Page 71 - JSOM Winter 2024

TABLE 2 Cannulation and Management Testing
Team 1 Team 2
Lights on Darkness Lights on Darkness
Total length of evolution, min 94 97 81 86
Successfully set up and prime circuit Yes Yes Yes Yes
Time to set up and prime circuit, min 26 22 21 13
Right femoral vein access
Time to obtain access, min 5 2 4 2
Number of attempts 3 1 2 1
Successfully place cannula Yes Yes Yes Yes
Left femoral vein access
Time to obtain access, min 5 1 1 15*
Number of attempts 3 2 1 4
Successfully place cannula Yes Yes Yes Yes
Successfully perform wet to wet connection of cannulas
to circuit Yes Yes Yes Yes
Appropriate position of cannulas Yes Yes Yes Yes
Time to initiate VV ECMO, min 42 35 33 36
Successfully suture cannulas in place Yes Yes Yes Yes
Surgical procedures successfully completed † Yes Yes Yes Yes
Managing the circuit
Successful titration of sweep and flow based on ABG Yes Yes Yes Yes
Successful removal of air Yes Yes Yes Yes
Successful management of cannula dislodgement Yes Yes Yes Yes
Number of VV ECMO alarms during procedures 5–10 5–10 5–10 5–10
‡
Number of VV ECMO adjustments during procedures 5–10 5–10 >10 5–10
§
*Artery located directly over vein. Able to obtain percutaneous access.
†Surgical procedures performed: chest tube, internal identification of cannulas, nephrectomy, splenectomy, posterior liver laceration, bowel re-
section, pulmonary laceration, aortic cross-clamp, right ventricular repair
‡Alarms encountered: low flow, air bubble, high venous pressure.
§Adjustments performed: flow change, fluids given, repositioning of cannulas, clamp cannulas, de-air circuit.
ABG = arterial blood gas; VV = ECMO = veno-venous extracorporeal membrane oxygenation.
FIGURE 2 Pre- and post-course self-assessment scores of self- completed venous access and cannula placement. During one
reporting at least moderate confidence in performance of skills. iteration in darkness, while attempting to access the left femo-
ral vein, the artery was observed to be immediately superior to
the vein for the entire length of the vein. This was deemed to be
difficult access by expert reviewers; however, Team 2 was still
able to obtain percutaneous access and cannula placement. VV
ECMO was successfully initiated in all four iterations of testing
independent of assistance. Time from start of scenario to VV
ECMO initiation ranged from 33 to 42 minutes.

After cannulating for VV ECMO, teams managed flow and
sweep based on provided arterial blood gases (ABG). All teams
successfully adjusted flow and sweep based on provided ABGs.
Teams then successfully performed de-airing procedures and
management of a cannula dislodgement at the end of testing.
Teams encountered between 5 and 10 alarms during the test-
ing scenario which included low flow, high venous pressure,
and air bubbles. Each team successfully managed alarms. Both
teams also performed multiple VV ECMO-related tasks in-
cluding flow changes, administering fluids, clamping cannulas,
and de-airing the circuit.
The x-axis represents (1) the self-assessment taken pre- or post-course Finally, surgical and resuscitative procedures were performed
and the category of self-assessment question (cognitive, technical, be- on VV ECMO. Procedures included chest tube insertion, ex-
havioral). The y-axis represents the number of responses (mean) in ploratory laparotomy, nephrectomy, splenectomy, posterior
each category where the participant answered at least a 3 (moderately
confident) on a 5-point Likert scale. The error bar represents the stan- liver laceration repair, bowel resection, pulmonary lacera-
dard deviation of each category. tion repair, aortic cross-clamp, and right ventricular repair.
There was a statistically significant increase in all categories of self- Both teams successfully performed all interventions in each
reporting of moderate confidence pre- and post-course (P<.001). environment.

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