Simulation versus live tissue training randomised trial for ECMO proficiency: is one better than the other?

Abstract

IntroductionExtracorporeal membrane oxygenation (ECMO) is a classic low-volume high-risk procedure that requires just in time and/or refresher training through animal or simulation modalities. This manuscript evaluated the performance of ECMO personnel trained with both modalities to determine which is better suited for ECMO skills training.MethodsParticipants (physicians, nurses and respiratory/medical technicians) completed a series of ECMO scenarios with synthetic tissue cannulation task trainer as well as a live tissue model. Objective performance quality was based on task completion using a validated ECMO skills assessment tool.ResultsThirty-eight individuals completed this study. Participants completed individual scenario tasks 3 min faster using the simulator (26 min vs 29 min; p=0.03). No differences were seen in percentage of individual tasks completed. In the group scenarios, participants completed a higher percentage of critical tasks using the simulator (97%) versus the animal model (91%; p=0.05), but no differences were seen in task completion times. Additionally, no differences were seen in either lab-based or participants’ prelab cognitive scores.ConclusionsRegardless of their self-assessment or experience, participants’ objective performances were similar among both animal and simulation labs. Task completion times were quicker with simulation model. The distinction between simulation versus animal model may be less important as both demonstrate benefit in development of and/or maintaining skill competency. In the era of questioning the need for and costs of live tissue training, expanding the role of simulation may achieve similar training goals.

Prior Extracorporeal Membrane Oxygenation (ECMO) Experience and Performance in High-Fidelity Simulation Scenarios

“…This study was a secondary analysis of a data set from a previously published study [4]. The following four scenarios were included (1) poor venous return, (2) gas failure, (3) pump failure, and (4) arterial air.…”

“…Excerpts From Original Study Added For Clarification [4] Simulation lab: The ECMO simulator system consisted of a high-fidelity synthetic tissue cannulation task trainer (SynDaver Labs, Tampa, Florida), connected to a water-tight closed reservoir pump, embedded into a low-fidelity newborn infant manikin (Laerdal Medical Corporation, Wappingers Falls, New York, USA) system. This prototype was optimized to advance the realism of the simulation model for this study and consisted of life-like skin and subcutaneous fat overlaying the sternocleidomastoid muscle, which was retracted to reveal a medially placed carotid sheath containing the internal jugular vein, the vagus nerve, and the common carotid artery.…”

“…Mu et al showed in 2020 that both animal and simulation models demonstrate benefits in the development of and/or maintaining skill competence, with no significant differences in participant performance between the two modalities. High-fidelity simulation training may be an effective and less costly option for ECMO training compared with animal models [4]. The purpose of this study is to determine if specific participant training or experience leads to better performance in emergency ECMO scenarios during high-fidelity simulation training.…”