Validation of a Training Model for Austere Veno-Venous Extracorporeal Membrane Oxygenation Cannulation and Management

Veno-venous extracorporeal membrane oxygenation (VV ECMO) is used in trauma patients with pulmonary injury in the acute setting. The United States Military has an advanced ECMO transport and management capability; however, future conflicts may require forward prolonged casualty care (PCC). Special Operations Surgical Teams (SOSTs) provide damage control surgery, resuscitation, and PCC in forward, unregulated, multidomain environments. We hypothesize that SOSTs can be trained to cannulate and manage patients requiring VV ECMO.

We developed a 2.5-day course using knowledge assessments (25 questions), self-assessments (5-point Likert scale, moderate confidence=3), and instruction checklists. The instruction checklists were used to assess performance during final evaluation with Yorkshire swine (Sus scrofa) models. Data were tested for normality, and statistical significance was defined as P<.05.

Twelve qualified SOST personnel completed the training. Four participants reported previous ECMO clinical exposure, and none reported formal ECMO training. When comparing pre- and post-course knowledge assessment scores, there was a significant improvement in overall scores (12.5 vs. 20.6, P<.001). The number of participants who self-reported at least moderate confidence in cognitive (2.8 vs. 11.3, P<.001), technical (1.2 vs. 11.6, P<.001), and behavioral (2 vs. 12, P<.001) aspects of VV ECMO set-up, cannulation, and management increased. Each team successfully set up, cannulated, and managed models with lights on and in darkness.

In a cohort of United States Air Force SOST personnel, using a modified training curriculum with 2-hour, hands-on validation testing improved self-assessment and knowledge assessment scores in performing VV ECMO. Given the rise of extracorporeal support use in the care of medical and trauma patients and the possibility of PCC in the military population, forward VV ECMO training and sustainment should be studied further.