November | 2016 | Tomoyuki Endo

I’ve been enthusiastic about providing ECMO simulation for these several years.

In 2013, I created a half-day ECMO sim at Simulation Center of Tohoku University Hospital in Sendai and I’ve been holding this simulation almost every single month for ECMO practitioners.

This is focused on VA-ECMO at Emergency Department. ELSO guideline was used as a reference. In order to make it possible for learners to practice ECMO cannulation and initiation of ECMO, I developed a low cost imitated vascular model named “Endo-Circuit”.

Recently I published a research about the long term efficacy of my ECMO simulation with the “Endo-Circuit” on peer-reviewed journal; “Acute Medicine & Surgery”, doi: 10.1002/ams2.236

My research revealed that many ECMO practitioners in Japan have some sort of PROBLEMS and FEARS about ECMO practice before simulation and then they have gotten some positive change in their knowledge, skills and attitudes after simulation. Since this research was only based on their retrospective self-evaluation, it’s unsure that their actual ECMO practices have been changed and lead to safer management. However some of their answers show that their usage of ultrasound for needle puncture and confirmation of guidewire placement during cannulation increased than before.

Even though the model is less expensive and imperfect in terms of anatomy of cardiovascular system, their evaluation about the circuit as a training model is relatively high. In order to keep quality of ECMO practice, this kind of simulation should be provided constantly.

In addition to my ECMO simulation, Japanese Circulation Society (JCS) and Japanese Resuscitation Council (JRC) had developed a one-day post cardiac arrest syndrome (PCAS) care training course in 2014 including ECMO skill training with “Endo-Circuit” and added an integrated ECPR team simulation in 2016.

Fortunately I got a fantastic opportunity to talk about JCS PCAS care training with my original training model at AHA/JCS Joint Session of Resuscitation Symposium in 2016 in New Orleans.

On Nov 12, I gave a 20-min presentation about our special educational experience including ECPR video for enthusiastic ECMO/ECPR providers attending the session. I had practiced my presentation a lot before the session and indeed my presentation was successful in terms of letting them know our project. There were some respected resuscitation researchers at the session. It was an amazing experience. My counterpart was Dr. David F. Gaieski and he talked about current US status of ECPR implementation and training. There were some hot discussions related to this topic.

On Nov 13-14, I did a ECPR cannulation Demo at JCS Booth in Exhibition Hall. Several attendees enjoyed my training model and some gave me compliments about it. I spent such a fantastic time in New Orleans.

ECPR is always challenging in terms of cost, human resources, time sensitivity, difficulty of cannulation, combination with TTM, uncertainty of heat and neurological recovery etc.

To make ECPR validated, I believe the standardized training including cannulation practice should be held for every advanced resuscitation provider repeatedly like BLS/ACLS.

I want to stay in touch with current enthusiasm about ECMO/ECPR and keep providing decent simulation seminars for practitioners.

It’s been a long time from the last post on this blog site. My blog has been dead for a while. It took about 7 months to come back here.

The main reason of this dead period was due to dysfunction of the World Press Blog system. I could not figure out how to fix it and then I left the problem as it was. Recently my blog has recovered after updating the system to the new version. Ironically the problem seemed to be very simple.

The second reason that my silent period was so long is because of much less free time to write blog. Up until the end of this March, I had been working at Tohoku University Hospital in Sendai City as both an emergency physician and a simulation educator for more than a decade. Sendai is the biggest city in Tohoku (north-east) area, which has more than a million people. And then in this April I have moved to my new workplace, “Tohoku Medical and Pharmaceutical University (TMPU) Hospital” in the same city as only one emergency physician in the hospital. This is a transforming event in my life.

My mission is to establish a completely new emergency center in the current hospital, which had been a relatively small local hospital of about 400 beds with neither emergency room nor emergency physicians and to create a whole new culture about emergency and disaster medicine. This hospital is located very close to the north-east coast of main land hit by gigantic tsunami in 2011.

Here I want to explain about the outline and perspective of this new medical university and hospital in Japan. TMPU is the 81st medical college in Japan, and interestingly enough the period from the last one established in Okinawa to TMPU is 37 years. It’s quite long. Japanese government had stopped to build a new medical school in 1979 because of controlling and limiting the numbers of physicians intentionally.

Despite the government policy, the shortage of physicians has been a big concern around Tohoku area for many years. In addition to this preexisted imbalance of physician resources, the 2011 huge earthquake and Tsunami disaster occurred in Tohoku area made this situation worse. Nowadays physician shortage makes it much more difficult for rural hospitals to hire attending physicians and then some hospitals have to stop clinical practice of some specialties. Not only the shortage of attending physicians in hospitals, but some elderly outpatient-clinic physicians in charge of local medical care are retiring.

Because of the urgent need of getting physicians in Tohoku area, Japanese government eventually decided to establish a brand new medical college in 37 years. TMPU encourages new medical students to being physicians dedicated to Tohoku area in the future. That means physicians of TMPU should also commit themselves to teaching and coaching them and being role models of them.

That’s the story of my new workplace. Because medical education, especially simulation about emergency medicine has been my favorite field for many years, I’m very excited about this new mission.

Since I’m only one emergency physician this year, I have to do bunch of stuff every day. Even worse, our hospital has few residents, therefore I’m in charge of almost of all small stuff. On the other hand, several general physicians and a nurse practitioner help me deal with emergency patients and caring admitted patients. I can’t thank them enough. I really appreciate their contribution to our emergency center.

Next year one more well-trained emergency physician will come to my hospital. That will make things much better.

In order to make our emergency center team much stronger, I create the code for our team. I’m really excited about developing super positive team.

Our Code

1．We Do The Best We Can

2．We Always Learn, Grow and Share Our Mind

3．We Stay Positive and Don’t Allow Negativity