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Nemours Conducts ECMO Simulation and Training Program in Beijing

Goal is to narrow knowledge gap for providers in China

Friday, May 23, 2014

Delaware

For Chris Beaty, Critical Care ECMO Coordinator, a recent trip to Beijing, China was eye-opening and exhilarating in many ways. Beaty and Mark Ogino, MD, Division Chief of Neonatology, traveled to China to share their expertise in ECMO simulation in an effort to standardize the training experience there and improve the practice of ECMO and resultant health outcomes. Thanks to their outreach efforts and those of Cardiac ECMO Coordinator Marc Priest, Nemours is considered an international forerunner in ECMO education.

ECMO or extracorporeal membrane oxygenation, is used for critically ill newborns, children and adults, as a temporary means of pulmonary and cardiac support. A mechanical circuit allows the heart and lungs to rest and recover for patients with potentially reversible conditions. While ECMO is not a new treatment modality, it is complex and requires a high level of training to acquire and maintain proficiency.

ECMO simulation techniques create scenarios designed to improve a team’s technical, decision-making and communication skills, so vital in caring for ECMO patients. In April, Beaty and Dr. Ogino conducted three, 8-hour days of training at FuWai Hospital in Beijing, a sprawling government-run facility that treats both children and adults. FuWai has 23 operating room devoted entirely to heart surgery and performs 15,000 open heart surgeries a year. To put that number in perspective, duPont Hospital does about 300 such procedures annually; major adult heart centers in the U.S. perform about 2,000 surgeries a year. In terms of pediatrics, 2,600 patients cycle through FuWai’s pediatric intensive care unit annually. FuWai’s patient volume is, in a word, enormous.

FuWai Hospital is about to undergo a major expansion to include an update of facilities, equipment and amenities. Still, given the present infrastructure, its infection rates are low (< 1%) and its outcomes are quite good. The language barrier, though present, was not significant as several of the 55 physicians, perfusionists and others who came for training spoke fluent English. “From the get-go, there were ‘Aha’ moments,” said Beaty. “The ability to go through a variety of team scenarios using the manikins in a real-time way was extremely well received.”

In an ECMO care situation, clear communication among team members is of utmost importance. Culturally, it is difficult for the Chinese to give what we term “constructive criticism” to their elders or those in higher level positions, Beaty said. “We encouraged everyone to be honest in giving feedback. That was probably the most daunting aspect of training is such a polite society.”  He and Dr. Ogino felt warmly appreciated, and said the trainees were very open to learning. Beaty added: “It was gratifying to see them develop new strategies to refine their techniques and to use in educating their own trainees” as they return to their respective institutions. Physicians came from all over China and Hong Kong to FuWai to take part in the program.

Dr. Ogino ( on right, in photo at left) added:  “This course was the first of its kind. No one has done ECMO training for people in China. If we teach them well with our ‘train the trainer’ model, we’ve begun a whole new ripple effect in terms of educating providers there.” Dr. Ogino echoed Chris Beaty’s sentiments about their warm reception by the Chinese and the high level of interest. “We set capacity for the course at 40 and it filled immediately. There was a waiting list and we relented and let more people in.” The program was so popular that another has been scheduled for November. Dr. Ogino said they could easily fill the course every other month. He noted that the Beijing trainees at FuWai want to become known as China’s ECMO training center and eventually identify other institutions in the country as satellites.

The majority of attendees rated the course excellent in the areas of teaching and learning style, course material, lectures, simulation and workshops. Among their remarks:

“Great appreciation! The course was very good. Teachers and instructors worked very hard, especially the two invited foreigners (Dr. Ogino and Chris). I have learned a lot about ECMO. Thank you for everything you did.”

— Physician from Chengdu, Sichuan Province (1,100 miles from Beijing)

“Your first simulation course was a great success. I have learned a lot about ECMO management. If you will organize a second course of ECMO simulation, I will send more colleagues to participate. Hope they will get a chance for this kind of learning. Please accept my respect for your hard work. Thanks a lot.”

— Physician from Guangzhou, Guangdong Province (1,300 miles from Beijing)

The ECMO training course is just one way Nemours is reaching out to an international community of patients, families and providers, bringing our expertise to bear for the benefit of children everywhere.

About Nemours

Nemours is an internationally recognized children's health system that owns and operates the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and Nemours Children's Hospital in Orlando, along with major pediatric specialty clinics in Delaware, Florida, Pennsylvania and New Jersey.

Established as The Nemours Foundation through the legacy and philanthropy of Alfred I. duPont, Nemours offers pediatric clinical care, research, education, advocacy and prevention programs to all families in the communities it serves.