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The Utility of High-Fidelity Simulation for Training Critical Care Fellows in the Management of Extracorporeal
Bishoy M Zakhary1, Lily M Kam, Brian S Kaufman
11Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University School of Medicine, New York, NY.2Department of Anesthesiology, New York University School of Medicine, New York, NY.3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Veteran's Administration New York Harbor Healthcare System, New York, NY.
Objective:
Although extracorporeal membrane oxygenation volume has increased, proficiency in the technology requires extensive training. We compared traditional water-drill-based extracorporeal membrane oxygenation training with simulation-based extracorporeal membrane oxygenation training with the hypothesis that simulation-based training is superior.
Design:
Randomized controlled trial.
Setting:
Academic medical center.
Subjects:
Pulmonary/critical care fellows.
Interventions:
Participants had a preintervention simulated extracorporeal membrane oxygenation emergency (Sim1-recirculation) then randomized into simulation and traditional groups. Each group participated in three teaching scenarios, via high-fidelity simulation or via water-drills. After 6 weeks and after 1 year, participants returned for two simulated extracorporeal membrane oxygenation emergencies (Sim2-pump failure and Sim3-access insufficiency). Sim2 was a case encountered during teaching, whereas Sim3 was novel. A critical action, necessary for resolution of each scenario, was preidentified for timing.
Measurements And Main Results:
Primary outcome was time required to perform critical actions. Twenty-one fellows participated in the study (simulation, 10; traditional, 11). Groups had similar scenario scores (p = 0.4) and times to critical action (p = 0.8) on Sim1. At 6 weeks, both groups had similar scenario scores on Sim2 (p = 0.5), but the simulation group scored higher on Sim3 (p = 0.03). Times to critical actions were shorter in the simulation group during Sim2 (127 vs 174 s, p = 0.004) and Sim3 (159 vs 300 s; p = 0.04). These findings persisted at 1 year.
Conclusions:
In novice critical care fellows, simulation-based extracorporeal membrane oxygenation training is superior to traditional training. Benefits transfer to novel scenarios and are maintained over the long term. Further studies evaluating the utility of simulation in other learner groups and for maintenance of proficiency are required.