Evaluating the introduction of extracorporeal life support technology to a tertiary-care pediatric institution: Smoothing the learning curve through interprofessional simulation training

doi:10.1016/j.jpedsurg.2015.02.037

Journal of Pediatric Surgery

Volume 50, Issue 5, May 2015, Pages 798-804

https://doi.org/10.1016/j.jpedsurg.2015.02.037 Get rights and content

Abstract

Background

Extracorporeal life support (ECLS) is a life-saving technology for the critically ill child. Our objective was to evaluate the outcomes of an educational curriculum designed to introduce an ECLS program to a noncardiac pediatric surgical center.

Methods

An interdisciplinary curriculum was developed consisting of didactic courses, animal labs, simulations, and debrief sessions.

We reviewed all patients requiring ECLS between October 2011 and December 2013. All health care practitioners involved in the ECLS training curriculum were surveyed to evaluate their perception of the educational program. Primary outcomes include successful cannulation and 30-day survival.

Results

The knowledge and confidence improved with statistical significance (p < 0.0001–0.0003) for all of the components of the training curriculum. The highest score was given to the simulations. Twenty-one patients underwent cannulation. All patients were successfully cannulated to bypass, including six (28.6%) ECPR. Median time from activation to cutting was 52 min (IQR 40–72), and from cutting to bypass 40 min (IQR 30–45). Sixteen patients (76.2%) were decannulated to a sustainable cardiac rhythm and survived 30-days.

Conclusion

An ECLS curriculum incorporating simulation and dedicated practice seems to have eliminated the potential learning curve associated with the introduction of a complex technology to a novice environment.

Section snippets

Study design

Perception of the educational curriculum was assessed by survey of all healthcare providers taking part in ECLS (physicians – pediatric-intensivists, cardiologists, and surgeons; nurses, respiratory therapists and perfusionists). Survey questions were generated through a multiple iterative process (MB, SL) to identify key elements of educational inquiry. The survey included demographic factors such as respondent age, gender, specialty and ECLS experience, as well as questions regarding the

Educational results

Fifty-six healthcare professionals were invited to participate in the survey. Survey response rate was 71.4% (n = 40). Table 1 depicts the demographics of those surveyed. Prior to the training program, the majority of the respondents had been involved with less than 10 ECLS cases. Since the onset of the program, 57.5% (n = 23) have been involved in 1–5 ECLS cases.

Summary data for knowledge and confidence are presented in Fig. 1, Fig. 2, respectively. All educational components had a statistically

Discussion

Traditional training through apprenticeship models fails when cases are infrequent and there is global lack of team expertise. The Extracorporeal Life Support Organization (ELSO) suggests that institutions developing ECLS programs provide didactic lectures, water-drills (ECLS circuit training) and animal-labs to obtain proficiency [2]. The concept of dedicated practice and improved performance is supported across multiple domains of expertise [6]. Simulation-based training has been shown to

Acknowledgments

We would like to thank the Alberta Children's Hospital's operating room and PICU nurses for their support and hard work during these challenging procedures. We would also like to thank Dr. Luis G. Quiñonez, Dr. Laurance Lequier, and Don Granoski (Stollery Children's Hospital) for their help in educating our staff.

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CAPS PaperEvaluating the introduction of extracorporeal life support technology to a tertiary-care pediatric institution: Smoothing the learning curve through interprofessional simulation training

Abstract

Background

Methods

Results

Conclusion

Section snippets

Study design

Educational results

Discussion

Acknowledgments

Semin Perinatol

Aust Crit Care

J Thorac Cardiovasc Surg

ECLS Registry Report: International Summary

ECMO Specialist Training Manual

Extracorporeal Life Support Organization

Human error: models and management

BMJ

Deliberate practice and acquisition of expert performance: a general overview

CAPS Paper
Evaluating the introduction of extracorporeal life support technology to a tertiary-care pediatric institution: Smoothing the learning curve through interprofessional simulation training