title: Simulation-based postcardiotomy extracorporeal membrane oxygenation crisis training for thoracic surgery residents.
abstract: BACKGROUND
  We developed and tested a clinical simulation program in the principles and conduct of postcardiotomy extracorporeal membrane oxygenation (ECMO) with the aim of improving confidence, proficiency, and crisis management.
  
  
  METHODS
  Twenty-three thoracic surgery residents from unique residency programs participated in an ECMO course involving didactic lectures and hands-on simulation. A current postcardiotomy ECMO circuit was used in a simulation center to give residents training with basic operations and crisis management. Pretraining and posttraining assessments concerning confidence and knowledge were administered. Before and after the training, residents were asked to identify components of the ECMO circuit and manage crisis scenarios, including venous line collapse, arterial hypertension, and arterial desaturation.
  
  
  RESULTS
  In the hands-on portion, residents had difficulty identifying the gas source and flow rate, centrifugal pump head inlet, and oxygenator outflow line. Timely and accurate ECMO component identification improved significantly after training. The arterial desaturation crisis scenario gave the residents difficulty, with only 22% providing the appropriate treatment recommendations in a timely and accurate fashion. At the end of the simulation training, most residents were able to manage the crises correctly in a timely manner. Posttraining confidence-related scores increased significantly. Most of the residents strongly recommended the course to their peers and reported simulation-based training was helpful in their postcardiotomy ECMO education.
  
  
  CONCLUSIONS
  We developed a simulation-based postcardiotomy ECMO training program that resulted in improved ECMO confidence in thoracic surgery residents. Crisis management in a simulated environment enabled residents to acquire technical and behavioral skills that are important in managing critical ECMO-related problems.
authors: Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota, USA. burkhart.harold@mayo.edu
authors: Harold M
authors: HM
authors: Burkhart
authors: Jeffrey B
authors: JB
authors: Riley
authors: James J
authors: JJ
authors: Lynch
authors: Rakesh M
authors: RM
authors: Suri
authors: Kevin L
authors: KL
authors: Greason
authors: Lyle D
authors: LD
authors: Joyce
authors: Gregory A
authors: GA
authors: Nuttall
authors: John
authors: J
authors: Stulak
authors: Hartzell V
authors: HV
authors: Schaff
authors: Joseph A
authors: JA
authors: Dearani
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D015199:Extracorporeal Membrane Oxygenation / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D011182:Postoperative Care / Q000193:education*; D013903:Thoracic Surgery / Q000193:education*