Methods utilized to assess the effectiveness of a simulation program for ECMO cannulation include but are not limited to pre- and post-surveys of participants assessing their comfort with their role during the simulation, timing of when to decide to place a patient on ECMO to following successful cannulation, testing and timing ECMO specialists to prepare a circuit, and conducting chart reviews of ECMO cannulation times in patients before and after implementation of an ECMO simulation curriculum.[9] One program saw a decrease in medical errors with the implementation of simulation-based training.[10]

Medical errors continue to and remain a significant cause of death.[11]  Simulation-based training continues to become significant in healthcare settings, where there are often complex and multidisciplinary approaches to decision-making.  The placement of a patient on extracorporeal support demands that there be adequate staffing and support, which can then lead to having numerous individuals in a room where a profoundly ill patient needs guided and efficient medical care. Often, the placement of patients onto ECMO, whether they be in a CPR situation or not, can be chaotic and stressful. The significance of developing a curriculum whose focus is to organize a large group of people of various degrees of training to communicate and work together effectively is essential in centers wanting to achieve excellence and efficiency in ECMO. A situation where a patient is unstable enough to require extracorporeal support is a highly stressful environment. Without effective communication and methods developed by simulation training, it could be a situation that would potentiate medical errors. There remains a difference in survival in pediatric and adult patients when it comes to extracorporeal support.  The Extracorporeal Life Support Organization (ELSO) registry states that the survival rate for adults with pulmonary complications on ECMO is 66% and 55% for those with cardiac complications versus in pediatrics where the survival rates are 67% for pulmonary and 68% cardiac complications.[5] With these rates of survival, there is always room for improvement regarding resuscitation length, time to ECMO cannulation, and fewer errors in assembling, setting up, and maintaining the ECMO circuit. These potential focuses are addressable with simulation.

Simulation-based training has become an important and necessary field of education within the medical community. The need for the use of simulation with high-fidelity mannequins has become increasingly crucial in resuscitation training.  Complex medical scenarios that require numerous personnel, such as with ECMO simulation, can often be perceived as chaotic and loud. Utilizing simulation-based techniques to implement a curriculum can help streamline and assign roles in what may otherwise be an unorganized and physiologically complex situation. The goal would be to achieve a standardized approach to every step of the ECMO cannulation process - recognition of the proper candidates for ECMO therapy, checklists to assure adequate equipment, a method to efficiently contact each member necessary, continuing resuscitation measures with minimal interruptions up until the patient is officially cannulated and on ECMO, and approaching mechanical issues to the ECMO circuit. 

Simulation-based training has shown to be effective in multiple medical environments. With the rise of centers offering ECMO as therapy for patients with cardiac and respiratory failure, it has become increasingly important to standardize our approach to a patient that would need this level of support.[5] There is still room for improvement in the outcomes of patients that require ECMO.[5] By developing an ECMO simulation curriculum that involves multiple disciplines, coordination between the teams could be improved.  Placing a patient on ECMO, whether it is during cardiopulmonary resuscitation or not, can prove to be unorganized and stressful.  This is where the role of simulation with participation from everyone from each dedicated discipline can help each team practice interprofessional communication and coordinate care to the same goal of successfully placing a patient on ECMO. The goals should be the same, which would be to lower medical errors that can often happen in high-stress environments, improve outcomes of patients on ECMO as the time to placement, especially during CPR, could be lessened, and optimizing team performance.   Research related to  ECMO simulation has shown improvement in cannulation time, improvement in setting up ECMO circuits, and improvement in the perception of team dynamics.[9][12][13] [Level 4]