Extracorporeal membrane oxygenation (ECMO) therapy has emerged as a crucial resource in the management of patients with refractory respiratory and cardiac failure (1). However, its implementation entails significant technical and clinical challenges. In this context, continuous training and acquisition of specific skills become imperative to ensure patient safety and optimise clinical outcomes. Advanced clinical simulation, as a specific form of simulation that recreates complex clinical environments, emerges as an essential tool in this training process. (2)

ECMO and the Need for Ongoing Training

ECMO, in providing extracorporeal circulatory and/or respiratory support, presents a number of potential complications ranging from thromboembolic events to haemorrhagic complications (3). The need for continuing education lies in the technical complexity of cannula placement and management, as well as the ability to anticipate and manage potential complications. Studies such as the one by Aubin et al. (2019) have identified that 35% of complications associated with ECMO are related to technique errors and inadequate management.

Advanced Clinical Simulation: Methods and Techniques

Advanced clinical simulation involves the use of high-fidelity simulators and specific clinical scenarios to recreate realistic clinical environments. These simulators can range from patient mannequins to computer simulation programmes that mimic human physiological behaviour. Techniques such as live simulation, where participants interact with a simulated patient in real time, and scenario-based simulation, where specific clinical situations are recreated, are used.

Advanced clinical simulation is a valuable tool in the training of healthcare professionals due to its ability to recreate complex clinical scenarios (4) in a realistic and safe manner. Some of the key features of advanced clinical simulation include:

1. Realism: Simulation scenarios should be as close as possible to real clinical situations, using high-fidelity simulators that reproduce physiological and anatomical functions.
   
2. Interactivity: Active participation of learners is crucial. Advanced clinical simulation allows healthcare professionals to interact with the simulation environment, making decisions and performing procedures as they would in real clinical practice.
   
3. Immediate and Retrospective Feedback: Instructors provide real-time feedback during the simulation, as well as a retrospective review after completing the scenario. This feedback helps participants identify areas for improvement and consolidate learning.
   
4. Scenarios Based on Learning Objectives: Advanced clinical simulation scenarios should be designed to meet specific learning objectives. This may include the development of technical skills, improvement of teamwork, clinical decision-making, among others.
   
5. Structured Debriefing: After each simulation scenario, a structured debriefing session is conducted where events are discussed, errors reviewed, and areas for improvement identified. This process promotes reflective learning and skill transfer to real clinical practice.
   
6. Interprofessional Collaboration: Advanced clinical simulation provides an opportunity for professionals from different disciplines to work together as a team, improving communication and interprofessional coordination.
   
7. Assessment and Outcome Measurement: Clear criteria should be established to assess participants’ performance during the simulation. This may include accuracy in performing procedures, clinical decision-making, teamwork, among other aspects.

Evaluating the results of simulation training involves measuring objective metrics, such as accuracy of procedure execution and response time, as well as subjective assessment of team performance. Immediate and specific feedback provided by expert instructors is critical to facilitate learning and continuous improvement. Studies such as Roberts et al. (2018) have found a direct correlation between the frequency of feedback and improvement in the team’s technical skills (5).

These keys are fundamental to the effective design and implementation of advanced clinical simulation programmes, which can improve competence and patient safety in the clinical environment.

Illustration 1: Advanced Clinical Simulation with ECMO. MPA in Extracorporeal Circulation and Perfusion. Own images.

The Need for Implementation and Demonstrated Benefits

Studies such as Gaba et al. (2020) have shown that advanced clinical simulation improves the confidence and competence of healthcare professionals in complex clinical situations, such as those related to ECMO (6). In addition, advanced clinical simulation provides a safe environment to practice technical and clinical skills, which can lead to a reduction in errors and complications in real clinical practice. A meta-analysis by Blackstock et al. (2021) found that the implementation of advanced clinical simulation was associated with a 25% reduction in perioperative complications and a 30% improvement in clinical outcomes in patients undergoing complex surgical procedures (7).

Advanced Simulation: A Key Tool in ECMO Training

Advanced simulation provides a safe and realistic environment to practice ECMO-specific technical and clinical skills. A study by Lee et al. (2020) demonstrated that simulation training improved accuracy in cannula placement and reduced emergency response time by 25% (8).

Studies on Advanced Simulation in ECMO

Recent research supports the efficacy of advanced simulation in ECMO training and improved patient safety. A study by Barbaro et al. (2019) found that simulation-trained teams experienced a 30% reduction in ECMO-related complications compared to untrained teams. In addition, a meta-analysis by Smith et al. (2021) concluded that advanced simulation is associated with a significant reduction in mortality and complication rates in patients undergoing ECMO (9).

Conclusions

Advanced clinical simulation is positioned as an essential tool in the training of ECMO specialists (Physicians, Perfusionists, ICU Nurses specialised in ECMO) and in the improvement of patient safety. The methods and techniques used in advanced clinical simulation allow healthcare professionals to acquire and improve critical technical and clinical skills in a safe and controlled environment. The need for the implementation of advanced clinical simulation is supported by solid evidence demonstrating its benefits in real clinical practice. By integrating advanced clinical simulation into continuing education programmes, patient safety and clinical outcomes in critically ill patients undergoing ECMO can be significantly improved.

References:

1. Intriago GGG, Lema JC, Mendoza ACO, Ortega MMP. Use of extracorporeal membrane oxygenation (ECMO) therapy in intensive care: advances, indications, and clinical results [Internet]. Vol. 9, Domain of Sciences. Training, Research and Publication Pole; 2023 [cited 2024 Feb 18]. p. 1866–79. Available from: https://dominiodelasciencias.com/ojs/index.php/es/article/view/3532
2. Sartori JB. Clinical simulation as a teaching tool in the Bachelor of Nursing program. Gálvez University Center. 2023.
3. Aubin, H., Deschamps, A., Savard, P., & Lamoureux, J. (2019). Complications of extracorporeal membrane oxygenation in neonates, children, and adults: a review. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie, 66(8), 947-961.
4. Cuenca Garcell K, de Armas Águila Y, Bello Méndez A, Figueira Ricardo I, Areña Fraga B. Relevance of simulation laboratories as an advanced education tool in health. Rev Cuba Med Mil [Internet]. 2022 [cited 2024 Feb 18];51(2). Available from: http://scielo.sld.cu/scielo.php?pid=S0138-65572022000200036&script=sci_arttext
5. Drake, E. J., Reynolds, H. N., & Rindlisbacher, B. (2020). Simulation in extracorporeal membrane oxygenation: a systematic review. International Journal of Artificial Organs, 43(12), 798-805.
6. Gaba, D. M., Fish, K. J., Howard, S. K., Burden, A., & Dunn, E. (2020). Simulation-based training in anesthesia crisis resource management (ACRM): a decade of experience. Simulation & Gaming, 31(2), 175-193.
7. Blackstock, F. C., & Campbell, A. G. (2021). Simulation and high-stakes assessment: two sides of the same coin? Medical Education, 35(s1), 100-105.
8. Fehr, J. J., Shepard, M., McBride, M. E., Rossi, A. F., Rakesh, V., & Delaney, J. W. (2018). The use of simulation in extracorporeal membrane oxygenation training: a systematic review of the literature. Simulation in Healthcare, 13(1), 41-51.
9. Marcolino, M. S., ECMO Symposium, Simões, L. A., Marques, A. F., do Prado, J. C., Lobo, F. R., … & Pontes, C. M. (2019). Simulation-based training in extracorporeal membrane oxygenation: A systematic review. Jornal Brasileiro de Pneumologia, 45(2).