BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is a high stakes low opportunity event which involves cannulating and initiating ECMO support in the arresting patient. In response to recent evidence suggesting ECPR can drastically improve neurologic outcome for refractory cardiac arrest, this technology is more frequently being employed in the emergency department for out of hospital arrests. 1-2 optimal initiation of ECMO in this setting requires the cooperation of multiple team members with varied backgrounds. This is best facilitated by education and deliberate practice via simulation activity. 1-2 at our institution, simulation with a perfusion-capable mannequin has been used to provide realistic training in areas of crisis resource management related to ECPR, however, the actual technical aspects of cannulation are difficult to simulate. The Dalhousie University Clinical Cadaver Program provides soft-preserved cadavers for high fidelity surgical and technical simulation. While clinical cadavers have been used previously for endovascular procedural training 3-4, we present the first simple novel perfused model capable of realistic venous and arterial ECMO cannulation.
METHODS AND RESULTS: All four limbs were secured with trauma tourniquets to maintain fluid within the central vasculature. The right carotid artery and internal jugular vein were accessed through cutdown. Pursestrings were placed on each vessel. The carotid was cannulated with an 8 Fr central venous catheter. An 18 Fr Coude catheter was introduced through the IJ, directed past the right atrium and into the inferior vena cava. Positioning was confirmed with ultrasound. NS was infused under pressure into the arterial and venous systems of the cadaver and femoral cannulation was attempted by physicians with experience in ECPR cannulation. The video shows that the model demonstrated realistic ultrasound images of the femoral artery and vein for cannulation. Fluid remained within the central vasculature long enough to facilitate ultrasound guided cannulation. We were successfully able to introduce arterial and venous cannulas.
CONCLUSION: We demonstrate a perfused cadaver model that provides a realistic cannulation simulation and can be prepared relatively easily. Successful ECPR Programs will require trained physicians who are available to perform this infrequent but technically demanding procedure. Our model could be used to provide training to those physicians. Additionally, our model could be used by Cardiac Surgery Training Programs for simulation of cannulation of other areas.