Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) is an internationally recognised treatment for refractory cardiac arrest, with evidence of improved outcomes in selected patient groups from cohort studies and case series. In order to establish the clinical need for an in-hospital extracorporeal cardiopulmonary resuscitation service at a tertiary cardiac centre, we analysed the inpatient cardiac arrest database for the previous 12 months. Methods Evidence-based inclusion criteria were used to retrospectively identify the number of patients potentially eligible for extracorporeal cardiopulmonary resuscitation over a 12-month period. Results A total of 261 inpatient cardiac arrests were analysed with 21 potential extracorporeal cardiopulmonary resuscitation candidates meeting the inclusion criteria (1.75 patients per month, or 8% of inpatient cardiac arrests (21/261)). The majority (71%) of these cardiac arrests occurred outside of normal working hours. Survival-to-discharge within this sub-group with conventional cardiopulmonary resuscitation was 19% (4/21). Conclusion Sufficient numbers of refractory inpatient cardiac arrests occur to justify an extracorporeal cardiopulmonary resuscitation service, but a 24-h on-site extracorporeal membrane oxygenation team presents a significant financial and logistical challenge.
In 2007, the acute care common stem pathway changed the delivery of acute specialty training. Acute care common stem is the core training programme for all emergency medicine trainees, 46% of anaesthetic trainees and a cohort of acute medicine trainees with more than 630 places nationally, the third highest of any core training programme. In their first 2 years of core training (CT1–2), trainees rotate through 6-month rotations in emergency medicine, acute medicine, anaesthetics and intensive care to gain core competencies in the assessment and management of acutely unwell patients, before completing 1 year (CT3) in their parent specialty. Acute care common stem trainees benefit from undertaking rotations in allied acute specialties, which is invaluable when treating complex and comorbid patients in an ageing population. Acute care common stem gives trainees core skills in management of acutely unwell patients, which can be built upon in higher specialty training.
Introduction: Changing expectations in the accessibility of medical education and concomitant increases in inclusion of technology have led to demand for novel content delivery methods in medical education. Classical paradigms of educational preference based on geographical accessibility are gradually being replaced in a progressively online and connected environment by learners' preference for convenience, with selection between educational options becoming increasingly based on the quality of the content, and not necessarily its physical proximity. Livestreaming a medical education programme presents a new set of technical, logistical, and ethical considerations. Cambridge University Pre-Hospital Care Programme delivers a regional academic Pre-Hospital Emergency Medicine (PHEM) teaching programme mapped to the GMC recognised sub-specialty of the national PHEM curriculum and this programme has begun to stream the programme's monthly forums. We describe a literature review on livestreaming in medical education, a summary of our results with livestreaming, and recommendations for organisations interested in similar expansion.
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