oa The evolving role of ECMO simulation

The utilization of extracorporeal membrane oxygenation (ECMO) to support patients with respiratory and/or cardiac failure continues to increase annually, with growth primarily in the adult population.¹ The life-saving therapy requires a multidisciplinary team to deliver the highly technical treatment with clinical competency in three areas: cognitive knowledge, technical skills, and behavioral skills. The use of traditional methods of education in which knowledge is transmitted through lectures and reading materials results in limited retention and ability to apply learned information in the clinical setting.² Adult education theory promotes alternative methods of learning, which organizes abstract information through association with previous experiences and leads to mastery of knowledge through functional application.³ The educational tool which supports this approach to learning is simulation.

Multiple forms of simulation have been used to enhance ECMO education. These include task trainers, virtual patients, standardized patients, human patient simulator, and a combination of these models. High-fidelity ECMO simulation (fidelity on the ECMO circuit versus patient manikin) has been successfully implemented in many clinical centers and reported to have a greater impact on education in the three areas of required competency in ECMO care.^4,5 Using simulation in ECMO training, the technical aspects of routine and emergent care can be rehearsed and mastered. Scenarios can be designed with various objectives and can promote the critical thinking aspects of bedside management of these medically complex patients. Incorporating the lessons learned from the airline industry for effective teamwork in a crisis situation, Crew/Crisis Resource Management (CRM) proficiencies embedded in a scenario, also assists in the development of behavioral skills required for effective communication across multiple disciplines.⁶

The use of ECMO simulation incorporates all elements of adult learning theory and improves the learning experience of the clinical staff. The goal of this improved educational experience is to improve quality and safety in care, and ultimately, improve clinical outcomes.