Does Prior ECMO Experience Lead to Better Performance on Simulation Scenarios?

Background: Extracorporeal Membrane Oxygenation (ECMO) provides heart-lung bypass for patients with life-threatening cardiorespiratory failure. It is a classic low-volume, high-risk procedure that requires specialized training to maintain knowledge and experience. Therefore, our ability to train efficiently and effectively is essential. Historically, training has utilized live tissue models but more recently, simulation models have demonstrated increased sophistication and promise. Recent research showed that both animal and simulation models demonstrate benefit in development of and/or maintaining skill competence, with no significant differences in participant performance between the two modalities. The purpose of this study was to determine what participant factors are associated with better performance in emergency ECMO scenarios in the subset using simulation model.

Methods: Fifty-one physicians, nurses, and respiratory/medical technicians participated in a study comparing live tissue vs. simulation-based ECMO education. All completed a multiple-choice questionnaire about prior ECMO experience and other demographics as well as a four-hour pre-lab didactic session. They completed individual ECMO scenarios with both modalities during two sessions, and task completion times (minutes) and scores (percentage) were measured using a validated ECMO skills assessment tool. Participants that completed the simulation-based scenarios during their first session were further analyzed in the context of their self-reported ECMO experience. Statistical testing included the Mann-Whitney U test (times) and Fisher’s exact test (scores).

Results: Data from the 19 participants who completed the simulation-based ECMO training on the first session showed no statistically significant differences in the task completion time or scores among those with zero vs. ≥ one year of ECMO experience (28 vs. 34 minutes; p=0.66 and 61% vs. 62%; p=0.54). There was also no statistically significant difference in those with no vs. ≥ one cannulation (30 vs. 25 minutes; p=0.11 and 59% vs. 62%; p=0.82) or those who had never cared for an ECMO patient vs. those who had cared for at least one (28 vs. 34 minutes; p=0.30 and 57% vs. 62%; p=0.54).

Conclusion: Among this small subset of participants, we observed no statistically significant differences in performance quality based on participant experience during simulation-based ECMO scenarios. The didactic/review sessions preceding the training may have contributed as an effective form of training for participants with no prior ECMO experience. Due to the small sample size of this study, further studies are needed to better elucidate what factors lead to better performance in emergency ECMO scenarios.