Project 1: Surgical Airway Training
Project Lead: Aaron Joffe, MD
Associate Professor, Anesthesiology and Pain Medicine/Critical Care
The cannot intubate, cannot oxygenate (CICO) clinical scenario is an infrequent, but life-threatening emergency, which may occur any time tracheal intubation is required. The most appropriate management of the patient’s airway when this occurs is the rapid placement of a surgical airway (cricothyrotomy or tracheotomy). Whether it occurs within the operating room (OR) or in a non-OR location such as the emergency department or intensive care unit, it remains a low-frequency high-impact event. Data from the American Society of Anesthesiologists (ASA) closed claims database as well as international airway management registries have reported almost universally catastrophic patient outcomes (death or severe brain damage) when a surgical airway is needed and either delayed or not successfully performed. Skills, which are needed in such rare circumstance cannot be taught/attained during routine training and thus must be supplemented using skills trainers and clinical simulation. Currently available molded plastic surgical airway task trainers do not adequately mimic real tissue and the continued reliance on stand alone task trainers does not allow realistic skill attainment and ability to achieve ongoing competence. The Surgical Airway Training Project supported by WISH will aim to develop anatomically correct, inexpensive, modular, and reusable tabletop models utilizing 3-D printing technology in collaboration with the University of Washington’s Center for Research in Education and Simulation Technologies (CREST). The models will highlight CREST’s knowledge in bio realistic tissue engineering, and the ability to print multi-layer realistic “skin” incorporating layers of skin, fat, subcutaneous tissue, and blood packets to be used as a covering for the models. In this way, the look and feel of the model should closely resemble a human patient.
The project will transform current training for practitioners who are largely responsible for airway management throughout the UW Medicine System, primarily Anesthesiologists, Emergency Medicine, and Critical Care Physicians. Trainees will be tested on their ability to recognize and appropriately manage a CICO situation by performing a surgical airway utilizing the new bio realistic models in formal clinical simulation.
Project 2: corECMO
Project Lead: Jenelle Badulak, MD
Acting Assistant Professor, Emergency Medicine and Critical Care
Extracorporeal life support (ECLS), also called Extracorporeal Membrane Oxygenation (ECMO), is an advanced form of life support that enables bypass of the heart and lungs in settings of severe cardiogenic shock or severe respiratory failure. ECLS has long been used with success in pediatric and neonatal intensive care units, and due to technological advancements, the use of ECLS in adult ICUs has rapidly expanded in recent years. The increase in use heralds an increased need for education.
ELSO guidelines recommend that “Each ECMO center should have a well-defined program for ECMO physician and staff training, certification, and re-certification. This program should include: didactic lectures, laboratory training with the ECMO equipment, bedside training, and a defined system for testing proficiency of the team members.” Despite this recommendation, anecdotal evidence suggests high variability of curricula and educational materials available. Locally available, institutionally-based curricula depend largely on the historical ECLS experience of the institution. While multi-day intensive courses are comprehensive, they are also costly and time-consuming, pulling providers away from patient care. Podcasts and blogs are available online, which contain educational content, but none contain a comprehensive curriculum.
As the University of Washington (UW) Medical Center and Harborview Medical Center expand their ECLS programs, the need for enhanced education of physicians, nurses, respiratory therapists and perfusionists is apparent. The vision for ECLS training will encompass three main components: 1) web-based didactic curriculum, 2) in-person high fidelity simulation, and 3) bedside clinical care of patients. Given scheduling time constraints, in-person didactic education for all healthcare personnel is extremely challenging, thus web-based educational tools, which are currently unavailable, are an attractive alternative, especially when combined, with hands-on simulation based training opportunities. Web-based education, which can be quickly referenced at the bedside, is also a pragmatic solution for on-the-job learning. To meet this need, we have created a hybrid web-based curriculum entitled corECMO, which is complemented by hands-on practice using simulation.
WISH support allows the corECMO program to continue development of an innovative hybrid-training model, which supplements on-line content delivery with hands-on experiential training via simulation.