Comprehensive Healthcare Simulation: ECMO Simulation: A Theoretical and Practical Guide

Foreword
Preface
Contents
Contributors
Part I: History of ECMO & ECMO Simulation
1: ECMO from Conception to Execution
Introduction
Birth of an Idea
Development of Perfusion Technology
Conclusions
References
2: Simulating ECMO: Rationale and Genesis
Rationale for Simulating ECMO
Genesis of ECMO Simulation
Core Developmental Strategies
Lessons Learned
Human and System Performance Assessment During ECMO Simulation
Program Assessment
Looking to the Future (The Future Is Now)
Summary
References
Part II: Educational Theory Behind ECMO Simulation
3: The Critical Role of Simulation in ECMO Education
Introduction
Simulation in Medical Education
Adult Learning Theory
Andragogy
Social Learning Theories
Constructivism
Cognitivism
Transformative
Experiential
Procedural Skills Training
Simulation in Medical Education
Simulation as Part of an Overarching ECMO Educational Curriculum
Creation of Goals and Objectives Based on Institutional Needs
Use of Simulation for Low-Frequency, High-Risk Events and Review of Rare Cases
Use of Simulation for Implementation of Programmatic Changes
Creation of Goals and Objectives Based on Learner Population
Matching Goals to Instructional Methods
How to Incorporate Procedural/Technical Skills training into an ECMO Program
Benefits of Simulation on Cognition
Critical Thinking Under Stress
Benefits of ECMO Simulation on IPE Teamwork
Interprofessional
Current ELSO guidelines for Simulation Training
Potential Role for Simulation in Assessment of ECMO Providers
Conclusion
References
4: A Conceptual Framework for Development of a Simulation-Enhanced ECMO Training Program: Use of a Zone-Based Framework
Introduction
Zone-Based Framework for Simulation-Enhanced Training
Overall Framework for Simulation-Enhanced ECMO Training
Development of Psychomotor Skills
Development of Cognitive Skills
Development of Teamwork Skills
Summary
References
5: Brain-Based Learning
Introduction
Brain-Based Learning
Conclusion
References
6: Designing an ECMO Simulation Curriculum
Introduction
Curriculum Development
Components of an ECMO Simulation Curriculum
Extracorporeal Cardiopulmonary Resuscitation
Physiologic Framework for ECMO Complications
ECMO Preload
ECMO Pump “Contractility”
ECMO Afterload
Considerations
Conclusions
References
Part III: Technology for ECMO Simulation
7: Innovations and Options for ECMO Simulation
Introduction
Definitions
Foundational Knowledge and Skills Acquired Through Low Physical Resemblance, Low Functional Task Alignment Simulation
Development of Psychomotor and Critical Thinking Skills
Development of Surgical Cannulation Skills
ECMO Team Development and Crisis Management
Logistics of ECMO Simulation: A User’s Guide
Equipment
Technical Innovations for Simulation of ECMO Emergencies
Personnel
Space
Conclusion
References
8: Physiologic Modeling
Overview of the Chapter
Introduction to Physiological Modeling
Physiologic Modeling in ECMO Simulation
Full Model-Driven and Hybrid ECMO Simulation
Explanatory Models in ECMO Simulation
Current Available Models for Use in ECMO Simulation
Future of Physiological Modeling
Introduction to Physiological Modeling
Physiological Modeling in ECMO Simulation
Full Model-Driven and Hybrid ECMO Simulation
Explanatory Models in ECMO Simulation
Current Available Models for Use in ECMO Simulation
Future of Physiological Modeling
Conclusion
References
9: Immersive Technologies in ECMO Simulation
Introduction
Definitions
Immersive Technologies
Augmented Reality (AR)
Mixed Reality (MR)
Virtual Reality (VR)
The Psychology of VR Design
Immersive Technologies in Healthcare
Therapeutic Uses
Clinical Use Cases
Educational Use Cases
Advantages and Disadvantages of the Immersive Technologies in Simulation
Evidence Behind VR Simulation
The Future of Immersive Technology in ECMO Simulation
Summary
References
Part IV: Other Topics for ECMO Simulation
10: Interprofessional Education and ECMO Simulation
Introduction
Theory to Support Interprofessional Education
Andragogy and IPE
Transformative Learning and IPE
Social Psychology and IPE
Interprofessional Team Training
Interprofessional Simulation for ECMO Teams
A Practical Guide for Interprofessional ECMO Simulation
Knows
Knows How
Shows
Needs Assessment
Learning Objectives
Resources for IPE ECMO Simulation
Scheduling for IPE ECMO Simulation
Debriefing
Does
Conclusion
References
11: Optimizing ECMO Teams: What Every ECMO Educator Needs to Know About the Latest Advances in Team Science
ECMO Simulation as the Ultimate Team Sport
Simulation as a Lab to Study the Human Behavior of Teams
Team Science and Relevant Team Processes
From Teamwork to Teaming
Coordination
Team Sensemaking
Solutions to Improve Human Performance in ECMO Teams
Thinking of ECMO as a Multiteam System
Team Reflexivity
Psychological Safety
Conclusion
References
Part V: Practical Considerations
12: Current Training Recommendations for ECMO Providers and Specialists
Introduction
Adult Learning and ECMO Training
ECMO Provider Didactic Course
ECMO Simulation Training
Historical Perspective
Considerations
High- Versus Low-Technology Simulation
In Situ Versus Simulation Lab
Developing Simulation Scenarios
Continuing Education of the ECMO Provider
Novel Educational Strategies
Conclusion
References
13: The Role of Simulation in Starting a New ECMO Program
Introduction
Considerations to Start a New ECMO Program
Components of Curriculum for a New ECMO Center
Overall Curriculum Design
Didactic Sessions and Monthly Lectures
Introduction of Complex Physiology and Hands-On Practice
Design of the Simulation Curriculum: Circuit Labs
Design of the Simulation Curriculum: High-Fidelity Simulation
Operationalizing ECMO Training in a New ECMO Center: Establishment of Superuser Group and Training from Expert Center
Dissemination of Simulation Training for Larger Audience
Conclusions and Recommendations
References
14: Using Simulation to Develop an ECMO Transport Program
Introduction
ELSO Guidelines Regarding ECMO Transport
Principles of ECMO Transport to Incorporate into Practical Simulation
Transport Simulation Design
Goals and Objectives
Setting
Equipment
Transport Simulation Scenarios
Conclusion
References
15: Debriefing ECMO Simulations: Special Considerations
Introduction
Debriefing Timing and Facilitation
Debriefing Process Elements
Essential Elements of Debriefing
Conversational Techniques/Educational Strategies
Debriefing Adjuncts
Special Considerations for Debriefing ECMO Simulations
Debriefing Training and Assessment
Conclusion
References
16: Controversies on Certification of ECMO Practitioners Using Simulation
The Need for Standardized ECMO Practitioner Certification
The ECMO Practitioner
Growth of ECMO Utilization
Risks Associated with ECMO
High-Risk, Low-Frequency Events
Variability in ECMO Center Training and Center Volume
Standardization
The Role of Simulation in Certification
Miller’s Model of Medical Competence
Simulation in Medical OSCE
Maintenance of Certification
Simulation in the Neonatal Resuscitation Program (NRP), Pediatric Advanced Life Support (PALS), and Advanced Cardiac Life Support (ACLS)
Controversies in Simulation-Based Certification of ECMO Practitioners
ECMO Certification
Defining Minimal Competency
Differentiating Performance in Clinical Practice Versus in Simulation
Lack of Evidence of the Efficacy of Simulation Training in Improving Patient Outcomes
Buy-in from ECMO Centers
Assessment of Multidisciplinary Team
Instructors/Assessor Training
Recertification Criteria
Conclusion
References
17: Research in ECMO Simulation: A Review of the Literature
Introduction
ECMO Simulation for Training Providers
Development of ECMO Simulation Equipment
Evidence for Improvement in Knowledge and Skills
Evidence of Improved Clinical Outcomes
Conclusion
References
18: Faculty Development for ECMO Simulation
ECMO Faculty Development for Simulation
Evolution of Faculty Development
Faculty Development for Simulation
Theoretical Frameworks to Guide ECMO Simulation Faculty Development
Situated Learning Theory
Communities of Practice (CoP)
Transformative Learning Theory
Methodology (Approaches) of ECMO Simulation Faculty Development
Formal Approaches
Workshops/Seminars/Conferences/Short Courses
Faculty Simulation Fellowships/Longitudinal Programs (6 Months–2 Years)
Advanced Education
Informal Approaches
Work-Based Learning
Peer Coaching and Feedback
Professional Community of Practice (See Theory Section for Further Details)
Mentorship
Role Modeling
Structure and Components of Simulation Faculty Development Program
ECMO Faculty Development
Development of a Simulation ECMO Faculty Development Course
Faculty Assessment
Future Directions and Sustainment
Appendix 18.1: Simulation Faculty Program Example
Appendix 18.2
Appendix 18.3
Appendix 18.4
References
19: Quality Improvement
Introduction
Background and Terminology
Simulation
Continuous Quality Improvement (CQI)
Total Quality Management (TQM)
Systems Thinking
Quality Indicators: Benchmarking Performance and Optimizing Safety
Benchmarking Performance
Performance Management for Optimizing Safety
Improving and Sustaining Performance
Examples
Sustaining Performance
Summary
References
Part VI: Special Considerations for Different ECMO Populations
20: Neonatology
Introduction/Chapter Overview
Background
Education Overview
ECMO Curriculum/Scenario Design
Participants in ECMO Sim
Equipment Considerations for Neonatal ECMO Simulation
Conclusions
References
21: ECMO Simulation in Infants, Children, and Adolescents
Background
Scope
VA Versus VV ECMO? The Answer Lies in the Oxygen Delivery Equation
Common Pediatric VA ECMO Indications
Common Pediatric VV ECMO Indications
Cannulation Considerations
Pediatric ECMO Flows: Guidelines and Considerations
Pediatric Anticoagulation/Hematologic Nuances
Pediatric Vital Signs: One Size Does Not Fit All
Systematic Approach to Develop, and Prioritize, the Most Appropriate Pediatric ECMO Simulations for Your Program
Where Things Can Go Wrong: Common Pediatric ECMO Complications
Recirculation in VV ECMO
Where Things Can Go Wrong: Psychomotor Skills
Where Things Can Go Wrong: Systems Processes
Prioritizing Simulations for Your Program
ECMO Simulation: High(er) Fidelity Is Not Necessarily Better – Just More Complicated
Conclusion
Appendix 21.1: Pediatric Age-Based Vital Signs, Typical ECMO Flows and Cannula Sizes
References
22: ECMO Simulation in Patients with Cardiac Disease
Introduction
Simulation Design and Setup
ECMO Pump Type
Cannulation Strategy – Anatomical Location and Implications
Cannulation Strategy – Number and Dimensions
Additional Cardiac and ECMO Circuit Monitoring
Left Heart Decompression on ECMO
Investigation for Cardiac Lesions Implicated in Cardiopulmonary Failure
Simulation of Complex Cardiac Anatomy and Physiology
Biventricular Circulation
Acute Coronary Syndromes, Myocardial Infarction, and Pulmonary Embolism
Acute Coronary Syndromes and Myocardial Infarction
Aortic Balloon Pumps/Impella
Single-Ventricle Circulation
Bidirectional Glenn Circulation
ECPR
Cardiovascular Care Microsystems
Conclusions
References
23: Surgical Considerations
Introduction
Simulation Techniques
ECLS Scenarios in a Surgical Context
Human Factors in ECLS Team Training
Summary
References
24: Nursing Aspects of ECPR and ECMO Training
Introduction
Description of SimZones
Zone 0 Foundational Training with Simulation
Creating Psychological Safety
Zone 1 Foundational Instruction
Zone 2 Acute Situational Instruction
ECMO-Specific Prerequisite Training
Zone 3 Team and Systems Development Training
Zone 4 Real-Life Debriefing and Development
Ongoing Education
Conclusion
References
25: ECMO Simulation in the Adult Population – Proning, Awakening and Breathing Trials, and Mobilization
Introduction
Overview of Prone Positioning (PP) and Mobilization on ECLS
Prone Positioning (PP) for Adult Respiratory Distress Syndrome (ARDS)
Emerging from Sedation and Mobilization on ECLS
Simulation Design for Proning, SAT/SBT, and Mobilization on ECLS
Conclusion
Appendix 25.1: Proning Protocol of a Mechanically Ventilated Patient
Appendix A: Figures
Appendix B: Potential Complications of Prone Positioning and Interventions
Appendix C: CPR on a Prone Patient
Appendix 25.2
Appendix 25.3: Mobilization on ECLS
Bibliography
26: The Role of Simulation in Training of ECMO Specialists
Introduction
Utilization of ECMO Simulation Technology to Assist Learning of the ECMO Specialist
ECMO Specialist Training
Phase I: 12 Hours of Didactics
Phase II: 4 Hours of Hands on Wet Drills
Phase III: 12 Hours of Proctoring
Phase IV: Testing and Certification
Phase V: Continuing Education
Advancement of Simulation for Training of ECMO Specialists
Technology
Cost
Environment and Equipment
Circuit-Centered Emergency Scenarios
Team-Based Approach
Conclusion
References
Part VII: Practical Guide
27: A Practical and Pictorial Guide for Creating ECMO Simulation
Introduction
Basic Simulation: Water Drills
Manikin-Integrated Simulation
Circuit Obstruction/Thrombosis
Air Entrainment
Bleeding
Preparation for Cannulation/Extracorporeal Cardiopulmonary Resuscitation (eCPR)
Conclusion
References
Index