ABSTRACT
Rescue Extracorporeal Life Support Programs based at non-cardiac surgery centers have unique needs to be able to ensure successful outcomes despite low patient volumes. In this paper we describe the important role simulation had in each stage of development, implementation, and maintenance of our pediatric Rescue ECLS Program. Systems-focused simulations were used to develop robust workflows, processes, and bundles. Simulation-based education targeted the acquisition and maintenance of clinical skills for individual team members, bringing together a multidisciplinary team of local clinicians who do not routinely perform pediatric cannulation related tasks. Translational simulation ensured continued improvement by addressing adverse events or latent safety threats observed during system-focused or educational simulations. Realism of all simulations was our priority, and was achieved through in situ simulations, participation of multidisciplinary teams, use of real equipment and medical supplies, and use of a high-fidelity cannulation manikin. This holistic simulation approach allowed us to overcome the barriers to high quality care, and maintain outcomes comparable to high volume centers. A similar approach can help other centers design simulation for their own Rescue ECLS Program, and can be translated to other high-risk and high-acuity critical care programs.
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.
