O3264: Creation and Use of High-fidelity Simulators for Neonatal Neck and Pediatric Groin Extracorporeal Membrane Oxygenation (ECMO) Cannulation

Background: ECMO cannulation in pediatrics requires technical expertise, efficiency, and multidisciplinary collaboration to improve patient outcomes. This high-stress, low-frequency procedure lends ideal for a simulation trainer; however, commercial high-fidelity ECMO simulators for cannulation are not widely available. Our aim was to create and implement high-fidelity neonatal neck and pediatric groin ECMO simulation models that closely mimic the structure and behavior of real human tissue to allow surgeons and trainees to complete the operative steps of cannulation in technical sessions as well as multidisciplinary crisis resource management team training.

Methods: Initial development of the high-fidelity groin and neck simulation models involved collaboration between pediatric surgeons and a simulation engineering team. Desired functionality included the ability to perform both VA (veno-arterial) and VV (veno-venous) ECMO cannulations involving the groin and neck, high-fidelity simulated anatomy and tissues, CPR-capable compressible chest, and an airway that can be intubated.

For the groin modeling process, prototype components were created in 3-Matic and Solidworks, then fabricated using techniques including 3D printing, silicone casting, vacuum forming and handcrafting. Iterations were evaluated and resulted in improvements in material selection and component fabrication of vessels, fat, and fascia. The final design was frozen before small batch production and use in simulation training.

For the neck modeling process, our clinical collaborators and engineers partnered with the special effects company, Fractured Fx. Fractured Fx artisans provided prototypes of blood vessels, fascia, fat, and skin. These samples were tested by the surgical team who provided directional feedback as they cut and sutured the simulated components. This feedback was used to create iterations of the components to ensure the materials mimicked the physical properties of real tissue and haptic experience.

Results: The final simulation models created are pictured in figure 1 and figure 2. Between 2016-2022, 354 total trainees participated in simulation scenarios involving the neonatal neck trainer. 60 of these participants were surgical trainees performing VA ECMO cannulation. Between 2020-2022, 32 surgical trainees and attendings completed VA ECMO cannulation involving the groin model. Feedback on the model from the simulation sessions is recorded and used to guide subsequent iterations of the models.

Conclusion: The use of simulation trainers is ideal for practicing ECMO cannulation given the low-frequency, life-threatening conditions of cannulations. This high-fidelity simulator is one of the first of its kind to model a neonatal neck cannulation or pediatric groin cannulation with materials that closely mimic human tissue in anatomy and tissue handling, which allow surgeons and trainees to sharpen their skills. Future research with this model will involve further validation with the goal to incorporate its use into a disseminated standardized simulation program that aims to develop and sustain these critical and life-saving procedures.