Vanessa Moll

Rapid Development and Implementation of an ECMO Program

Extracorporeal membrane oxygenation (ECMO) is an established therapy in the management of patients with refractory cardiogenic shock or acute respiratory failure. In this report, we describe the rapid development and implementation of an organized ECMO program at a facility that previously provided ad hoc support. The program provides care for patients within the Emory Healthcare system and throughout the Southeastern United States. From September 2014 to February 2015, 16 patients were treated with either venovenous or venoarterial ECMO with a survival to decannulation of 53.3% and survival to intensive care unit discharge of 40%. Of the 16 patients, 10 were transfers from outside facilities of which 2 were remotely cannulated and initiated on ECMO support by our ECMO transport team. Complications included intracerebral hemorrhage, bleeding from other sites, and limb ischemia. The results suggest that a rapidly developed ECMO program can provide safe transport services and provide outcomes similar to those in the existing literature. Key components appear to be an institutional commitment, a physician champion, multidisciplinary leadership, and organized training. Further study is required to determine whether outcomes will continue to improve.

Highly visible sepsis publications from 2012 to 2017: Analysis and comparison of altmetrics and bibliometrics

Purpose: We sought to delineate highly visible publications related to sepsis. Within these subsets, elements of altmetrics performance, including mentions on Twitter, and the correlation between altmetrics and conventional citation counts were ascertained. Materials and Methods: Three subsets of sepsis publications from 2012 to 2017 were synthesized by the overall Altmetric.com attention score, number of mentions by unique Twitter users, and conventional citation counts. For these subsets, geolocated Twitter activity was plotted on a choropleth, the lag between publication date and altmetrics mentions was characterized, and correlations were examined between altmetrics performance and normalized conventional citation counts. Results: Of 57,152 PubMed query results, Altmetric.com data was available for 28,344 (49.6%). The top 50 publications by Altmetric.com attention score and Twitter attention represented a mix of original research and other types of work, garnering attention from Twitter users in 143 countries that was highly contemporaneous with publication. Altmetrics performance and conventional citation counts were poorly correlated. Conclusions: While unreliable to gauge impact or future citation potential, altmetrics may be valuable for parties who wish to detect and drive public awareness of research findings and may enable researchers to dynamically explore the reach of their work in novel dimensions.

837: IMPROVING CARE OF CRITICALLY ILL CARDIAC SURGERY PATIENTS AND FAMILIES WITH PREOPERATIVE EDUCATION

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: The role of the patient’s family is increasingly recognized in the ICU as reflected by recent practice guidelines Up to 50% of family members experience anxiety and depression during and after critical illness of their loved one. Communication between clinicians and patients/families has been associated with these symptoms. Studies outside the ICU have shown that family support may improve patient outcomes by facilitating the family to be more effective caregivers. Our group is one of 63 ICU teams nationally that are participating in the Patient-Centered Outcomes Research Initiative (PCORI) ICU Collaborative. Here, we describe the implementation and outcomes of preoperative education for patients and families in the cardiothoracic intensive care unit. Methods: We performed initial surveys targeting clinicians and patient’s families to establish a baseline of family satisfaction, gather areas for improvements and identify perceived roadblocks for changes (clinicians). Post ICU surveys targeting clinicians and patient’s families were initiated 7 months after project started. The following action points were identified to elevate education and patient/family’s experience: 1. Development of a “preoperative teaching script” 2. Identify preoperative patients 3. Daily staff assignment for teaching 4. Patient education logbook 5. Development of a hospital specific education booklet capturing the patient’s journey Results: Initial surveys showed that Patients/families were unaware of: Educational materials in languages other than English, supporting services such as access to a chapel, availability of snacks 24/7, kitchen or laundry facilities Clinician Surveys revealed perceived challenges to implementation: staffing, clinician time. Opportunities revealed that clinicians were not aware of all patient/family centered care practices available. Initially 25% of elective cardiac surgery patients received preoperative teaching; with an increase to above 80% by May. Follow up surveys show increased clinician satisfaction and buy in with preoperative patient teaching. Conclusions: Patient/family centered care requires a well working collaborative team. It is clear that we had to assign staff to education to establish accountability. Staffing was identified as a major obstacle. Patient/family centered care necessitates a culture change. Families need to be embraced as allies in the care of loved ones rather than obstacles while ensuring that clinician work load remains balanced.

Distributed Learning: Revitalizing Anesthesiology Training in Resource-Limited Ethiopia

Background Ethiopia has a significant paucity of available health-care workers. Despite the increasing number of medical schools, there are not enough physician instructors. Furthermore, availability and standardization of postgraduate training are lacking. Modalities of e-learning have been shown to be successful when used to impart medical education in other resource-limited countries. The Emory University and Addis Ababa University (AAU) Departments of Anesthesiology have formed a collaboration with the intent of improving the AAU Anesthesiology residency program, one of two postgraduate training programs for anesthesiology in Ethiopia. Methods An initial educational needs assessment identified areas in the existing training program that required improvement. In this pilot study, we describe how the current classroom-based curriculum is augmented by the introduction of interactive educational sessions and distributed learning in the form of video lectures. Video lectures covered topics based on areas identified by Ethiopian residents and faculty. Interactive sessions included hands-on ultrasound workshops and epidural placement practicums, a journal club, problem-based learning sessions, and a mock code simulation. Assessment of the additions of the newly introduced blended learning technique was conducted via pre- and posttests on the topics presented. Results Pre- to posttest score averages increased from 54.5% to 83.6%. Conclusion An expansion of educational resources and modes of didactics are needed to fill the gaps that exist in Ethiopian anesthesiology training. Incorporating distributed learning into the existing didactic structure may lead to more efficacious instruction resulting in a higher retention rate of information.

Antipsychotic-Induced Neuroleptic Malignant Syndrome After Cardiac Surgery.

We report a case of neuroleptic malignant syndrome (NMS) in a postoperative cardiac surgery patient after the administration of typical and atypical antipsychotics for the treatment of delirium. On postoperative day 8, the patients temperature peaked at 40.6°C. Agitation, rigidity, elevation in creatine kinase, and leukocytosis were associated findings. NMS was suspected on postoperative day 10. All antipsychotics were discontinued; dantrolene infusions and fluid therapy were initiated. After 2 days of NMS treatment, the patients symptoms resolved. The temporal relationship between discontinuation of all antipsychotics, initiation of dantrolene, and clinical improvement supports the diagnosis of antipsychotic-induced NMS.