Can simulation improve ECMO care ?

المؤلفون المشاركون

Alinier, Guillaume
Labib, Ahmad

المصدر

Qatar Medical Journal

الناشر

مؤسسة حمد الطبية

تاريخ النشر

2017-06-30

دولة النشر

قطر

عدد الصفحات

4

التخصصات الرئيسية

الطب البشري

الموضوعات

• الرعاية الطبية
• المرضى
• أساليب المحاكاة
• الطب
• الأكسجة الغشائية خارج الجسم

الملخص الإنجليزي

Bringing ECMO simulation to life": The main theme of the 4th Annual Conference of the Extracorporeal Life Support Organisation – South and West Asia Chapter (ELSO-SWAC), "Bringing ECMO Simulation to Life", is meant to emphasise the growing role of simulation in healthcare and medical education at large and in the highly specialised and complex field of extracorporeal life support (ECLS), and in particular for extracorporeal membrane oxygenation (ECMO).

Application of ECMO simulation to improve team response to ECMO emergencies was first described in 2006.1 In the last decade, several authors have described the development, utility, and advantages of simulation-based training for ECMO.

In this editorial, we will discuss the role of and evidence supporting the use of simulation-based education in ECMO.

ECMO is a complex intervention: The first point to consider when it comes to ECMO is the complexity, time critical, and inter-disciplinary nature of the intervention.

Typically, ECMO is considered for the most sick and physiologically deranged patient, sometimes as a last resort rescue measure.

Time pressure, the patient critical condition, the potential rapid deterioration, and the uncertainty interact within the critical care environment to make decisionmaking, planning, and execution quite challenging for the less experienced members of the clinical team.

This relates to the domains of team and crisis resource management in which there is a complex interplay of human and environmental factors involved.2 Appropriate training programmes of the required technical and non-technical skills for ECMO are lacking.3,4 In addition, ECMO is relatively new to many centres and/or countries, and this novelty brings with it a general lack of experience regarding such therapy and the fear of the unknown.

Simulation can help relieve staff anxiety and introduce ECMO in a safe, less intimidating learning environment.3,4 Ideally, all aspects of ECMO patient care can be progressively introduced to the staff being trained through the use of various simulation modalities to promote better Running in-situ simulations in particular is very useful to test the implementation of new services and identify potential risks and actual omissions of critical safety components.16,17 Putting clinical teams in various simulated normal and emergency situations within their own context allows for observation of their actions and challenges they face in relation to the procedure, equipment availability or familiarity, or physical environment configuration.

The immediate next phase is to engage them in a debriefing that will help identify potential as well as actual system or environmental issues, and assist in developing appropriate solutions.

Organising in-situ simulation can however be challenging, especially in an operational clinical environment where real patients who might be critically ill are also present.18 In the case of ECMO patient care-related in-situ simulation, it is the ideal setting to train a team to respond to a patient or circuit emergency, as it will test their ability to act appropriately and test the availability of the resources required to deal with an emergency circuit change or pump failure for example.

A facility that has limited regular exposure to ECMO patients should be recommended to impose more regular in-situ simulations to ensure the clinical team and equipment are always ready to deal with any aspect of ECMO, right from the cannulation phase (wherever it may take place) and ability to bring together all required resources, performing an emergency circuit change, right through to weaning off a patient from ECMO.

Conclusion: There is a universal growing interest in various aspects and applications of simulation-based training.

Simulation for the initiation and maintenance of ECMO provides several advantages over traditional passive learning approaches.

ECMO simulation improves technical skills such as cannulation as well as non-technical skills that include, among others, effective communication, team working, decision making, and leadership skills.

Appropriately designed simulation-based and educational ECMO interventions can alleviate staff anxiety with regard to new technology and equipment, and boost confidence in relation to crisis management.

In future, advances in simulation technology will allow for increased realism and higher fidelity, and subsequently further enhance the clinical team learning experience.

نوع البيانات

أوراق مؤتمرات

رقم السجل

BIM-789656

• APA
• MLA
• AMA