High-fidelity extracorporeal membrane oxygenation simulation in medical training: A review and opportunities for the future

Background: The growing popularity of extracorporeal membrane oxygenation (ECMO) necessitates adequate education and training of the multidisciplinary teams caring for these medically complex patients. Simulation-based education (SBE) has been used in medical education for decades and has demonstrated effectiveness for teaching both procedural competency and teamwork-related skills. The continued wider adoption of SBE within medical training and the development of newer digital technologies have also seen SBE being increasingly adapted for ECMO education. Purpose: To qualitatively review the state of published knowledge on simulation-based ECMO education and training. Research Design: A literature search of electronic databases was conducted using Medical Subject Headings (MeSH) terms “Extracorporeal Membrane Oxygenation”, “Simulation Training”, “High-Fidelity Simulation Training”, and “Patient Simulation”, as well as relevant synonyms and keywords. Studies meeting inclusion criteria were analyzed, with information extracted regarding study characteristics and key findings. Major themes were identified and compiled into a narrative review. Results: A total of 38 articles published from 2006 to 2023 met criteria for inclusion for review. The literature reveals significant heterogeneity in the use of simulation-based ECMO curricula across medical specialties and institutions. A wide array of ECMO simulators and equipment are commercially available or have been described, with numerous small studies describing individual ECMO simulation training programs with substantial differences in practices. More recently, ECMO procedural skills training has utilized augmented reality, which may be a promising modality for future training. Conclusions: The literature regarding simulation-based ECMO education is heterogenous, but available studies suggest this modality of education can improve procedural skills, increase efficiency and familiarity with equipment, reduce procedural errors, practice team-based communication skills, and increased learner confidence. As the use of ECMO simulation expands, efforts should focus on the identification of high-fidelity simulators for specific purposes, developing standardized training regimens, and emphasizing team-based dynamics.