“Bridging the Gap” international ECLS training and simulation - evaluation of the 10th educational corner on EuroELSO congress 2022 in London,United Kingdom

Abstract

Introduction: Simulation training offers an authentic team-based learning opportunity without risk to real patients. The Educational Corner at the annual congress of the European Branch of Extracorporeal Life Support Organisation (EuroELSO) provided an opportunity for multiple simulation training sessions facilitated by experts from all over the world.

Aim: We aimed to review the educational impact of EuroELSO Educational Corner and whether it provides a quality ECLS training to a wide spectrum of multidisciplinary international attendees utilising high and low fidelity simulation, workshops and hands on sessions.

Methods: During the congress, 43 sessions were conducted dedicated to ECLS education with identified educational objectives. The sessions focused on management of adults and children on V-V or V-A ECMO. Adult sessions covered emergencies on mechanical circulatory support with management of LVAD and Impella, managing refractory hypoxemia on V-V ECMO, emergencies on ECMO, renal replacement therapy on ECMO, V-V ECMO, ECPR cannulation and performing perfect simulation. Paediatric sessions covered ECPR neck and central cannulation, renal replacement on ECMO, troubleshooting, cannulation workshop, V-V recirculation, ECMO for single ventricle, PIMS-TS and CDH, ECMO transport and neurological injury.

Results: The Educational Corner was attended by more than 400 participants over the two congress days. Majority of responders (88%) reported that training sessions met the set educational goals and objectives and that this would change their current practice. Almost all (94%) reported that they received useful information and 95% would recommend the session to their colleagues.

Conclusion: The Educational Corner, as an integral component of the annual EuroELSO congress, achieved the set educational goals and provided quality education based on the recipient survey. Structured multidisciplinary ECLS education with standardised curriculum and feedback is an important key step in delivering quality training to an international audience. Standardisation of European ECLS education remains an important focus of the EuroELSO.

Keywords

education extracorporeal membrane oxygenation extracorporeal life support extracorporeal cardiopulmonary resuscitation mechanical life support

Introduction

Simulation for extracorporeal life support (ECLS) has become an important modality for education of the multidisciplinary ECLS care team. ECLS care is delivered by teams of providers, therefore establishing optimal educational strategies requires considerations of interprofessional collaboration, communication, and teamwork. Simulation-based training for ECLS has emerged as a valuable tool offering the opportunity to improve technical skills^1–5 and reduce the risk of human errors⁶ potentiating training to an individual team member along with the whole interdisciplinary team, and it has found to be superior to traditional training.⁷ An integration of both clinical and nonclinical skills is important to improve survival and complications in the high risk and complex patients that require ECLS.⁸ Simulations can be provided in different environments: directly in hospitals (in situ, on site), in dedicated facilities (simulation rooms) or, on occasion, at scientific meetings, thus taking advantage of the delegates’ motivation.⁹

The Educational Corner has been an integral part of the European branch of Extracorporeal Life Support Organisation (EuroELSO) - annual congress since the first meeting in Rome, Italy in 2012.⁹ The Educational Corner is an area dedicated to active learning and training providing well organised high-quality simulation sessions, hands on sessions and didactic teaching focusing on the acquisition of both technical and behavioral skills facilitated by experienced experts from all over the world. It allows attendees to consolidate knowledge about ECLS alongside the congress activities. Historically, sessions organised by Educational Corner have been well attended with excellent structured feedback with the number of participants increasing each year. It is therefore key to develop structured ECLS courses and educational programs within EuroELSO.⁹ Based on this, we aimed to review the impact of Educational Corner and whether it provides a quality ECLS simulation training to a wide spectrum of multidisciplinary international attendees utilising high and low fidelity simulation, workshops and hands on sessions.

Methods

The 10th EuroELSO Congress took place in London, United Kingdom in May 2022 and the Educational Corner was held during two main congress days. Previous Educational Corner feedback from 2019 was considered whilst planning for the sessions.⁹ Feedback from 2019 was positive with recommendations to expand the Educational Corner to two full days through the length of the congress. During Educational Corner, a total of 43 sessions, 32 adult and 11 paediatric, took place in four different rooms. Each room hosted six sessions on 5th May and five sessions on 6th May with extensive educational programme. The topics for the simulations were advertised in advance on the EuroELSO website and via EuroELSO social media channels with outlined learning objectives, allowing the congress delegates to select and sign up for specific simulations (Table 1). The overall goals of the sessions were to increase knowledge base and competencies in managing adult and paediatric patients. Adult sessions covered emergencies on mechanical circulatory support with management of LVAD and Impella (Abiomed, Danvers MA, USA.), managing refractory hypoxemia on V-V ECMO, membrane failure and circuit change on ECMO, renal replacement therapy/plasmapheresis on ECMO, troubleshooting V-V ECMO, ECPR cannulation and sessions about performing of perfect simulation. Paediatric sessions covered ECPR neck cannulation, ECPR central cannulation, renal replacement on ECMO, troubleshooting, ECMO cannulation workshop, V-V recirculation, ECMO for single ventricle, ECMO in Paediatric Inflammatory Multisystem Syndrome Temporarily Associated with SARS CoV-2 (PIMS-TS), ECMO for CDH, ECMO transport and neurological injury on ECMO.

Table 1.

Educational corner programme.

MCS: mechanical circulatory support; ECMO: extracorporeal life support; LVAD: left ventricular assist device; V-V: veno-venous; CRRT: continuous renal replacement therapy; ECLS: extracorporeal life support; ECPR: Extracorporeal Cardiopulmonary Resuscitation; IHCA: in hospital cardiac arrest; OHCA: out of hospital cardiac arrest.

Educational Corner provided three sessions on performing a perfect simulation and helped developing adequate multidisciplinary teamwork skills whilst managing patients on mechanical life support. The sessions were facilitated by international, highly experienced faculty dedicated to education and training using various educational modalities. (Table 2). The leaders of the sessions and majority of the faculty had a formal medical simulation certificate. Each session had at least two formally certified debriefers present during simulations. Other members of the faculty were selected on their experience and special expertise.

Table 2.

Advanced sessions facilitated by international, highly experienced trainers.

Title and number of the sessions	Trainers
Emergencies on mechanical circulatory support Six sessions	Alex Rosenberg Waqas Akhtar Sofia Da Costa Pinto Emanuele Gerlando	Chris Bowles Olaf Maunz Joe Hughes Agnieszka Wypych
Managing refractory hypoxemia on V-V ECMO Seven sessions	Ibrahim Fawzy Hassan Abdul Salam Saif Ali Ait Hssain
Membrane Failure and Circuit Change on ECMO Four sessions	Chris MeadowsDan TaylorPeter SherrenStephen TricklebankNicholas IoannouNicola AgnewNigel Gooby	Kath DalyMaria LozinskiSimon BatemanCharlotte BelmonteCatherine WhitleyCarl Von Dutch
Renal replacement therapy/plasmapheresis on ECMO Seven sessions	Jo-Anne FowlesKerry Pooley	Andrew Hadley-BrownLaura Bowden
How to perform perfect simulation Two sessions	Justyna SwolMarek Dąbrowski	Sebastian StefaniakMateusz Puslecki
Troubleshooting V-V ECMO Three sessions	Justyna SwolMarek Dąbrowski	Sebastian StefaniakMateusz Puslecki
ECPR cannulation Three sessions	Justyna SwolMarek Dąbrowski	Sebastian StefaniakMateusz Puslecki
Adventure in paediatric ECMO Eleven sessionsECPR neck cannulationECPR central cannulationCRRT on ECMOTroubleshootingECMO Cannulation WorkshopV-V recirculationECMO for Single VentricleECMO PIMS-TS (MIS-C)ECMO for CDHECMO TransportNeurological injury on ECMO	Mirjana CvetkovicMaura O’CallaghanAparna HoskoteMatteo Di NardoVelia Marta AntoniniAjay DesaiAlex RobertsonAlice HutinArun BeemanChris HarveyGiacomo CavallaroGillian WylieHannah Staines	Heidi DaltonJon LillieLars Mikael BromanLindsey PulfordMalaika MendoncaMarisa VieiraPeter P. RoeleveldRavi ThiagarajanRobert Jan HoumesRoberto ChilettiSylvia BeldaUri Polak

ECMO: extracorporeal life support; V-V: veno-venous; ECPR: extracorporeal cardiopulmonary resuscitation; CRRT: continuous renal replacement therapy; PIMS-TS: Paediatric Inflammatory Multisystem Syndrome Temporarly Associated with SARS CoV-2; MIS-C: Multisystem inflammatory syndrome in children; CDH: congenital diaphragmatic hernia.

All the sessions were set up according to the recognised simulation standards in non-threatening learning environment.¹⁰ All the simulations and hands-on sessions were inspired by previous face to face Educational Corner in 2019⁹ using the principle of the suspension of disbelief to help the attendees learn using scenarios similar to their clinical practice though in a controlled environment.^6,11 Each session started with briefing introduction where the trainers and trainees were presented, followed by explanation of the learning objectives and then an introduction to scenario to ensure engagement and active participation (Figure 1). Confidentiality was highlighted both for participants and cases discussed. The sessions lasted between 60 and 90 min and covered one or two topics. Trainers were observing the sessions facilitating the requirements of attendees. Time for questions was allocated during and after the sessions. Sessions were built to cover not only technical skills but also behavioral skills maintaining professionalism during teamwork, leadership, call for help, closed loop communication, utilization of available resources etc. Sessions utilised high and low fidelity simulation mannequins, hands on sessions (Figure 2) Majority of the sessions 28 (65%) were simulation based, whilst 15% were hands-on workshops. At the end of each session, a debriefing was performed addressing clinical questions and teamwork, followed by a conclusion and feedback from the participants. A specially tailored questionnaire evaluating the quality of the simulation session was developed by the Working Group for Education of the EuroELSO (appendix 1). The aim was to evaluate the impact of this learning strategy on the attendees using a dedicated questionnaire after each simulation session. The questionnaire included three open-ended questions (with an option for a free response for suggestions and ideas) and five closed-ended questions with response options of ‘yes’, ‘somewhat’ or ‘no’, referring to the educational goals (Table 3). The questionnaire was distributed and collected by congress organisers.

Table 3.

Feedback form.

Question	Answer
1. Have you received useful information during this workshop?	Yes/Somewhat/No
2. Will it change your current practice?	Yes/Somewhat/No
3. Did the workshop meet the set educational goals & objectives?	Yes/Somewhat/No
4. Do you have suggestions to improve the efficacy of the workshop you attended?	Free text
5. Would you recommend the workshop you participated to your colleagues?	Yes/Somewhat/No
6. Are there any new topics you would like to see included at the Educational Corner of the next EuroELSO Conferences?	Free text
7. Do you consider the Educational Corner – being a practical approach towards ECLS-related techniques – an important part of the EuroELSO annual meeting?	Yes/Somewhat/No
8. Do you have any other recommendations for future EuroELSO Educational Corner workshop?	Free text

ECLS: extracorporeal life support; EuroELSO: Educational Corner within European Chapter of Extracorporeal Life Support Organisation.

Data analysis

All the data from the completed questionnaires were analysed using an Excel form (Microsoft™ Office Standard Excel version 2016) calculating the numbers, percentages and evaluating free text responses.

Results

The EuroELSO Congress 2022 in London, United Kingdom, was widely attended by 1225 face to face and 175 online international participants from 56 countries. The Educational Corner was attended by more than 400 participants (approximately 33% of face-to-face participants) over the two main congress days. During 43 sessions we collected 107 (approximately 27%) evaluation forms. The feedback for one session (CRRT on ECMO) were misplaced and consequently this session could not be analysed. On feedback form, one session was missing (Membrane Failure and Circuit Change on ECMO) and could not be added to the results. Out of 107 responders, 101 (94%) stated that the Educational Corner was an important part of the EuroELSO annual meeting providing a practical approach to Extracorporeal Life Support (ECLS) related techniques.

The majority of responders 94 (88%) acknowledged that training sessions within Education Corner met the set educational goals & objectives for all sessions (Figure 3). The comments were positive - 101 (94%) responders received useful information during Educational Corner, whilst the vast majority 102 (95%) of responders would recommend the workshop to their colleagues. Importantly, 94 (88%) stated that the workshops would change their current practice in both adult and paediatric settings (Figure 4). The session about troubleshooting V-V ECMO had 69% positive feedback. The participants stated in the free text that there was a time pressure to finish the scenarios and that the groups were large. The sessions about managing refractory hypoxemia had 59% positive feedback. Several participants stated in the free text that the time for simulation was limited. The responses to the five closed questions were extrapolated and compared (Figure 5). In the free text, participants commented that sessions simulating practical aspects, problem solving and emergency ECLS management, for example circuit emergencies, troubleshooting, complications on V-V and V-A ECMO were the most desirable.

Participants reported several potential suggestions for improvement for future sessions requesting more time for comprehensive case-based simulations, use of ultrasound for ECMO cannulations and providing workshop material and treatment algorithms. Furthermore, 20 (19%) participants suggested interesting topics for the next Educational Corner as ECPR, discussion about ECMO candidacy and targets for successful ECMO run, combination and transition from cardiopulmonary bypass to ECMO, daily ECMO management on intensive care unit, troubleshooting for ECMO emergencies and post-cannulation, V-V and V-A ECMO for specific diagnoses, ECMO weaning strategies, paediatric ECMO, hybrid configurations for ECLS support with rationale for changes of configuration and strategy during ECLS, ultrasound guidance in ECMO and more. Participants also suggested separating between basic and advanced training with multidisciplinary sessions providing the workshop material and treatment algorithms on the day. Topics on organisation and leadership in the ECMO Centre and comprehensive training about simulation setup and handling challenges during simulation were suggested.

Discussion

Educational Corner is an integral ECLS educational platform within EuroELSO Congress. Study results from Educational Corner EuroELSO 2022 showed that the Educational Corner sessions met the set goals and learning objectives, provided useful information to participants and facilitated the changes in their ECLS practice. Majority of participants would recommend Educational Corner to colleagues, and they considered the Educational Corner to be an integrated part of EuroELSO Congress. The Educational Corner Team is aims to use the feedback constructively in further developing the standardised ECMO curriculum, course structure, certification criteria and research in line with the Education ELSO Statement on global ECMO education.¹²

Simulation was first applied to ECLS training in 2006.^13,14 Members of an interprofessional ECMO team have varying levels of experience, and therefore have different educational needs.¹⁵ Several authors have demonstrated positive effects of ECMO simulation training on subsequent performance in simulated scenarios, as well as improved care delivered to patients.^3–5,7 With the significant increase in ECMO utilisation and wider understanding of the challenges for centers, teams, and individual providers, patient care is becoming a dynamic team effort requiring effective training, commonly via simulation.^1,4,6–9,16 Simulation-based training was beneficial in building a successful procedural chain, and to eliminate errors at the stage of identification, notification, transportation, and providing ECMO perfusion therapy.¹⁷ In addition, simulation training is a valuable resource employed to implement novel procedures and pathways.^18,19 Free Open Access Medical Education (FOAM) on social media is a resource used during EuroELSO 2022. FOAM represents an important building block in the acquisition of information in the context of medical training being the ultimate resource for the background, logistics, and evidence for ECMO.^20,21 Simulation safety during the international medical conference was found to be feasible and very successful in increasing the knowledge alongside with understanding and accepting international differences.²²

The Educational Corner has provided high-quality training utilising different teaching modalities during annual EuroELSO congress since 2012. The Educational Corner has gained popularity and was well described during the annual congress in Barcelona 2019.⁹ The feedback results from attendees of international multidisciplinary background in Barcelona showed that Educational Corner training was an excellent way to improve attendees’ motivation and knowledge about ECLS using an active learning environment, with a positive impact on their practice. The majority of the delegates expressed the wish to extend the duration of the offered simulation framework in order to demonstrate more types of circuits and increase the number of scenarios. The results extracted from this evaluation provided a framework for improving the efficacy of the workshops for the coming Educational Corners.⁹ During COVID-19 pandemic, in 2020 and 2021, no in person training was available but some virtual tools had been offered during EuroELSO Virtual Congress.^23,24 The available direct feedback was excellent for the virtual sessions, but there were some limitations regarding essential training like skill stations - ECMO cannulation and the team-based simulation training which coud not be replaced virtually.

Educational Corner during EuroELSO congress in London 2022 took the previous feedback into account. Educational Corner expanded to 2 days, the number of the sessions increased from 17 to 43 and sessions included both technical skills and multidisciplinary team training. The Educational Corner was running in parallel in four different rooms including V-A and V-V ECMO modalities, cannulations, complications, emergencies and ECPR. The novel sessions included simulation training setup and tips from various international centres. Paediatric sessions expanded providing a large spectrum of high-quality simulation modalities with variety of topics specifically tailored for paediatric population. Current feedback results show an increasing satisfaction with simulation scenarios for all sessions including team training and simulation set up. Attendees from international multidisciplinary background also identified that the aims and goals were set and increasingly met (88%) during the Educational Corner 2022 training sessions. The number of the attendees stating that the sessions would change their current practice increased from 50–88%. This significant increase could be used as a non-specific marker for Quality Improvement facilitated by Educational Corner. Vast majority of the attendees (95%) stated that they would recommend Educational Corner to their colleagues, and that Educational Corner was perceived as an integrated part of the EuroELSO Congress. Spontaneous positive comments of the attendees suggested that expansion of Educational Corner would be desired. Simulation training during Educational Corner represents an ideal platform to deliver standardised training in the safe environment, allowing the rehearsal or unusual or infrequent life-threatening critical incidents. The sessions on troubleshooting V-V ECMO had 69% positive feedback. The participants stated in the free text that there was a time pressure to finish the scenarios and that the groups were large. The sessions about managing refractory hypoxemia had 59% positive feedback. Several participants stated in the free text that the time for simulation was limited. This will be addressed for the next Education Corner EuroELSO 2023 in Portugal.

The advantages of Educational Corner during the congress include – no additional cost to delegate, delivered by highly experienced faculty, access to sessions without complex registration process, and user satisfaction as shown in the evaluation of feedback. The future developments of the Educational Corner will be aimed at standardisation of the educational programs and guidelines across Europe providing EuroELSO attendance certificate upon conditional feedback.

Limitations

The main limitation of this study was the low response rate. Due to missing forms, unfortunately, some attendees expressed their thoughts which could not be considered during the evaluation as the forms were lost. The forms for two topics in particular (Membrane Failure and Circuit Change on ECMO and CRRT on ECMO) were lost, however validation of the other sessions remained feasible. To address this, we will simplify the evaluation at future Educational Corners congresses using online feedback forms with shared QR code and providing EuroELSO standardised attendance certificate upon conditional feedback. Another significant limitation is that demographic data were not collected on the delegates who filled in the questionnaires nor the level of their ECMO experience. An important limitation was the difficulty in linking Educational Corner sessions with improved clinical practice or other local outcomes. With increasing standardisation of the training facilitated by Educational Corner, the clinical outcomes may become apparent in the future. Moreover, organising Educational Corner workshop is demanding regarding time invested, logistics and equipment needed. Hence, support from the industry and congress organisers is necessary to maintain the Educational Corner.

Conclusion

Educational Corner represents high-quality simulation based ECLS training and is seen as an integrated event dedicated to ECMO education and training during annual EuroELSO. Significant variability and limitations in global ECLS education is apparent.²⁵ Structured high quality ECLS based education with unified curriculum, evaluation, assessment tools and research are current focus for EuroELSO society.¹² The Educational Corner Team is aiming to follow and participate in further developing the standardised ECMO curriculum, course structure, certification criteria and research in line with the Education ELSO Statement ELSO on global ECMO education.¹²

Supplemental Material

Supplemental Material - “Bridging the Gap” international ECLS training and simulation - evaluation of the 10th educational corner on EuroELSO congress 2022 in London, United Kingdom

Supplemental Material for “Bridging the Gap” international ECLS training and simulation - evaluation of the 10th educational corner on EuroELSO congress 2022 in London, United Kingdom by Mirjana Cvetkovic, Marta V Antonini, Alex Rosenberg, Christopher IS Meadows, Marek Dąbrowski, Mateusz Puslecki, Ibrahim Fawzy Hassan, Jo-Anne Fowles, Maura O’Callaghan, Sebastian Stefaniak, Jordi Riera, Nicholas A Barrett, Jan Bělohlávek, Matteo Di Nardo, Aparna Hoskote and Justyna Swol in Perfusion

Footnotes

Acknowledgements

We thank Louisa Fraederich, Annika Jaeckel, Katja Barthel, Alexandra Held, and Christian Reim from INTERPLAN (Hamburg, Germany) who helped managing the Educational Corner and distributed the feedback forms during the 10th EuroELSO Congress in 2022 in London. The Educational Corner has been supported over the years by experienced trainers who offer training in kind with only privilege being the waiver of EuroELSO congress registration fee.

Declaration of conflicting interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: EuroELSO and Educational Corner received ECMO devices and disposables from Getinge. Simulator for cannulation was provided by The Simulation Company (London, UK).

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The shipment of institutional educational equipment was supported by EuroELSO.

Author contributions

Conceptualisation: Mirjana Cvetkovic, Justyna Swol, Aparna Hoskote, Marta Velia Antonini. Manuscript drafting: Mirjana Cvetkovic, Justyna Swol, Aparna Hoskote, Marta Velia Antonini. Manuscript revision: Mirjana Cvetkovic, Justyna Swol, Aparna Hoskote, Marta Velia Antonini, Alex Rosenberg, Christopher I.S. Meadows, Marek Dąbrowski, Mateusz Puslecki, Ibrahim Fawzy Hassan, Jo-anne Fowles, Maura O’Callaghan, Sebastian Stefaniak, Jordi Riera, Nicholas A Barret, Jan Bělohlávek, Matteo Di Nardo.

ORCID iDs

Mirjana Cvetkovic

Marta Velia Antonini

Jordi Riera

Nicholas A Barrett

Matteo Di Nardo

Justyna Swol

Supplemental Material

Supplemental material for this article is available online.

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