Human factors in ECLS – A keystone for safety and quality – A narrative review for ECLS providers

Abstract

Introduction Although the technology used for extracorporeal life support (ECLS) has improved greatly in recent years, the application of these devices to the patient is quite complex and requires extensive training of team members both individually and together. Human factors is an area that addresses the activities, contexts, environments, and tools which interact with human behavior in determining overall system performance. Hypothesis Analyses of the cognitive behavior of ECLS teams and individual members of these teams with respect to the occurrence of human errors may identify additional opportunities to enhance safety in delivery of ECLS. Results The aim of this article is to support health‐care practitioners who perform ECLS, or who are starting an ECLS program, by establishing standards for the safe and efficient use of ECLS with a focus on human factor issues. Other key concepts include the importance of ECLS team leadership and management, as well as controlling the environment and the system to optimize patient care. Conclusion Expertise from other industries is extrapolated to improve patient safety through the application of simulation training to reduce error propagation and improve outcomes.

GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe (GENERATE)

“…44,46,48,49,51 However, volume per se might not be the leading factor; several important factors include training, protocols, team expertise, benchmarking, maintaining a low threshold for asking for support. 51,53,68…”

“…44,46,48,49,51 However, volume per se might not be the leading factor; several important factors include training, protocols, team expertise, benchmarking, maintaining a low threshold for asking for support. 51,53,68 Health systems focus primarily on improving the health of the population and may align resources to assist referring hospitals through regionalization, 45,[69][70][71][72][73][74][75][76][77] and might be better positioned to accomplish this, as efficiency can be increased by sharing resources and capabilities across facilities. 47,55,[78][79][80] The combination of high-volume ECLS center with an effective and appropriately located retrieval service may balance out certain local deficits.…”

“Bridging the Gap” international ECLS training and simulation - evaluation of the 10th educational corner on EuroELSO congress 2022 in London, United Kingdom

“…[3][4][5]7 With the significant increase in ECMO utilisation and wider understanding of the challenges for centers, teams, and individual providers, patient care is becoming a dynamic team effort requiring effective training, commonly via simulation. 1,4,[6][7][8][9]16 Simulationbased training was beneficial in building a successful procedural chain, and to eliminate errors at the stage of identification, notification, transportation, and providing ECMO perfusion therapy. 17 In addition, simulation training is a valuable resource employed to implement novel procedures and pathways.…”

“…10 All the simulations and hands-on sessions were inspired by previous face to face Educational Corner in 2019 9 using the principle of the suspension of disbelief to help the attendees learn using scenarios similar to their clinical practice though in a controlled environment. 6,11 Each session started with briefing introduction where the trainers and trainees were presented, followed by explanation of the learning objectives and then an introduction to scenario to ensure engagement and active participation (Figure 1). Confidentiality was highlighted both for participants and cases discussed.…”

“…ECLS care is delivered by teams of providers, therefore establishing optimal educational strategies requires considerations of interprofessional collaboration, communication, and teamwork. Simulation-based training for ECLS has emerged as a valuable tool offering the opportunity to improve technical skills [1][2][3][4][5] and reduce the risk of human errors 6 potentiating training to an individual team member along with the whole interdisciplinary team, and it has found to be superior to traditional training. 7 An integration of both clinical and nonclinical skills is important to improve survival and complications in the high risk and complex patients that require ECLS.…”