Search

During the SARS-CoV-2 pandemic, many challenges were faced in the global healthcare system, one of which was the lack of competent professionals to implement therapies such as extracorporeal membrane oxygenation (ECMO), which proved to be lifesaving during the H1N1 virus infection. In response to this need, this project aimed to determine the characteristics of a blended training process to contribute to the development of competencies in the management of ECMO therapy and to understand the perception of participants regarding this training process as a suitable strategy for competency development. A mixed design with a descriptive scope based on design-based research was used. The main results indicated that the designed learning environment was suitable for competency development in ECMO therapy management, as well as the importance of including high-quality simulation scenarios in the development of skills for managing this type of therapy. However, the most significant impact was observed in the development of competencies and skills of the participating healthcare professionals through the process of feedback. [ABSTRACT FROM AUTHOR]

This study aimed to develop the Perfusionists' Intraoperative Non-Technical Skills tool, specifically to the perfusionists' context, and test its inter-rater reliability. An expert panel was convened to review existing surgical nontechnical skills taxonomies and develop the Perfusionists' Intraoperative Non-Technical Skills tool. During a workshop held at a national meeting, perfusionists completed the Perfusionists' Intraoperative Non-Technical Skills ratings after watching 4 videos displaying simulated cardiac operations. Two videos showed "good performance," and 2 videos showed "poor performance." Inter-rater reliability analysis was performed and intraclass correlation coefficient was reported. The final version of the Perfusionists' Intraoperative Non-Technical Skills taxonomy contains 4 behavioral categories (decision making, situation awareness, task management and leadership, teamwork and communication) with 4 behavioral elements each. Categories and elements are rated using an 8-point Likert scale ranging from 0.5 to 4.0. A total of 60 perfusionist raters were included and the comparison between rating distribution on "poor performance" and "good performance" videos yielded a statistically significant difference between groups, with a P value less than.001. A similar difference was found in all behavioral categories and elements. Reliability analysis showed moderate inter-rater reliability across overall ratings (intraclass correlation coefficient, 0.735; 95% confidence interval, 0.674-0.796; P <.001). Similar inter-rater reliability was found when raters were stratified by experience level. The Perfusionists' Intraoperative Non-Technical Skills tool presented moderate inter-rater reliability among perfusionists with varied levels of experience. This tool can be used to train and assess perfusionists in relevant nontechnical skills, with the potential to enhance safety and improve surgical outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract: The success of cardiac surgery is the result of revolutionary thinking by those who were unafraid to take risks in the 1950s, when cardiopulmonary bypass was in its infancy. The development of the heart–lung machine has moved a long way from the cumbersome screen oxygenator to today''s modern disposable hollow-fibre units. Perfusionists are one part of a team of highly skilled professionals dedicated to delivering the best quality care. Perfusion science is going through a number of changes, many of which are focused on receiving recognition from the Health Professions Council. Hospitals can enact local policies enabling perfusionists under the supervision of consultants to administer drugs on bypass. Regulation of parameters on cardiopulmonary bypass remains controversial. Best practice is still evolving with regard to perfusion pressure, pump flow, temperature management and central nervous system monitoring. Most coronary artery bypass surgery is now performed at normothermia or mild hypothermia, making the argument for α-stat or pH-stat blood gas management less critical. Indeed, if the patient has intact cerebral autoregulation (not routinely tested preoperatively), neither pump flow nor pressure influences cerebral blood flow over that autoregulatory range. [Copyright &y& Elsevier]

Summary: Tradition and experience of cardiopulmonary bypass in the hand of cardiac surgeons led to several spin-offs of this extracorporeal technique. Acute organ support is realized for situations of failing cardiac output, circulatory arrest respectively, of pulmonary failure and of drowning. Extracorporeal circulation is a promising adjunct to aim in better surgical technique and treatment in neurosurgery, thoracic aortic surgery, complex lung resection, tumor surgery and procedures where safe organ perfusion must be ascertained. Chemotherapy and hyperthermia in limb carcinoma is highly successful if performed with the help of extracorporeal circulation. Progression in transcutaneous cannulation technique makes application of machinery easy and from operation facilities independent. Replacement of long lasting periods of chest compression for heart massage is a future perspective if circulation is maintained by transcutaneously adapted miniaturized heart–lung-machine. Long lasting traumatizing mechanical ventilation of a severely diseased lung maybe replaced by extracorporeal lung assistance to give better chances for the lung to recover. Thoughts for these new interdisciplinary duties of cardio surgical units were discussed in the committee for the Symposium for the Future of Cardiac Surgery. [Copyright &y& Elsevier]