Introduction
Extracorporeal Membrane Oxygenation (ECMO) is a life-saving technology. Cannulation of major blood vessels is the first step and physicians must be competent in this procedure. Any procedural error may result in fatal complications. However, acquisition of such skill in early days was difficult due to a lack of platform for deliberate practice.
Methods
We designed a prototype model for ECMO cannulation training in 2016. The cannulation model, made of platinum-catalyzed silicones and psyllium husks powder, allowed ultrasonography imaging and multiple puncture with large-bore cannulas. The model was later modified to allow conduction of different simulation scenarios, including bedside percutaneous cannulation and extracorporeal cardiopulmonary resuscitation (ECPR). In COVID-19 pandemic, infection control restrictions had prohibited face-to-face ECMO simulation training. We piloted the use of telesimulation to link instructors and simulators to off-site learners in an overseas ECMO training.
Results
Our cannulation model is the first cannulation model in the world which can be operated as a partial task trainer for percutaneous ECMO cannulation or incorporated into a scenario-based simulation training environment. The model had been used in physician training courses in Hong Kong, Qatar, Japan, Singapore and USA. In a pilot run involving 78 Hong Kong clinicians, mean product evaluation rate was 4.53 out of 5 (a higher rate implied higher realism). Mean confidence score of participants before and after cannulation workshops were 4.3 and 7.1 out of 10 respectively (p<0.01). Mean competency score of participants before and after cannulation workshops were 4.6 and 6.8 out of 10 respectively (p0.01). The model could be easily replicated and cost of the cannulation model was deemed affordable. During the pandemic, telesimulation technology was adopted by our team to conduct an overseas ECMO training programme in Asia. The programme was well perceived by both trainers and participants. Pre-course and post-course evaluation showed an improvement in knowledge.
Conclusion
ECMO is a high-risk but relatively low-occurrence therapy. Adoption of simulation-based training can enhance competency of ECMO practitioners and patient safety.
