Full-Scale high-fidelity simulation compared to procedural simulation workshop for veno-arterial ECMO cannulation during refractory cardiac arrest: a randomized controlled trial.

BACKGROUND

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a critical intervention for patients in refractory cardiac arrest. Rapid and high-quality cannulation is essential for timely ECMO initiation and improved patient outcomes. Therefore, optimizing educational strategies for VA-ECMO training is crucial to ensure skill acquisition and effectiveness in clinical practice. This study aimed to compare the effectiveness of full-scale high-fidelity simulation versus a procedural simulation workshop for VA-ECMO cannulation training in anesthesiology and critical care residents.

METHODS

We conducted a prospective, randomized, two-arm, single-center, open-label trial at the Nantes university hospital simulation center. Thirty anesthesiology and critical care residents were randomly assigned to either a high-fidelity simulation group or a procedural simulation workshop group. Prior to the intervention, all participants completed an e-learning module on VA-ECMO cannulation. The procedural simulation workshop group underwent a 3-hour session focusing on technical skills, with guided hands-on practice. The high-fidelity simulation group participated in a full-day session incorporating immersive high-fidelity scenarios of refractory cardiac arrest, hands-on VA-ECMO cannulation, training on ECMO console management, and transesophageal echocardiography simulation. The primary outcome was total cannulation time (seconds) on a mannequin in a simulated refractory cardiac arrest scenario, measured from sterile preparation to circuit connection. Secondary outcomes included a procedural quality score, developed using a Delphi consensus method and assessed by blinded evaluators, as well as skill-specific sub-item analyses.

RESULTS

Median cannulation times were similar between the procedural simulation workshop group (908 s; IQR 817-1015) and the high-fidelity simulation group (836 s; IQR 801-1029; p=0.71). Overall procedural quality scores did not significantly differ between groups. However, exploratory sub-item analyses suggested that specific procedural skills might be differentially influenced by each training modality.

CONCLUSIONS

High-fidelity simulation and procedural workshops yielded similar performance for VA-ECMO cannulation. Although each may enhance specific skills, neither proved superior. Further research should determine the optimal integration of these training modalities.