Simulation training for crises during venoarterial extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) education, in particular with regards to crisis management during the provision of venoarterial extracorporeal membrane oxygenation (VA ECMO), is challenging due to its intrinsic characteristics-a complex, high risk, low volume clinical activity which requires dynamic decision making, interdisciplinary teamwork and communication, and rapid response. Simulation training that focuses on crisis resource management and interprofessional communication is well-suited to address these training needs. Institutional commitment to provide both capital and human resources is instrumental to the success of ECMO training programs. Future multicenter studies with standardized training curricula are required to investigate the impact of ECMO simulation training on patient outcome.

Keywords: ECMO crisis; Simulation; crisis resource management; venoarterial extracorporeal membrane oxygenation (VA ECMO).

Figure 1

Basic setup of a high-fidelity extracorporeal membrane oxygenation (ECMO) simulation environment. (A) ECMO simulation is in progress with a functioning ECMO machine (blood pump and oxygenator). Physiological parameters are displayed and modified according to the action of the learners. (B) Debriefing after simulation activity (adopted from Asia-Pacific Adult ECMO Course, Queen Mary Hospital).

Figure 2

Basic setup of a high fidelity extracorporeal membrane oxygenation (ECMO) simulation. (A,B) Hidden volume reservoir and tubings inside a paediatric manikin; and the setup of a volume reservoir (photos courtesy of Dr. Mark Ogino); (C) Closeup of the ECMO circuit setup with additional pressure transducers (in red) for display of circuit pressure.

Figure 3

Simulation training for ECMO-cardiopulmonary resuscitation (E-CPR). Inter-professional collaboration between different healthcare professions from the point of activation of E-CPR, resuscitation in the emergency room, ECMO cannulation, to ICU transfer is emphasized. ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit.