Preliminary Implementation of the Next Generation Cannulation Simulator

© 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.Extracorporeal Membrane Oxygenation (ECMO) is a highly complex/critical lifesaving procedure known to support patients with cardiac and respiratory issues. Patients on ECMO are monitored 24/7 by a team of highly trained ECMO team comprising nurses, physicians, respiratory therapists, and perfusionists promptly intervening to any potential emergency situation. Simulation-Based Training (SBT) allows clinicians to experience and practice realistic hands-on procedures and scenarios without any risk. In ECMO, cannulation is a critical procedure performed to externally reroute the blood flow so it can be re-oxygenated by the ECMO machine before being recirculated through the patient's body. In a close collaboration with Hamad Medical Corporation (HMC), this project aims to develop a cost effective, realistic, and user-friendly ECMO simulator focusing on the venous and arterial cannulation procedure, The main features of this simulator include cannulation emergencies caused by low pressure flow, excessive force, recirculation, or mispositioned wire/cannula. Therefore, the ECMO cannulation simulator will not only greatly contribute to the initial and ongoing local training of HMC ECMO clinicians but also contribute to improving patient care by lowering the risks associated with the cannulation process

Towards next generation cannulation simulators

Background: Cannulation, in extracorporeal membrane oxygenation (ECMO), is the act of inserting a cannula through the body1. For femoral veins, femoral arteries, and the jugular vein, the cannula stops at the inferior vena cava (IVC) beside the hepatic vein and at the beginning of the distal aorta, and the superior vena cava at the right atrium, respectively. Cannulation is considered a critical operation and requires intensive training. Simulation-based training (SBT) is the gold standard, allowing for training in risk-free, versatile, and realistic environments2. A research collaboration was established between Hamad Medical Corporation and Qatar University College of Engineering to support the development of the ECMO training programme. Initially an ECMO machine simulator was developed with thermochromic ink to simulate blood and modules that simulate common emergencies practitioners may face during ECMO runs3. This cannulation simulator is now being designed to close the gap in the market in relation to cost and fidelity4,5. Methods: The cannulation simulator is composed of several modules. Firstly, a 3D-printed femoral pad mold was constructed to facilitate the production of cannulation pads (Figure 1(a), (c)). Secondly, cannulation pads were designed so they are anatomically correct and ultrasound compatible. For the arteries, the superficial artery was added at the access point to simulate possible incorrect routes for the cannula. Furthermore, the orientation of the veins and arteries were set to further resemble the human anatomy, where the arteries are situated above the veins (Figure 1(a), (b)). In addition to the implementation of a closed loop linking the jugular to the femoral, cannulation access points with a pump connected to a tank between them to regulate the flow. The blood flow in the arteries was enhanced with a pump to simulate a pulsatile flow while the flow in the veins is laminar as seen in the single loop implementation (Figure 1(h)). The connection of the pump to the embedded system is shown in Figure 1(g). The junctional point in the IVC was designed in the venous loop to allow for two cannulas to pass and an alternative path simulating the renal vein was added. A force sensing resistor (FSR) was connected to detect and measure incorrect entry of the guide-wire as this, in real-time scenarios, could cause internal bleeding to the patient (Figure 1(g)). Lastly, the Y-connector showing the renal vein entry is shown in Figure 1(d) and (e). Results: Tests were done on the system namely on the FSR to recalibrate it in the presence of liquid. Tests on the pulsatile flow were conducted to optimize for realism in terms of pressure. Since both jugular and femoral cannulation access points are included, the simulator can be used for training for all ECMO modes including veno-arterial and veno-venous. After testing, the main limitations of the current prototype include the flexibility of the tubes, limits on FSR measurements, and the rigidity of the available 3D printing material. Conclusion: After implementing the stated features, the anticipated outcome is a realistic and cost-efficient ECMO cannulation simulator.qscienc

Towards the design and implementation of a human circulatory system for Extracorporeal Membrane Oxygenation simulation

Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving procedure developed for the care of patients with short-term respiratory and/or cardiac issues (MacLaren et al., 2011). ECMO patients must be monitored twenty-four hours a day by an ECMO-trained multidisciplinary team. The trained healthcare professional needs to watch over fifty variables and rapidly intervene to assess and resolve any given emergency. Hence hands on training is very important for ECMO professionals to develop rapid and correct actions upon different scenarios. Simulation based training (SBT) offers ECMO practitioners an opportunity to develop the skills needed for the initiation of the ECMO procedure and the care of ECMO patients without exposing patients to undue risks (Al Disi et al., 2018). For ECMO to work, cannulation is required to reroute the blood flow to the machine rather than the lung and/or heart. Cannulation is the insertion of a cannula through the blood vessels. In collaboration with Hamad Medical Corporation (HMC), the main healthcare provider in Qatar, the aim of this project is to develop an effective, economical realistic, user-friendly, low-cost, and a multi-functional high-fidelity cannulation simulation mannequin. Keywords: Extracorporeal Membrane Oxygenation, ECMO, Medical training, Cannulation, Healthcar