Designing and maintaining a rescue extracorporeal life support program: A holistic simulation approach

Area of Science:

• Medical Simulation
• Pediatric Critical Care
• Extracorporeal Life Support

Background:

• Rescue Extracorporeal Life Support (ECLS) programs at non-cardiac surgery centers face challenges due to low patient volumes.
• Ensuring successful outcomes requires tailored strategies for program development, implementation, and maintenance.

Purpose of the Study:

• To describe the integral role of simulation in establishing and sustaining a pediatric Rescue ECLS program.
• To demonstrate how simulation can overcome barriers to high-quality care in low-volume settings.

Main Methods:

• Utilized systems-focused simulations to develop workflows, processes, and care bundles.
• Employed simulation-based education for clinical skill acquisition and maintenance in multidisciplinary teams.
• Incorporated translational simulation to address adverse events and safety threats.
• Prioritized realism through in situ simulations, multidisciplinary participation, and high-fidelity manikins.

Main Results:

• The holistic simulation approach facilitated the development of robust ECLS program infrastructure.
• Simulation-based education enhanced the skills of clinicians not routinely performing pediatric cannulation.
• Continuous improvement was achieved by addressing identified safety concerns through translational simulation.
• The program maintained outcomes comparable to high-volume ECLS centers.

Conclusions:

• A comprehensive simulation strategy is effective for developing and maintaining pediatric Rescue ECLS programs in low-volume centers.
• This simulation model can be adapted for other high-risk, high-acuity critical care programs.
• Simulation is key to overcoming challenges and achieving high-quality outcomes in specialized critical care.