Maggie Savelberg's blog

There is an education link now that some may find interesting. If others have presentations, articles etc., that may be of interest to students, or fellow clinicians it would be greatly appreciated if you would share by posting them!

If you click on "Education" in the top blue bar, and then scroll down on that page you will find a sub-page on presentations, clinical tools, and research.

There is also room for questions, comments and suggestions for readings if you have ideas for further developing these topics.

Thanks as always,

Maggie

Hi Everyone,

While it is hard to sometimes keep up-to-date, I thought I would post a few excerpts from the latest Michener News Magazine. Being supportive of the upcoming students, to me, also means being aware of the advancements taking place at the institution from which they come. So here are a few tidbits.

"Building Knowledge, Relationships and Awareness"; page 15 of the Holiday 2009 Edition 

"Michener was well represented at the Association for Medical Education in Europe (AMEE) Annual Conference , August 29-September 2, 2009, Malaga, Spain. Dr. Paul Gamble, President and CEO; Dr. Karim Bandali; Associate Vice President, Business Development; and Brad Niblett, Chief Information Officer delivered two presentations. The first was titled "A Revolutionary Alliance Between Aviation and Medical Simulation: Working Towards Creating an International Standard in Health Simulation", K. S. Bandali, G Herve, P. Gamble, and A Ziv. The second was "Politics Meets Medicine:Electronic Magic Board Revolutionizes Healthcare Education", B. Niblett, J. Robertson, P. Gamble, J. Verbovszky and K Bandali.

"Building Knowledge, Relationships and Awareness"; page 12 of the Michener News Fall 2009

.... Dr K. Bandali, Associate Vice President, Business Devleopment and Chair, Cardiovascular Perfusion, was invited to speak at a few conferences over the last months. At the International Consortium for Evidence Based Perfusion, held in New Orleans, Louisiana,  June 24-27, 2009 Karim gave two presentations titled "Using Simulation-Based Education for Incident Prevention" and "Simulation-Based Education and Continuous Improvement Process." AmSECT's Perfusion Safety/Best Practices 2009 Meeting marks a unique union in perfusion that combines the evolution of perfusion safety through simulation training and the translation of the evidence surrounding perfusion to the clinician. He also spoke at a special meeting at the Mayo Clinic in Rochester, N.Y., in the spring of 2009; his talk focused on "Inspiring Innovation and Collaboration Through Healthcare Simulation".

Here are a few photos from the CSCP AGM 2009 in Edmonton.

Click here to see the photos

Although it is important to collect all of the inventory data available I am going to throw out the idea, that it may be equally important to have some form/attempt at planning in preparation of an H1N1 pandemic. As perfusionists, we bring not only to the table our skilled abilities in ECMO specialists, but also our expertise in the field (well the majority of you moreso than myself, as a new graduate, but nonetheless..) and as such, to participate in the brainstorming of issues surrounding the provision of ECMO to a large number of people is something I would think we are somewhat responsible for. I may be wrong and there are others which are already taking this all into account. But as a society, I feel that it still may be fun and informative and somewhat necessary to think about some of these things. Here are some things that came to mind:

1. Adequate Blood Products:

a) The ability of Canadian Blood Services to keep up with the demands of 2-8% (quoted from Perflist posting) of hospitalized H1N1 patients being on ECMO?
b) ECMO is resource intensive. Should an estimated hospital cost per potential ECMO case be determined to eitheri) request appropriate funding or ii) address adequacy of proposed government funding?
b) Will there be enough blood for other services, i.e. ortho? How will that be prioritized?

2. Indications for H1N1 Requiring ECMO:

a) In order to aid in the prioritization and best utilization of limited ECMO products, staffing over an underdetermined period of time, precise indications for the use of ECMO in H1N1 patients should be outlined.
This would require a committee of surgeons, anesthetists, intensivists, nurses, and perfusionists. ECMO is a method of support and not a treatment. Specific guidelines do need to be set in order that the most severely ill subset of patients with novel influenza A virus (H1N1) be treated with the most advanced methods of care. How do we identify those which are high risk and may require ECMO?

i. The Center for Disease Control and Prevention (CDC) had an article posted on the use of ECMO on novel A H1N1 patients. This article and other cases need to be evaluated and indications for ECMO outlined.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0710a1.htm

ii. Is there a role for ICEBP (International Consortium for Evidence Based Perfusion).
On the ICEBP website it says “The ICEBP has chosen to focus its efforts on systematically reviewing the literature pertinent to our profession.” Is there already evidence based literature being collected and reviewed on this topic that we may be privy to?
- I believe Dwayne Jones is the liason between the ICEBP and the CSCP. Is there such project?

b) Should a committee at the National level be formed to address preparation issues, has this already been formed?

i. In a posting by one American nurse on http://allnurses.com/pandemic-flu-forum/ecmo-will-we-410682-page2.html they suggest that in their estimation 200-300 ECMO services will be able to be provided at any given time spread across the USA in the case of an H1N1 flu pandemic.

ii. Can we or will we be expected to provide a similar number to the Canadian/Ontario government? This would be necessary in order to evaluate required funding.

3. Reporting:

a) In order to monitor, at a provincial level, the number of ECMO services being provided for H1N1 should there not be a registry of some sort?
a) Allows for better resource management (have resources where they need to be).

b) Anticipate rate at which resources are being used, to make projections as to how long provincial inventory will last?

c) Should an international registry such as ELSO (Extracorporeal Life Support Organization) be our medium for reporting? So that we are participating at all levels in helping to monitor, track and project health, economic, etc., effects of H1N1. See link below: http://www.elso.med.umich.edu/Default.htm

d) Should we be reporting inter-hospital ECMO product transfers? In order to monitor effectiveness of the OHPIP on OSCP site?

4. Centralization of ECMO Services:

a) Possible centralization of ECMO services to specific hospital sites in Ontario was mentioned by Patrick Weighell as a notion floating about, as a method of dealing the an overwhelming need for resources, skill, ICU/CVISU/CSU staff etc.

- Again would have to deal with the transfer of products and the liability thereof potentially.

- Would there be an assembly of those perfusionists more familiar and proficient in ECMO services, transport, and management at these centers? How would these perfusionists be covered if their services were required at another hospital? How long would that process take in the respective HR departments, especially with additional or extra staff not at work?

H1N1 Product Inventory Project (OHPIP) Update #1: Sept 22, 2009

1.At the 2009 OSCP AGM it was suggested that a collective product inventory be established.
This inventory has been launched for about one week now, by Andrew Zajac, and as previously
posted can be found under the tab [OHPIP].

2.All Ontario perfusion department leaders were contacted through email and were invited to participate.
To date, three sites (Trillium Health Centre, London Health Sciences Centre, and Kingston General Hospital)
have posted their ECMO related product inventory. Thank you to all who have posted so quickly!

3.Updates were to be provided as progress was made through the OSCP website. So we are updating. :)

4.Suggestions, recommendations and alterations are still welcomed and encouraged, however none have been
received to date. But that is alright. They say no news is good news right?

Please feel free to make comments.

Dear All,

In lieu of our discussions surrounding the potential H1N1 pandemic and in trying to discern the role ECMO may play in treating these patients I thought the following article I spotted last week may be of some interest.

Peek and colleagues, published Sept 16, 2009 in The Lancet, a report on a multicenter randomized controlled trial (RCT) involving 180 patients (90 assigned to ECMO, and 90 to receive ventilatory support). The comparison looked at the efficacy and economic differences between treating patients with either method. In short, they were able to conclude that for patients with severe but potentially reversible respiratory failure, with a Murray score of 3.0 and a pH of less than 7.20 that transfer to ECMO would allow for improved survival without disability.

This study will become increasingly important as the physician's need to support costly decisions in transfering patients to ECMO, will need evidence-based literature to gain the required financial aid of the government. 

Another article for the desktop! :)

At the OSCP AGM meeting this past weekend, September 11-12th, 2009, a discussion surrounding the possible implications of an H1N1 pandemic, on provincial wide perfusion departments, was brought to the members' attention by Jim’s presentation.

Questions of government funding, steps for preparation by perfusion, problems of resource attainment, and potential staffing issues were brought up by members from the floor and ideas were shared. One concluding recommendation from this discussion was that an H1N1 web based product inventory be set up through the OSCP website. Cyril Serrick suggested that while we are unable to plan for additional stocking at this point, that at least perfusion departments across the province should be able to share the status of their current stock necessary to be able to provide ECMO service to our patients. Steve Ditmore proposed that an online inventory through the OSCP site would eliminate the need for one individual person to check in and update site specific stock numbers. I think this would be a great idea, and furthermore would allow for real-time updates as stock numbers can be changed by hospital sites themselves. In these potential pandemic scenarios, fewer paths of second hand information save not only time, but also translate into more accurate data shared.

I have spoken to my colleague here at KGH, Andy Zajac, who is our OSCP website engine maintainer regarding this idea. He is willing to work on setting up a section of the website on which individual hospital sites are able to log on, maintain and edit their own ECMO product/disposable inventory. Andy will keep us updated as to the steps required to access this page, how to enter the inventory and so on. (See tab at top of page - OHPIP) This will hopefully allow Ontario perfusionists to be able to report our collective ability to provide this service to all Ontario patients requiring ECMO for H1N1, as well as to act as a networked resource for one another, to aid all Ontario perfusion departments, in meeting their commitment for ECMO services.

Anyone with additional ideas, or suggestions as to how this should be done or alterations to the OSCP H1N1 product inventory (OHPIP) project, please feel free to give them! In order to have a starting point prior to funding, stocking and preparation discussions we should aim to invite all department managers and have all inventories submitted to the OHPIP by a specified date. This will depend on the ease of set-up on the OSCP site, but should not be long. If anyone has a deadline to suggest, please let us know.

Thank you so much for opening this important discussion Jim, and to Andy for looking into making this happen. We will all keep in touch with regular updates.

OSCP H1N1 Product Inventory Project (OHPIP) Summary:

1.At the 2009 OSCP AGM it was suggested that a collective product inventory be established.
2.For ease of access, real-time updates, accuracy a web-based inventory was recommended.
3.Andy Zajac our OSCP web engine maintainer is working on the design and implementation of this inventory project.
4.All Ontario perfusion department leaders will be contacted/emailed and invited to participate, and a deadline to submit all numbers determined.
5.Updates will be provided as progress is made through the OSCP website.
6.Suggestions, recommendations and alterations are welcomed and encouraged, this is only a start. :)

In the spirit of collegiality and communication I thought it may be nice to post some of the photos taken at this year's (2009) OSCP AGM and Scientific Sessions. If only to point out our silly pictures, and bad hair - they are up. :)

To view the 2009 OSCP AGM and Scientific Session photographs please follow the link provided below, or follow the AGM link in the top screen bar.

http://www.oscp.ca/image

Good Afternoon!

Today I came across a meeting being held in Ottawa this upcoming weekend, June 4-7th, 2009 - for all of those involved in health care practice that are responsible or have been delegated the act of blood product transfusion. It is called the Canadian Society for Transfusion Medicine 2009 Meeting. I have attached the program for those of you that are interested. The topic of blood conservation, as well as adverse reactions, a talk on "Cardiac Disease, Hematopoiesis and Autoimmune Diseases", recent trials, special patients i.e. sickle cell anemia, ethics of transfusion, and the basic science of the "red cell age". I am unfortunately unable to make it, however thought it may be of interest to some.

I have also posted a recent publication (Jan 2009) by the CBS which discusses the manor in which blood products are to be visually examined. I was not aware previously that there was a "specific method" and explanations for abnormalities we should be looking for, and was happy to come across this. There are a lot of good pictures which accompany the booklet.

Hope everyone is enjoying the sunshine!

Maggie