and the first veno-venous ECMO case in the next year, 2014. We recognized the healthcare team who was taking care this patient has inadequate in ECMO knowledge. So ECMO team was established by CVT surgeon, adult and pediatric intensivist, cardiologist, anesthesiologist and perfusionist and ECMO training was developed at the same time.
ECMO training program was divided into two parts, basic and advanced ECMO course. The topics of basic course consists of overview, cannulation, circuit and monitoring equipment, indications and physiology for VV and VA-ECMO, ECMO initiation, basic monitoring and weaning during ECMO and nursing care in ECMO patient. The topics of advanced course consists of management of mechanical ventilation, anticoagulation, renal replacement therapy and drug dosing including complications during ECMO. After in-house training program, ECMO Survival rate is increase from 20% to 56%, as shown in table.
First ECMO case in Ramathibodi hospital, one of the ECMO centers in Bangkok, Thailand, is a near drowning pediatric patient occurred in 2003, 15 years ago. Veno-arterial ECMO was used in this patient who was intensive cared in CVT-ICU with the cooperation between cardiovascular surgeon, pediatrician and perfusionist. During the first 10 year, there was only 15 cases. All of them was veno-arterial ECMO cases and pediatric patient or post-operative cardiac surgery. ECMO Survival rate is about 20%. At that time, there was no ECMO training program in Thailand.
In 2013, there was the first ECMO case in pediatric ICU and the first veno-venous ECMO case in the next year, 2014. We recognized the healthcare team who was taking care this patient has inadequate in ECMO knowledge. So ECMO team was established by CVT surgeon, adult and pediatric intensivist, cardiologist, anesthesiologist and perfusionist and ECMO training was developed at the same time.
ECMO training program was divided into two parts, basic and advanced ECMO course. The topics of basic course consists of overview, cannulation, circuit and monitoring equipment, indications and physiology for VV and VA-ECMO, ECMO initiation, basic monitoring and weaning during ECMO and nursing care in ECMO patient. The topics of advanced course consists of management of mechanical ventilation, anticoagulation, renal replacement therapy and drug dosing including complications during ECMO. After in-house training program, ECMO Survival rate is increase from 20% to 56%, as shown in table.