Comprehensive Healthcare Simulation: ECMO Simulation: A Theoretical and Practical Guide

Foreword
Preface
Contents
Contributors
Part I: History of ECMO & ECMO Simulation
	1: ECMO from Conception to Execution
		Introduction
		Birth of an Idea
		Development of Perfusion Technology
		Conclusions
		References
	2: Simulating ECMO: Rationale and Genesis
		Rationale for Simulating ECMO
		Genesis of ECMO Simulation
		Core Developmental Strategies
		Lessons Learned
		Human and System Performance Assessment During ECMO Simulation
		Program Assessment
		Looking to the Future (The Future Is Now)
		Summary
		References
Part II: Educational Theory Behind ECMO Simulation
	3: The Critical Role of Simulation in ECMO Education
		Introduction
		Simulation in Medical Education
			Adult Learning Theory
			Andragogy
			Social Learning Theories
			Constructivism
			Cognitivism
			Transformative
			Experiential
			Procedural Skills Training
		Simulation in Medical Education
		Simulation as Part of an Overarching ECMO Educational Curriculum
			Creation of Goals and Objectives Based on Institutional Needs
			Use of Simulation for Low-Frequency, High-Risk Events and Review of Rare Cases
			Use of Simulation for Implementation of Programmatic Changes
			Creation of Goals and Objectives Based on Learner Population
			Matching Goals to Instructional Methods
			How to Incorporate Procedural/Technical Skills training into an ECMO Program
		Benefits of Simulation on Cognition
			Critical Thinking Under Stress
		Benefits of ECMO Simulation on IPE Teamwork
			Interprofessional
		Current ELSO guidelines for Simulation Training
			Potential Role for Simulation in Assessment of ECMO Providers
		Conclusion
		References
	4: A Conceptual Framework for Development of a Simulation-Enhanced ECMO Training Program: Use of a Zone-Based Framework
		Introduction
		Zone-Based Framework for Simulation-Enhanced Training
		Overall Framework for Simulation-Enhanced ECMO Training
		Development of Psychomotor Skills
		Development of Cognitive Skills
		Development of Teamwork Skills
		Summary
		References
	5: Brain-Based Learning
		Introduction
		Brain-Based Learning
		Conclusion
		References
	6: Designing an ECMO Simulation Curriculum
		Introduction
		Curriculum Development
		Components of an ECMO Simulation Curriculum
		Extracorporeal Cardiopulmonary Resuscitation
		Physiologic Framework for ECMO Complications
		ECMO Preload
		ECMO Pump “Contractility”
		ECMO Afterload
		Considerations
		Conclusions
		References
Part III: Technology for ECMO Simulation
	7: Innovations and Options for ECMO Simulation
		Introduction
		Definitions
		Foundational Knowledge and Skills Acquired Through Low Physical Resemblance, Low Functional Task Alignment Simulation
		Development of Psychomotor and Critical Thinking Skills
			Development of Surgical Cannulation Skills
			ECMO Team Development and Crisis Management
		Logistics of ECMO Simulation: A User’s Guide
			Equipment
		Technical Innovations for Simulation of ECMO Emergencies
			Personnel
			Space
		Conclusion
		References
	8: Physiologic Modeling
		Overview of the Chapter
			Introduction to Physiological Modeling
			Physiologic Modeling in ECMO Simulation
			Full Model-Driven and Hybrid ECMO Simulation
			Explanatory Models in ECMO Simulation
			Current Available Models for Use in ECMO Simulation
			Future of Physiological Modeling
		Introduction to Physiological Modeling
		Physiological Modeling in ECMO Simulation
		Full Model-Driven and Hybrid ECMO Simulation
		Explanatory Models in ECMO Simulation
		Current Available Models for Use in ECMO Simulation
		Future of Physiological Modeling
		Conclusion
		References
	9: Immersive Technologies in ECMO Simulation
		Introduction
			Definitions
		Immersive Technologies
			Augmented Reality (AR)
			Mixed Reality (MR)
			Virtual Reality (VR)
		The Psychology of VR Design
		Immersive Technologies in Healthcare
			Therapeutic Uses
			Clinical Use Cases
			Educational Use Cases
		Advantages and Disadvantages of the Immersive Technologies in Simulation
		Evidence Behind VR Simulation
		The Future of Immersive Technology in ECMO Simulation
		Summary
		References
Part IV: Other Topics for ECMO Simulation
	10: Interprofessional Education and ECMO Simulation
		Introduction
		Theory to Support Interprofessional Education
			Andragogy and IPE
			Transformative Learning and IPE
			Social Psychology and IPE
		Interprofessional Team Training
		Interprofessional Simulation for ECMO Teams
		A Practical Guide for Interprofessional ECMO Simulation
		Knows
		Knows How
		Shows
			Needs Assessment
			Learning Objectives
			Resources for IPE ECMO Simulation
			Scheduling for IPE ECMO Simulation
			Debriefing
		Does
		Conclusion
		References
	11: Optimizing ECMO Teams: What Every ECMO Educator Needs to Know About the Latest Advances in Team Science
		ECMO Simulation as the Ultimate Team Sport
		Simulation as a Lab to Study the Human Behavior of Teams
		Team Science and Relevant Team Processes
		From Teamwork to Teaming
		Coordination
		Team Sensemaking
		Solutions to Improve Human Performance in ECMO Teams
		Thinking of ECMO as a Multiteam System
		Team Reflexivity
		Psychological Safety
		Conclusion
		References
Part V: Practical Considerations
	12: Current Training Recommendations for ECMO Providers and Specialists
		Introduction
		Adult Learning and ECMO Training
		ECMO Provider Didactic Course
		ECMO Simulation Training
			Historical Perspective
		Considerations
			High- Versus Low-Technology Simulation
			In Situ Versus Simulation Lab
			Developing Simulation Scenarios
		Continuing Education of the ECMO Provider
		Novel Educational Strategies
		Conclusion
		References
	13: The Role of Simulation in Starting a New ECMO Program
		Introduction
		Considerations to Start a New ECMO Program
		Components of Curriculum for a New ECMO Center
			Overall Curriculum Design
			Didactic Sessions and Monthly Lectures
			Introduction of Complex Physiology and Hands-On Practice
			Design of the Simulation Curriculum: Circuit Labs
			Design of the Simulation Curriculum: High-Fidelity Simulation
			Operationalizing ECMO Training in a New ECMO Center: Establishment of Superuser Group and Training from Expert Center
			Dissemination of Simulation Training for Larger Audience
		Conclusions and Recommendations
		References
	14: Using Simulation to Develop an ECMO Transport Program
		Introduction
			ELSO Guidelines Regarding ECMO Transport
			Principles of ECMO Transport to Incorporate into Practical Simulation
		Transport Simulation Design
			Goals and Objectives
			Setting
			Equipment
		Transport Simulation Scenarios
		Conclusion
		References
	15: Debriefing ECMO Simulations: Special Considerations
		Introduction
		Debriefing Timing and Facilitation
		Debriefing Process Elements
			Essential Elements of Debriefing
			Conversational Techniques/Educational Strategies
			Debriefing Adjuncts
		Special Considerations for Debriefing ECMO Simulations
		Debriefing Training and Assessment
		Conclusion
		References
	16: Controversies on Certification of ECMO Practitioners Using Simulation
		The Need for Standardized ECMO Practitioner Certification
			The ECMO Practitioner
			Growth of ECMO Utilization
			Risks Associated with ECMO
			High-Risk, Low-Frequency Events
			Variability in ECMO Center Training and Center Volume
			Standardization
		The Role of Simulation in Certification
			Miller’s Model of Medical Competence
			Simulation in Medical OSCE
			Maintenance of Certification
			Simulation in the Neonatal Resuscitation Program (NRP), Pediatric Advanced Life Support (PALS), and Advanced Cardiac Life Support (ACLS)
		Controversies in Simulation-Based Certification of ECMO Practitioners
			ECMO Certification
			Defining Minimal Competency
			Differentiating Performance in Clinical Practice Versus in Simulation
			Lack of Evidence of the Efficacy of Simulation Training in Improving Patient Outcomes
			Buy-in from ECMO Centers
			Assessment of Multidisciplinary Team
			Instructors/Assessor Training
			Recertification Criteria
		Conclusion
		References
	17: Research in ECMO Simulation: A Review of the Literature
		Introduction
		ECMO Simulation for Training Providers
		Development of ECMO Simulation Equipment
		Evidence for Improvement in Knowledge and Skills
		Evidence of Improved Clinical Outcomes
		Conclusion
		References
	18: Faculty Development for ECMO Simulation
		ECMO Faculty Development for Simulation
		Evolution of Faculty Development
		Faculty Development for Simulation
		Theoretical Frameworks to Guide ECMO Simulation Faculty Development
			Situated Learning Theory
			Communities of Practice (CoP)
			Transformative Learning Theory
		Methodology (Approaches) of ECMO Simulation Faculty Development
			Formal Approaches
				Workshops/Seminars/Conferences/Short Courses
				Faculty Simulation Fellowships/Longitudinal Programs (6 Months–2 Years)
				Advanced Education
			Informal Approaches
				Work-Based Learning
				Peer Coaching and Feedback
				Professional Community of Practice (See Theory Section for Further Details)
				Mentorship
				Role Modeling
		Structure and Components of Simulation Faculty Development Program
			ECMO Faculty Development
			Development of a Simulation ECMO Faculty Development Course
		Faculty Assessment
		Future Directions and Sustainment
		Appendix 18.1: Simulation Faculty Program Example
		Appendix 18.2
		Appendix 18.3
		Appendix 18.4
		References
	19: Quality Improvement
		Introduction
		Background and Terminology
			Simulation
			Continuous Quality Improvement (CQI)
			Total Quality Management (TQM)
			Systems Thinking
		Quality Indicators: Benchmarking Performance and Optimizing Safety
			Benchmarking Performance
			Performance Management for Optimizing Safety
		Improving and Sustaining Performance
			Examples
			Sustaining Performance
		Summary
		References
Part VI: Special Considerations for Different ECMO Populations
	20: Neonatology
		Introduction/Chapter Overview
		Background
		Education Overview
		ECMO Curriculum/Scenario Design
		Participants in ECMO Sim
		Equipment Considerations for Neonatal ECMO Simulation
		Conclusions
		References
	21: ECMO Simulation in Infants, Children, and Adolescents
		Background
		Scope
		VA Versus VV ECMO? The Answer Lies in the Oxygen Delivery Equation
		Common Pediatric VA ECMO Indications
		Common Pediatric VV ECMO Indications
		Cannulation Considerations
		Pediatric ECMO Flows: Guidelines and Considerations
		Pediatric Anticoagulation/Hematologic Nuances
		Pediatric Vital Signs: One Size Does Not Fit All
		Systematic Approach to Develop, and Prioritize, the Most Appropriate Pediatric ECMO Simulations for Your Program
			Where Things Can Go Wrong: Common Pediatric ECMO Complications
			Recirculation in VV ECMO
			Where Things Can Go Wrong: Psychomotor Skills
			Where Things Can Go Wrong: Systems Processes
			Prioritizing Simulations for Your Program
		ECMO Simulation: High(er) Fidelity Is Not Necessarily Better – Just More Complicated
		Conclusion
		Appendix 21.1: Pediatric Age-Based Vital Signs, Typical ECMO Flows and Cannula Sizes
		References
	22: ECMO Simulation in Patients with Cardiac Disease
		Introduction
		Simulation Design and Setup
			ECMO Pump Type
			Cannulation Strategy – Anatomical Location and Implications
			Cannulation Strategy – Number and Dimensions
			Additional Cardiac and ECMO Circuit Monitoring
			Left Heart Decompression on ECMO
			Investigation for Cardiac Lesions Implicated in Cardiopulmonary Failure
		Simulation of Complex Cardiac Anatomy and Physiology
			Biventricular Circulation
			Acute Coronary Syndromes, Myocardial Infarction, and Pulmonary Embolism
			Acute Coronary Syndromes and Myocardial Infarction
				Aortic Balloon Pumps/Impella
			Single-Ventricle Circulation
				Bidirectional Glenn Circulation
		ECPR
		Cardiovascular Care Microsystems
		Conclusions
		References
	23: Surgical Considerations
		Introduction
		Simulation Techniques
		ECLS Scenarios in a Surgical Context
		Human Factors in ECLS Team Training
		Summary
		References
	24: Nursing Aspects of ECPR and ECMO Training
		Introduction
		Description of SimZones
		Zone 0 Foundational Training with Simulation
		Creating Psychological Safety
		Zone 1 Foundational Instruction
		Zone 2 Acute Situational Instruction
		ECMO-Specific Prerequisite Training
		Zone 3 Team and Systems Development Training
		Zone 4 Real-Life Debriefing and Development
		Ongoing Education
		Conclusion
		References
	25: ECMO Simulation in the Adult Population – Proning, Awakening and Breathing Trials, and Mobilization
		Introduction
		Overview of Prone Positioning (PP) and Mobilization on ECLS
			Prone Positioning (PP) for Adult Respiratory Distress Syndrome (ARDS)
			Emerging from Sedation and Mobilization on ECLS
		Simulation Design for Proning, SAT/SBT, and Mobilization on ECLS
		Conclusion
		Appendix 25.1: Proning Protocol of a Mechanically Ventilated Patient
			Appendix A: Figures
			Appendix B: Potential Complications of Prone Positioning and Interventions
			Appendix C: CPR on a Prone Patient
		Appendix 25.2
		Appendix 25.3: Mobilization on ECLS
		Bibliography
	26: The Role of Simulation in Training of ECMO Specialists
		Introduction
		Utilization of ECMO Simulation Technology to Assist Learning of the ECMO Specialist
		ECMO Specialist Training
			Phase I: 12 Hours of Didactics
			Phase II: 4 Hours of Hands on Wet Drills
			Phase III: 12 Hours of Proctoring
			Phase IV: Testing and Certification
			Phase V: Continuing Education
		Advancement of Simulation for Training of ECMO Specialists
			Technology
			Cost
			Environment and Equipment
			Circuit-Centered Emergency Scenarios
			Team-Based Approach
		Conclusion
		References
Part VII: Practical Guide
	27: A Practical and Pictorial Guide for Creating ECMO Simulation
		Introduction
		Basic Simulation: Water Drills
		Manikin-Integrated Simulation
			Circuit Obstruction/Thrombosis
			Air Entrainment
			Bleeding
		Preparation for Cannulation/Extracorporeal Cardiopulmonary Resuscitation (eCPR)
		Conclusion
		References
Index