Start a Neonatal Extracorporeal Membrane Oxygenation Program: A Multistep Team Training

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a complex life-saving support for acute cardio-respiratory failure, unresponsive to medical treatment. Emergency events on ECMO are rare but require immediate and proficient management. Multidisciplinary ECMO team members need to acquire and maintain over time cognitive, technical and behavioral skills, to safely face life-threatening clinical scenarios.Methods: A multistep educational program was delivered in a 4-year period to 32 ECMO team members, based on guidelines from the Extracorporeal Life Support Organization. A first traditional module was provided through didactic lectures, hands-on water drills, and laboratory animal training. The second phase consisted of a multi-edition high-fidelity simulation-based training on a modified neonatal mannequin (SimNewB®). In each session, participants were called to face, in small groups, ten critical scenarios, followed by debriefing time. Trainees underwent a pre-test for baseline competency assessment. Once completed the full training program, a post-test was administered. Pre- and post-test scores were compared. Trainees rated the educational program through survey questionnaires.Results: 28 trainees (87.5%) completed the full educational program. ECMO staff skills improved from a median pre-test score of 7.5/18 (IQR = 6–11) to 14/18 (IQR = 14–16) at post-test (P < 0.001, Wilcoxon rank test). All trainees highly rated the educational program and its impact on their practice. They reported high-fidelity simulations to be beneficial to novice learners as it increased self-confidence in ECMO-emergencies (according to 100% of surveyed), theoretical knowledge (61.5%) and team-work/communicative skills (58%).Conclusions: The multistep ECMO team training increased staff' knowledge, technical skills, teamwork, and self-confidence, allowing the successful development of a neonatal respiratory ECMO program. Conventional training was perceived as relevant in the early phase of the program development, while the active learning emerged to be more beneficial to master ECMO knowledge, specific skills, and team performance.

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

“…Even with skilled providers, ECMO has significant risks of morbidity and mortality (3). Knowledge and routine training are essential to improve patient outcomes, as recommended by ELSO (4, 5).…”

“…Only surgeons with at least 2 years of experience and more than 100 procedures of neonatal and vascular surgery were selected for the training after being evaluated by the head of Department. The surgical training was supported by the implementation of a larger multi-disciplinary training program (5). As previously reported, the training process started with the delivery of educational material, attendance to national and international courses, and observership programs at ECMO referral centers.…”

“…Once the surgeon in training had completed the whole program, having effectively cannulated at least 10 piglets, they were considered for the clinical surgical approach (5). Simulations were carried on systematically even after treating the first patients in order to maintain a high level of technical ability.…”

“…Accordingly, the Extracorporeal Life Support Organization (ELSO) strongly supports specific programs for education and training in order to improve patients' outcomes (4). Multidisciplinary team training has been previously described in the neonatal and pediatric ECMO setting (5, 6). Simulation-based cannulation curricula have been reported in the cardiac, pediatric setting (7).…”

Mentoring in Pediatric Thoracoscopy: From Theory to Practice

“…In summary, in our experience a multistep training program as previously described seems effective to start pediatric thoracoscopy safely. A support to this consideration also comes from results we obtained following the same steps in other surgical areas, such as the fetoscopic correction of myelomeningocele ( 21 ) and the setting of a neonatal ECMO team ( 22 ).…”