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0097 A single centre approach to using high fidelity simulation to provide training in the management of ecmo emergencies
  1. Mayavan Abayalingam,
  2. Bradley Pates,
  3. John Hickman,
  4. Kate L Hutchinson,
  5. Alex Rosenberg
  1. Royal Brompton and Harefield NHS Foundation Trust, London, UK

Abstract

Background ECMO is an effective yet high-risk treatment for advanced cardio-pulmonary failure. Within our centre we train the team how to correct life-threatening emergencies in a ‘wet-lab’ setting. Feedback from these sessions often suggests they do not feel prepared for a real-life emergency.

Description of innovation We used the SimMan3G manikin and software (Laardel). The circuit comprised of a Levitronix-centrimag pump, Medos-Hilite-LT oxygenator, customised extra-long tubing and soft-shell reservoir. The reservoir was concealed underneath the manikin’s bed sheet and the extra length of the tubing ran behind a curtain to the facilitator station. The facilitator had a console giving real time flow readings. An open-ended length of tubing was connected to the negative pressure side of the circuit and attached to a roller-pump facilitating entrainment of air. The monitoring software was controlled simultaneously from the facilitator station.

Oxygenator failure was simulated by compression of the outlet tubing via a gate-clamp, mimicking resistance within the oxygenator, causing a reduction in blood flow. An increase in trans-membrane pressure was shown via a partial clamp of the post-oxygenator pressure line.

Hypovolaemia was presented by either the partial compression of the inlet tubing using a gate clamp or the intermittent complete occlusion with a clamp.

These emergencies were then simulated to a pilot session of 12 senior nurses.

Outcomes Feedback was requested using simple 1–10 scale. 100% of feedback showed improved communication, teamwork, overall practice, assessment of ECMO patients and technical skills of ECMO with a score of 7 or more. 100% of staff found the session to be useful and would both recommend them to colleagues and attend future sessions.

Take home messages We created high fidelity, cost effective training in technical aspects of ECMO emergencies whilst enhancing communication and confidence within the team.

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