Simulation training on bedside veno-arterial extracorporeal membrane oxygenation decannulation

Area of Science:

• Cardiovascular Medicine
• Medical Devices
• Surgical Innovation

Background:

• Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides mechanical circulatory support for severe heart failure.
• Decannulation from VA-ECMO requires repair of the arteriotomy site, traditionally managed with open surgery.
• Arteriotomy repair presents challenges, including bleeding and infection risk.

Purpose of the Study:

• To evaluate the feasibility and safety of using percutaneous vascular closure devices for arteriotomy repair after VA-ECMO.
• To explore the potential benefits of this novel technique in terms of efficiency and patient outcomes.
• To describe the training requirements and logistical considerations for implementing bedside percutaneous closure.

Main Methods:

• Application of percutaneous vascular closure devices (ProGlide) for arteriotomy closure post-VA-ECMO.
• Comparison of percutaneous closure with conventional open surgical repair.
• Emphasis on simulation-based training for staff and team logistics.

Main Results:

• The ProGlide technique for VA-ECMO arteriotomy closure was demonstrated to be safe.
• Percutaneous closure resulted in smaller wounds compared to open repair, potentially reducing infection risk.
• The technique may offer savings in time and manpower.

Conclusions:

• Percutaneous bedside closure of VA-ECMO arteriotomy sites is a viable and safe alternative to open repair.
• Successful implementation requires meticulous planning, specialized training, and a well-coordinated team approach.
• Simulation-based training is crucial for mastering this technique and ensuring patient safety.