Ex-vivo Lung Perfusion (EVLP110)

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Ex-vivo Lung Perfusion (EVLP110)

Ex-vivo Lung Perfusion (EVLP110):
at a glance

Credential(s) Earned: Micro-credential

Program Length: 8 Weeks Full-Time (40 hours per week)

Start Date: October 16, 2023

Tuition: Provided upon request, contact ce@michener.ca

Program Code: EVLP110

Description

Ex-vivo lung perfusion (EVLP110) is a novel technique invented at the University Health Network by a team led by Dr. Shaf Keshavjee and Dr. Marcelo Cypel. This approach to lung perfusion has revolutionized organ transplantation. As the procedure becomes more mainstream in complex surgical facilities, the need to build capacity in the health care system to provide care in this way is increasingly important. Led by an expert faculty of international recognition, the Michener Institute of Education at UHN is excited to partner with UHN and members of the University of Toronto Department of Surgery to host this first-of-its kind course.

This EVLP Course is comprised of classroom-based and online lectures, research and simulation labs, rounds, case reviews, observation in operating rooms, and hands-on surgical skills sessions. Each week builds upon the other as the faculty present case scenarios that increase in complexity. Participants will engage in a comprehensive learning experience that integrates gaining highly specialized knowledge with practical application in high fidelity simulation environments. Trainees will complete the course having gained in-depth knowledge of the scientific foundations of EVLP, lung transplant operational procedures (donor selection, management of lung recipients), and treatment protocol (including assessment of lungs, EVLP circuits, and troubleshooting).

In the hands-on skills lab, participants will have the opportunity to practice the set up and running of an EVLP circuit and troubleshooting common and complex issues that arise. This will take place in small groups under the guidance and direction of faculty from the University of Toronto Department of Surgery that specialize in thoracic transplantation. Participants will additionally have the opportunity to gain hands-on experience in research labs. Each station will have an assigned instructor to provide dedicated skills development feedback along with insights into a variety of tips to ensure successful outcomes. The hands-on skills lab sessions will be hosted at Michener’s new Temerty Centre for Advanced Surgical Education and Simulation.

Objectives/Outcomes

At the end of this comprehensive course, participants will be able to:

  • Understand the process of selection of donor lungs
  • Understand the technique of donor lung retrieval and the potential surgical complications impacting a successful lung transplant
  • Assess a donor lung and set it up on an EVLP circuit ensuring proper techniques are employed while troubleshooting issues during perfusion
  • Understand the clinical reasoning and assessment criteria behind the selection of a recipient
  • Apply clinical/surgical knowledge and technical skills in the planning, set-up and running of an EVLP circuit
  • Address both expected and unexpected challenges in setting up an EVLP circuit and running a perfusion

Outline & Format

The course is designed as an intensive and immersive experience over eight (8) weeks.

Each of the 8 weeks has 40 hours of programming that generally runs Monday to Friday from 8:00am – 5:00pm. It is important to note that participants will be on call at varying times to maximize opportunities to observe live cases. Flexibility will be required to adapt to scheduling changes. Participants may be required to attend the hospital at night and/or on a weekend. This is integral to the learning experience. The research lab also runs EVLP experiments during the week and participants will be given blocks to rotate through different experiments involving EVLP during this time.

Every week the participants will be attending didactic lectures, given by a staff faculty, a case review session, research lab meetings, OR observation, hands-on skills lab, recipient selection meetings, donor rounds, and clinical EVLP meetings.

Intimate and Focused Learning Experience

The course will run as intentionally small cohorts to ensure learners have highly focused access to the course faculty. There will be a maximum of four (4) participants per offering, and will run with a minimum of two (2).

Week Objectives
Week 1:
Clinical Foundations of EVLP
  • Understand the rationale for EVLP
  • Review the different EVLP protocols
  • Review the steps of EVLP Technique including cannulation, initiation and ramp up of EVLP
  • Review the current evaluation method used by the Toronto team
  • Review the Toronto EVLP experience (over 700 EVLP) including the potential pitfalls during EVLP and how to solve them during setup and while running the EVLP
Week 2:
Management of the Donors
  • Review donor selection criteria (standard vs extended criteria), types of donors (brain dead vs different types of donors after cardiac dead)
  • Understand the donor management during the pre-surgical phase
  • Review the steps for a successful donor surgery and the potential complications during the surgical phase
  • Review the lung preservation technique used by The Toronto Lung Transplant Program
Week 3:
Management of the Recipient
  • Review recipient eligibly criteria and decision making regarding sizing, volume reduction and lobar transplant
  • Review intraoperative management of the allograft, the use of bypass vs extra corporeal membrane oxygenator
  • Review the steps for a successful lung transplant surgery and the potential complications during the surgical phase
  • Review the early complications (Ischemia reperfusion injury, primary graft dysfunction) and late complications (airway complications) and the Toronto experience
Week 4:
Assessment of Lungs on EVLP
  • Assess a lung on EVLP and understand the suitability of the lung for transplant
  • Perform and understand bronchoscopy, gas analysis, venous sample collection, data collection and reporting them to the transplant team
Week 5:
History, Present & Future of EVLP
  • Review the history, present and future of EVLP treatments
  • Review the potential for extended EVLP
  • Review the use of lobar EVLP for treatments and potentially transplants
  • Review the use of biomarkers during ex vivo lung perfusion (Assessment of the Inclusion of Biomarker Scoring in EVLP Decision-Making)
Week 6:
Case Reviews
  • Appreciate the practical and complex applications of EVLP as assessment and treatment platform
Week 7:
Formative Assessment Week
  • Participate in mock assessment/exam with faculty supervision the learner knowledge of all EVLP course content
  • Demonstrate key EVLP skills, techniques, and clinical application
  • Identify and respond to challenges while running of an EVLP circuit
Week 8:
Summative Assessment week 
  • Participate in final assessment, performing set up, management, monitoring and troubleshooting of an EVLP circuit independently

Who Is This Program Intended For?

Health care professionals with previous education and/or work experience in any of the following: (as evidenced by submission of CV/resume):

  • Medicine
  • Nursing
  • Perfusion
  • Respiratory Therapy

 

Course Dates

Dates ( 2 sections scheduled)

Cohort 1 Start date: October 16, 2023-December 8, 2023

Cohort 2 Start date: January 15, 2024- March 8, 2024

  • This is an 8-week, full-time course.
  • Programming is delivered Monday to Friday from 8:00am – 5:00pm EST.
  • There will be flexibility in the program schedule to accommodate varying hours for on-call cases.

Confirmed Faculty

This course at Michener is led by internationally recognized faculty and experts in the practice and administration of EVLP.

Program Chairs

Andrea Mariscal, MD, PhD
Hemant Gokhale, MD

Course Faculty

Shaf Keshavjee, MD, MSc, FRCSC, FACS
Thomas Waddell, MSc, PhD, MD, FRCSC
Marcelo Cypel, MD, MSc, FRCSC, FACS
Laura Donahoe, MD, MSc, FRCSC

Please review the Course Program for full faculty bios.

Application

For those applying to the EVLP Course at Michener, please complete the following steps:

  1. Complete a profile on Michener Self-Service Portal
  2. Upload a resume and cover letter outlining your relevant experience.
  3. Documentation must be completed by – date to be determined.

Admissions Requirements

Participants in the EVLP Course at Michener must meet one of the following professional criteria.

  • You must be a health care professional with previous education and/or work experience in any of the following areas
    • Medicine
    • Nursing
    • Perfusion
    • Respiratory Therapy; AND
  • A minimum of two years of current patient care experience* in your profession; AND
  • Computer literacy
    • Students must have access to a computer that meets the minimum system requirements, access to the Internet, and an e-mail account
    • Access to and basic proficiency with a PDF reader, Microsoft Word, and Microsoft PowerPoint are also required as they are used to access course material and submit evaluation items