Simulation training on bedside veno-arterial extracorporeal membrane oxygenation decannulation

Abstract

Veno-arterial extracorporeal membrane oxygenation is a form of mechanical circulatory support for patients with refractory decompensated heart failure. Blood is drawn from a large vein and pumped back to a large artery, usually a femoral artery through large bore catheters. When the heart recovers, the extracorporeal membrane oxygenation support can be terminated and the catheters are decannulated. The bleeding at the venous side can be controlled by prolonged compression; however, the arteriotomy wound needs to be repaired. Conventionally, the arteriotomy wounds require open vascular repair in the operating theater. The novel application of percutaneous vascular closure devices, which have been commonly used in vascular operations and percutaneous structural heart interventions, could be applied for closure of arteriotomy wounds at the bedside after extracorporeal membrane oxygenation support. The post-close ProGlide (Abbott Vascular) technique was shown to be safe and could potentially save time and manpower. The wounds are much smaller as compared with the conventional open repair and potentially, the chance of wound infection can be reduced. However, the success of percutaneous bedside closure requires careful prior planning and technique training. Backup plans with vascular surgeons’ standby are essential in case of failure of closure. Staffs in the extracorporeal membrane oxygenation centers need to be familiar with the preparation, the procedure as well as the device application technique for successful percutaneous closure. The long learning curve and the limited case load mean that such skills are best trained by simulation scenarios. This article described how this new technique and the team logistics can be trained by simulation.

A Scoping Review and Appraisal of Extracorporeal Membrane Oxygenation Education Literature

“…Of these, 11% provided reading materials or written guides ( 27 , 32 , 38 , 50 ), and 11% provided online instruction ( 21 , 38 , 40 , 47 ). Multimedia was used infrequently, with video instruction in 11% ( 31 , 35 , 38 , 41 ), video-assisted simulation feedback in 8% ( 20 , 39 , 44 ), and augmented reality in 3% ( 40 ).…”

“…The vast majority of ECMO education in the post-H1N1 era incorporates hands-on SBME, occasionally integrating video instruction/feedback ( 31 , 35 , 39 , 41 , 44 ), augmented reality ( 40 ), or online simulators ( 21 ). This is consistent with findings that 72% of recently surveyed ELSO centers reported having or developing ECMO simulation programs ( 7 ).…”

Development and evaluation of extracorporeal membrane oxygenation nursing education program for nursing students using virtual reality

“…In addition, the knowledge measurement tool in this study was intended to simply measure if the subjects had correct or wrong knowledge, which might be unable to detect signi cant differences in the knowledge level between the experimental and the control groups. Several previous studies that trained medical staff on ECMO simulation and evaluated their performance have shown the effects on performance [13][14][15]17]. Thus, future studies should verify the effectiveness of the ECMO nursing VR simulation program using tools evaluating empirical knowledge and nursing performance skills.…”

“…In addition, ECMO training has been dominated by instructor-centered training methods such as lectures and skills training. However, some training using e-learning and high-delity simulators have been conducted recently [12][13][14][15][16][17][18]. Some preceding studies have shown that training using high-delity simulators has no difference in effectiveness when compared to traditional training [17].…”