Revolutionizing ECMO simulation with affordable yet high-Fidelity technology

Abstract

Simulation-based training (SBT) is becoming a necessity in educating healthcare professionals who work in high-risk environments, such as the intensive care unit (ICU) [1]. This applies to extracorporeal membrane oxygenation (ECMO), a complication-burdened life support ICU modality employed to treat patients with circulatory and/or respiratory failure. Additionally, ECMO can quickly restore perfusion, and hence, used in the pre-hospital or emergency setting as an extracorporeal cardiopulmonary resuscitation (E-CPR) strategy or to maintain donors' organs after circulatory death [2], [3]. Different ECMO simulation models have been reported in the literature. It ranges from simple mannequin and circuit modification with manual control [3], [4], to hydraulically capable, remotely controlled mannequins [5], [6], and high-fidelity simulators [7]. However, the common factor in the incumbent practices is the reliance on a functioning ECMO console and circuit components, which introduces a colossal cost barrier and requires active spending to replace ECMO consumables [8]. Reliance of such specialized and potentially scarce pieces of equipment also significantly reduces training opportunities. Furthermore, attempts to improve the simulation paradigm are faced with ever-increasing technical difficulties. For example, basic objectives such as controlling the displayed circuit pressures require creating a sophisticated hydraulic model. It becomes even more problematic when considering higher level objectives such as simulating blood oxygenation color differentials, or remotely controlling blood gas parameters, displayed on in-line monitors. Hence, there is a need for lower cost, high-fidelity simulation systems with more customization capabilities that meet the expectations and increasing demand for ECMO therapy [9].