Creating a Portable High-Fidelity ECMO Mannequin for Developing an ECMO-assisted CardioPulmonary Resuscitation (eCPR) Programme

Background

eCPR is a complex process requiring multiple team members to conduct technical procedures in a coordinated, time-critical fashion. Simulation has an increasingly well recognised role in medical training, particularly in the field of critical care, allowing non-technical skills to be honed and logistical challenges to be identified and solutions sought in a safe environment. Despite the availability of commercial simulation mannequins for specific tasks in the eCPR process, e.g. ECMO cannulation, we were unable to identify a suitable and affordable product able to accommodate all stages of the resuscitation.

Objectives

We sought to design a high-fidelity mannequin to facilitate eCPR simulation encompassing advanced airway management, ventilation and chest compressions alongside ultrasound-guided cannulation and establishment of peripheral VA-ECMO. The mannequin was required to be portable to pilot a prehospital eCPR programme allowing sequential simulation and transfer from helicopter to trolley to cath lab and ICU.

Methods

To minimise cost and simplify construction we adopted a pragmatic approach; modifying a broken Laerdal SimMan ® to provide airway management and chest compressions ability. A circulatory system was created using rubber tubing, a loop of which was passed down the mannequins right leg. A window over the right groin allowed the tubing to be encased in ballistics gel, simulating soft tissues and skin, permitting ultrasound-guided cannulation of the femoral artery & vein. The two ends of the rubber tubing were connected to a two litre reservoir bag, filled with fake blood, forming a closed circuit which was then pressurised with a standard pressure bag. Once cannulated this allows a primed ECMO circuit to be attached and the mannequin to be perfused by the ECMO pump. As the mannequin was broken there was no interface to simulation software, this was circumvented using the virtual mannequin setting in the SimMan software to provide real time monitoring.

Results

To date we have conducted several multidisciplinary eCPR simulations with members of the medical, nursing, perfusion and prehospital teams. A brief survey conducted to evaluate the mannequin’s performance showed the 24 respondents unanimously ‘strongly agreed’ that the mannequin was believable, increased their confidence in eCPR and was a valuable learning experience.

Conclusion

Our DIY mannequin fulfilled our objectives of facilitating high-fidelity eCPR simulation as evidenced by unanimously positive feedback. To enable repeated simulations we plan to 3D print bespoke legs, incorporating a user-replaceable femoral vessels module, allowing the mannequin to be rapidly reset.