Patient Centred Educational ECMO Simulator (EduECMO) – An international training needs analysis

Background:

Extracorporeal membrane oxygenation (ECMO) simulators provide higher training levels for both technical and interdisciplinary team communication skills. The realism of ECMO simulators is called fidelity: “The ability of the simulation to reproduce the reactions, interactions, and responses of the real-world counterpart. It is not constrained to a certain type of simulation modality, and higher levels of fidelity are not required for a simulation to be successful.”, as defined by the Healthcare Simulation Dictionary. As a high-fidelity ECMO simulator does not yet exist, EduECMO aims to create extremely realistic experiences which cannot only be used for training but also for preclinical testing to reduce animal testing. The aim of this study is to obtain expert input on ECMO practices, to gain insights in the training needs and how to implement these in an ECMO simulator/simulation.

Methods:

A training needs assessment according to INACSL standards was conducted. Experts were invited by email to participate in an online survey (Google Forms) between July and October 2023. All participants signed informed consent. The study was approved by the University of Twente Natural & Engineering Sciences Ethics Committee (230117). Data were analysed with descriptive characteristics.

Results:

41 participants from 11 countries filled in the survey (See Fig. 1). Backgrounds varied from (intensive care) nurse (7), anaesthesiologist (5), cardiac surgeon (6), cardiologist (3), ECMO specialist nurse (1), intensivist (8), paediatric cardiologist (1), perfusionist (9) to physician assistant (1). Low-volume centres (<6 ECMO cases/year) were represented in 18% of respondents, mid-volume (6-30 ECMO cases/year) in 42%, and high-volume centres (> 30 ECMO cases/year) in 40% of respondents. Only 14/41 respondents (34%) attended ECMO training which was also examined, while 49% only attended ECMO training. ECMO simulator components deemed most important were diagnosis (23), followed by circuit priming (17), cannulation (17) and circuit monitoring (14). 40/41 respondents (98%) wanted patient-specific parameters other than diagnosis and anatomy to be included.

Conclusions:

An international multidisciplinary expert group from low-, mid-, and high-volume ECMO centres only received ECMO training with assessment in a minority of the cases. ECMO simulator training needs are not yet fulfilled by the current available low- to mid-fidelity ECMO simulators. EduECMO development should be continued with this expert input to allow for clinical adoption meeting the training needs.