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INTRODUCTION: Extracorporeal Membrane Oxygenation (ECMO) is an ever-evolving technical landscape that requires an advanced level of education. At our institution, a 367-bed pediatric teaching and research facility, learners include registered nurses, registered respiratory therapists, advanced practice registered nurses, resident physicians, pediatric and neonatal intensive care physicians. A certification class followed by an advanced course covers ECMO diagnoses, complications, equipment, and management prior to providing care for ECMO patients in our institution. Educational strategies include high and low fidelity simulations, didactic learning, and clinical hours at the bedside. A desire to increase the experiential learning opportunities was identified as an ECMO leadership goal. In 2018, a team member attended a conference and returned with a low fidelity simulation concept “ECMO in a Bag” from The Hospital for Sick Children in Toronto, Canada. This novel educational concept was subsequently adapted into a dynamic experiential teaching tool that met the interactive learning needs of the Children’s Mercy ECMO educational curriculum. METHODS: The “ECMO in a Bag” concept was first observed in May 2018 at the International Pediatric Simulation Society Workshop. The first version for our hospital was established with laminated equipment photographs and labels in September 2018 and was expanded upon in November 2018 to include non-sterile tubing to connect the photographs together schematically. The tubing, photos, and labels were intended to be used as an assessment for early ECMO learners. Introduction of “ECMO in a Bag” occurred in the August 2019 ECMO certification course. Modifications were implemented to develop an “Introductory ECMO in a Bag” after observations of the novice course participants deemed the task too difficult. In February 2020, the Advanced ECMO course utilized “ECMO in a Bag” in its original version for advanced learners. The class was divided into two teams and then competed against each other to correctly “assemble” an ECMO pump. All participants completed post surveys for each educational experience. RESULTS: When the original “ECMO in a Bag” was applied to 10 novice ECMO learners in August 2019 it was regarded as too difficult by the coordinators. The strategy was modified in the moment, using the laminated equipment names matched to an already assembled nonsterile ECMO pump along with definitions. The revised “Introductory ECMO in a Bag” has since been repeated in the ECMO certification course of 15 learners in August 2020. One hundred percent of the novice learners in both the 2019 and 2020 introductory class surveyed stated the hands-on sessions including “ECMO in a Bag” were effective and engaging. Quotes from the post class surveys included “I really enjoyed the breakout session looking at the circuit. Great to start understanding all of the circuit components,” “Hands on visualization was great, allowed for putting information together”. Additional positive feedback was gleaned from the application of the original “ECMO in a Bag” during the Advanced ECMO courses. One hundred percent of the transitional learners surveyed scored the hands-on portion of ECMO learning as beneficial. Comments included “Enjoy breaking up the talks with hands on activities,” and “I enjoy the games! It really breaks up the day.” DISCUSSION: The evolution of the experiential concept of “ECMO in a Bag” has been well received and is ongoing. It has been adapted for two different levels of ECMO learners in our hospital.. It is now used with resident physicians as well during shadowing experiences with the ECMO team. ECMO coordinators also use “ECMO in a Bag” to teach new critical care bedside nurse


Critical Care | Pediatrics


Presented at the 37th Annual CNMC Symposium: ECMO & the Advanced Therapies for Respiratory and Cardiac Failure; Keystone, CO; February 22-25, 2021.

“ECMO IN A BAG”: Successful Adaptation and Implementation of a Novel Conference Idea