title: An extracorporeal membrane oxygenation cannulation curriculum featuring a novel integrated skills trainer leads to improved performance among pediatric cardiac surgery trainees.
abstract: BACKGROUND
  American Heart Association guidelines recommend timely extracorporeal membrane oxygenation (ECMO) cannulation during cardiopulmonary resuscitation for pediatric cardiac arrest refractory to conventional resuscitation. Traditional cannulation training relies on the apprenticeship model. We hypothesized that a simulation-based ECMO cannulation curriculum featuring a novel integrated skills trainer would improve ECMO cannulation during cardiopulmonary resuscitation performance by cardiothoracic surgery trainees.
  
  
  METHODS
  An embedded surgical neck cannulation trainer, designed in collaboration with expert surgeons, formed the focus for a simulation-based cannulation curriculum. The course included a didactic presentation and 2 neck cannulations during cardiopulmonary resuscitation with video-assisted expert feedback with a further cannulation at 3 months. Primary outcome was time to cannulation on the trainer. Secondary outcomes were performance on a validated Global Rating Scale (GRS) of surgical technique and a novel Composite ECMO Cannulation Score (CECS).
  
  
  RESULTS
  Ten cardiothoracic surgery trainees participated. The trainer was rated as authentic, and sessions was rated as highly useful. Median time to cannulation decreased between cannulation 1 and 2 (15 minutes 24 seconds vs. 12 minutes 15 seconds, P = 0.002). Improvement was sustained at 3 months (13 minutes 36 seconds, P = 0.157 vs. attempt 2). Likewise, GRS increased significantly at attempt 2 versus 1 (77% vs. 62%, P = 0.003) as did CECS (88% vs. 52%, P = 0.002). No deterioration in GRS or CECS was measured at 3 months.
  
  
  CONCLUSIONS
  Cardiothoracic surgery trainees found a contextualized ECMO cannulation during cardiopulmonary resuscitation cannulation curriculum to be highly useful and demonstrated sustained improvement in time to cannulation, CECS, and GRS. Further work will focus on determining the clinical impact of this training and defining the optimal interval and number of training sessions.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Boston, MA, USA.
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Allan
authors.forename: Frank
authors.initials: F
authors.lastname: Pigula
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
authors.forename: Sitaram
authors.initials: S
authors.lastname: Emani
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Annette
authors.initials: A
authors.lastname: Imprescia
authors.forename: Gavin
authors.initials: G
authors.lastname: Hayes
authors.forename: Peter
authors.initials: P
authors.lastname: Weinstock
mesh_terms: D006348:Cardiac Surgical Procedures / Q000193:education*; D002404:Catheterization; D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D015199:Extracorporeal Membrane Oxygenation / Q000193:education*; D006801:Humans; D008348:Manikins; D010372:Pediatrics / Q000193:education*; D013997:Time Factors