Evaluating the introduction of extracorporeal life support technology to a tertiary-care pediatric institution: Smoothing the learning curve through interprofessional simulation training

J Pediatr Surg. 2015 May;50(5):798-804. doi: 10.1016/j.jpedsurg.2015.02.037. Epub 2015 Feb 20.

Abstract

Background: Extracorporeal life support (ECLS) is a life-saving technology for the critically ill child. Our objective was to evaluate the outcomes of an educational curriculum designed to introduce an ECLS program to a noncardiac pediatric surgical center.

Methods: An interdisciplinary curriculum was developed consisting of didactic courses, animal labs, simulations, and debrief sessions. We reviewed all patients requiring ECLS between October 2011 and December 2013. All health care practitioners involved in the ECLS training curriculum were surveyed to evaluate their perception of the educational program. Primary outcomes include successful cannulation and 30-day survival.

Results: The knowledge and confidence improved with statistical significance (p<0.0001-0.0003) for all of the components of the training curriculum. The highest score was given to the simulations. Twenty-one patients underwent cannulation. All patients were successfully cannulated to bypass, including six (28.6%) ECPR. Median time from activation to cutting was 52min (IQR 40-72), and from cutting to bypass 40min (IQR 30-45). Sixteen patients (76.2%) were decannulated to a sustainable cardiac rhythm and survived 30-days.

Conclusion: An ECLS curriculum incorporating simulation and dedicated practice seems to have eliminated the potential learning curve associated with the introduction of a complex technology to a novice environment.

Keywords: Curriculum; Extracorporeal Life Support Organization (ELSO); Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Learning curve; Pediatric cardiopulmonary failure; Simulation; Training.

MeSH terms

  • Adult
  • Animals
  • Child
  • Curriculum*
  • Education, Medical, Continuing / methods*
  • Extracorporeal Membrane Oxygenation / education*
  • Female
  • Humans
  • Learning Curve*
  • Male
  • Middle Aged
  • Pediatrics / education*
  • Sheep
  • Simulation Training*
  • Swine