A Simulation Curriculum for Ground and Air ECMO Transport

The use of extracorporeal membrane oxygenation (ECMO) for cardiopulmonary failure is increasing. ECMO transport teams are needed to expand patient access. Our goal was to design and implement a simulation curriculum for an ECMO transport team.

Using Kern's model, we developed a curriculum, built an ECMO protocol, and performed a pilot simulation. We conducted a needs assessment survey to evaluate presimulation confidence performing ECMO transport procedures using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). We used the results to refine a simulation script encompassing transport logistics, ambulance and aircraft loading/unloading, and emergencies. A simulation mannequin with attached ECMO circuit and all necessary equipment was used to simulate transfer of patients receiving ECMO and to ensure learners could manage in-flight emergencies. After implementation, we distributed a postsimulation survey to assess changes in confidence.

The needs assessment was implemented for four physicians, five ECMO specialists, and 11 flight nurses. The needs assessment revealed 95% of respondents were ECMO transport novices. Mean confidence scores for transporting an ECMO patient were low (3.4). The finalized simulation was implemented for 10 members, eight of which completed the needs assessment and postsimulation surveys. Confidence scores improved overall (3.0 to 4.3) and for emergency procedures: air entrainment (3.0 to 4.6), pump failure (3.3 to 4.6), patient loading/unloading (2.8 to 4.1), and use of transport protocols/checklists (3.5 to 4.8).

We successfully developed a simulation-based ECMO transport curriculum, which resulted in enhanced confidence in multiple aspects of ECMO transport.