HYBRID MODEL FOR TRAINING HYBRID EXTRACORPOREAL MEMBRANE OXYGENATION SPECIALISTS

Abstract

<h3>Objectives</h3> The latest global pandemic highlighted the need to change and adapt the approach to extracorporeal membrane oxygenation (ECMO) support provision. As one of the most complex and specialised extracorporeal organ support systems, the provision of ECMO tends to be less flexible compared to other services. This abstract outlines a hybrid model of training specialised hybrid ECMO specialist staff that can form the base of running an ECMO service that can adapt to shifting demands. <h3>Design and Methods</h3> Our ECMO centre delivers regular courses for staff aiming to become ECMO specialists. The course is aimed at nurses who have completed their critical care specialisation and have worked in the critical care unit for at least six months. A two-day hybrid course provides them with theoretical knowledge, "wet labs" for hands-on skills and high-fidelity simulations of ECMO emergencies. The content of the course follows the one suggested by the guidelines published by the extracorporeal life support organisation (ELSO). All candidates must complete pre-course and post-course assessments and be signed off for essential practical competencies before working as independent ECMO specialists. In order to maintain the specialisation, they need to complete a fixed number of shifts to ensure adequate experience and exposure. <h3>Results</h3> ELSO recognises that a safe and economically sound model of ECMO provision includes not relying on ancillary services such as perfusion scientists and cardiac surgery. The preferred alternative is training and having experienced ECMO specialists at the bedside. An ECMO centre with hybrid staff that functions both as bedside critical care nurses and ECMO specialists allows for flexibility in changing demand for ECMO support. A set minimum of shifts that the ECMO specialists need to sustain the specialisation ensures that they have enough exposure to maintain safe practice. The hybrid approach to course delivery was dictated by the reality of needing to train the staff during the global pandemic. However, it has clear benefits social distancing aside. It allows for more flexibility and time to focus on practical aspects of caring for a patient on ECMO support. The option to complete theoretical studies at their own time and pace fits adult learning theory. Since the candidates are experienced critical care nurses, they are familiar with concepts of basic physiology, hence the lectures can focus specifically on the physiology of ECMO. A hybrid course design also takes into consideration the practical realities of delivering courses in circumstances requiring social distancing. Adequate progression between the pre-course and post-course tests guarantees engagement with the course material and the impact of the intervention. <h3>Conclusions</h3> As highlighted by international ECMO societies, there is a need to ensure the possibility of expanding ECMO capacity rapidly in case of emergencies. Having hybrid staff can allow the healthcare system to achieve that. Utilising hybrid training methods can help train more staff in a more economically and time-efficient way, even if options for in-person training are limited.