Article Abstract

The introduction of a high-fidelity simulation program for training pediatric critical care personnel reduces the times to manage extracorporeal membrane oxygenation emergencies and improves teamwork

Authors: Matteo Di Nardo, Piero David, Francesca Stoppa, Roberto Lorusso, Massimiliano Raponi, Antonio Amodeo, Corrado Cecchetti, Yigit Guner, Fabio S. Taccone


Background: Extracorporeal membrane oxygenation (ECMO) is used to support patients with severe respiratory and/or cardiac failure unresponsive to conventional treatments. Despite being one of the most complex supportive therapy used in intensive care unit, there is a still a lack of training programs dedicated to improve both clinical and nonclinical skills. The aim of the current study was to evaluate if the introduction of an ECMO high-fidelity simulation curriculum among personnel reduces the times to manage bedside emergencies and improves the behavioral skills.
Methods: This retrospective study was performed from 2011 to 2016 in a 6-beds general pediatric intensive care unit (PICU) of a tertiary children’s hospital. The study population was the PICU personnel. From the beginning of 2011 to the end of 2013, ECMO education was provided without a simulation program. A high-fidelity simulation program instead, was provided from December 2013. Times to manage the most common ECMO emergencies (pump failure, oxygenator change and air embolism management) as well as the behavioral skills of the personnel were evaluated before and after the simulation intervention only in novice learners to reduce the bias related to the natural improvement associated with the bedside practice.
Results: There were a total of 30 ECMO runs and 27 ECMO emergencies over the study period. 10 ECMO emergencies occurred during the pre-simulation period and 17 in the post-simulation period. The median time to change an oxygenator in case of failure was 5.3 (4.80–6.02) min during the pre-simulation period vs. 3.9 (3.50–4.15) min in the post-simulation period (P=0.02). The median time to manage an air embolism emergency was 22 (20.00–23.50) min during the pre-simulation period vs. 15 (13.75–16.50) min in the post-simulation period (P=0.048). Only one episode of pump failure occurred in either the pre-simulation and post-simulation periods. In the pre-simulation period the median cumulative behavioral score was 40 (35.00–44.75) whereas it was 48 (44.5–49.00) in the post-simulation period (P<0.01).
Conclusions: The introduction of a high-fidelity simulation program for pediatric ECMO improved both the times to effective interventions and behavioral skills.