Simulation training for extracorporeal membrane oxygenation

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a complex treatment. Despite this, there are a lack of training programs designed to develop relevant clinical and nonclinical skills required for ECMO specialists. The aim of the current study was to describe the design, implementation and evaluation of a 1-day simulation course for delivering training in ECMO. Methods: A 1-day simulation course was developed with educational and intensive care experts. First, the delegates received a lecture on the principles of simulation training and the importance of human factors. This was, followed by a practical demonstration and discussion of the ECMO circuit, console components, circuit interactions effects and potential complications. There were then five ECMO simulation scenarios with debriefing that covered technical and nontechnical issues. The course culminated in a knowledge-based assessment. Course outcomes were assessed using purpose-designed questionnaires. Results: We held 3 courses with a total of 14 delegates (9 intensive care nurses, 3 adult intensive care consultants and 2 ECMO technicians). Following the course, 8 (57%) gained familiarity in troubleshooting an ECMO circuit, 6 (43%) increased their familiarity with the ECMO pump and circuit, 8 (57%) perceived an improvement in their communication skills and 7 (50%) perceived an improvement in their leadership skills. At the end of the course, 13 (93%) delegates agreed that they felt more confident in dealing with ECMO. Conclusions: Simulation-training courses may increase knowledge and confidence in dealing with ECMO emergencies. Further studies are indicated to determine whether simulation training improves clinical outcomes and translates to reduced complication rates in patients receiving ECMO.

Keywords

• Cardiac surgery; Coronary artery bypass grafting; European system for cardiac operative risk evaluation; Risk factor
• After drop; Extravascular lung water; Fluid balance
• Anesthesia; pregnancy; pulmonary hypertension
• Cardiac surgery; heart disease; mortality; postoperative complications; risk stratification in cardiac surgery
• Cardiac anesthesia; Etomidate; Propofol
• CPB
• Cardiac computerized tomographic angiography; Congenital heart disease; General anesthesia
• Image quality; Induced apnea
• Extracorporeal membrane oxygenation; simulation; training