1st Perfusion CPB Simulation WorkshopCollaboration Between Terumo Singapore &
National Heart Center Singapore
Maggie Cheah (CCP, Aust)
Perfusion Department
National Heart Center Singapore
Nov 2012
Introduction
• Perfusionist training has been in the form of on-the-job
training, hands-on-practical sessions
• Simulation is a technique – to replace or amplify real
experiences with guided experiences that evoke or
replicate substantial aspects of the real world in a fully
interactive manner
Gaba DM. The Future Vision of Simulation in Healthcare. Quality and
Safety in Heathcare. 2004; Oct 13th Suppl: 2-10.
• Simulation has been used in the initial and ongoing
training and professional development of many different
professions
• In the US, simulation has been integrated into the
clinical course and training curriculum of perfusionist
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Simulation in Process…..
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Simulation in Perfusion
• Initial skills development – individual skills & standard
techniques
• Development and refinement of skills – advanced techniques
• Crisis/emergency management
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Simulation in Perfusion
Initial skills development – individual skills & standard
techniques like:
Initiation & Weaning of CPB
Cardioplegia delivery
Blood gas monitoring and interpretation
Hemodynamic monitoring
Communication with other surgical team
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Simulation in Perfusion
Development and refinement of skills – advanced techniques:
VAVD
IABP
Circulatory arrest, retrograde cerebral perfusion
Retrograde autologous priming
Aortic insufficiency
Aortic dissection
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Simulation in Perfusion
Crisis/emergency management
Oxygenator failure
Electrical/mechanical failure
Gross air embolism
Drug/transfusion reaction
Line separation
Loss of venous return
Circuit coagulation
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Simulation in Perfusion
Aim:
1. Competitive understanding of the duties of a perfusionist
2. Competent with the major skills of a perfusionist
3. Practice good technique
4. Fully explore and understand the ramifications of bad
techniques
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Simulation Process
Start
Do
Teach/ feedback
Do
No
Assessment acceptable
Yes
End
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Assessment
Evaluation
system
(1,2,3,4)
Evaluation System
Guideline from
AMSECT
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Simulators
• Bucket/ Bag
• Abiomed
• Mid- western University Simulation Model
• Orpheus Perfusion Simulator
• ECC-SIM
Mid- western Model
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Orpheus Perfusion Simulator
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Simulation Platforms
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ECCSIM
• Extra Corporeal Circulation SIMulator
• Virtual patient model- reproduce the hemodynamic & metabolism
state of a patient
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ECCSIM
• Composed of a numerical section (virtual patient model) – computer that
stimulate vital patient behaviors
• Plus a hydraulic section – simple hydraulic mock circulation loop
Web Master
Shinji Ninomiya
Department of Clinical Engineering, Faculty of Health Sciences
Hiroshima International University
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ECCSIM
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ECCSIM
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ECCSIM
• The instructor can control several events
• Conduct trouble events such as kink of the arterial line or
venous line
Visual
interface for
instructor
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ECCSIM
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ECCSIM
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1st Basic- Intermediate Perfusion Stimulation
• 1st basic-intermediate perfusion simulation
workshop in South East Asia at 31/03/2012
• at Innoheart, Singapore
(a pre-clinical contract research organisation)
• organised by the National Heart Center
Singapore (NHCS) Perfusion Unit, sponsored
by Terumo, Singapore and supported by the
Singapore Society of Extracorporeal
Technology.
Singapore Society of
Extracorporeal
Circulation
Technology
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Basic- Intermediate Perfusion Workshop
Terumo
System 1 HLM
Terumo RX25
Oxygenator
• No Heatercooler
• Circuit preprimed and debubbled
Trainer Station
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Patient &
Perfusionist Monitor
Program outline
• Lectures and introduction.
• Topics coverage:
Principles and basics of CPB
Adequacy of perfusion
Myocardial preservation in CPB
Simulation in perfusion
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Simulation Sessions
• 6 participants from 3 Hospitals- NHCS, National University Hospital &
Mount Elizabeth Hospital
• 2 participants in each group take turn to carry out the simulation
training
• Each simulation session 40-45 mins
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Role play
• 2 instructors – Surgeon & Assistant surgeon
• 1 simulator controller – Anaesthetist
• 4 evaluators/ observers
• 2 participants – primary perfusionist & assistant perfusionist
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Simulation Training
• Repetition of scenarios were conducted
•10- 15 mins of debriefing by the evaluators after each scenario
 Active participation & interaction
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Group discussion
• Entire simulation session was video recorded
• The participants were given consent release form & evaluation form
• Exchange perfusion knowledge within perfusionist
• ECCSIM- Event trend log
 Participants will aware of the trend of CPB pressure during the event
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Benefits of the Workshop
By repetitive practice & feedback in a realistic but safe
environment, the simulation workshop serves to:
1. Consolidate particular skills, e.g. procedural skills- initiation
of bypass, coming off bypass, cardiopledia delevery etc.
2. Develop skills in patient/ system monitoring
3. Communication with other surgical team members in a
concise & professional manner
4. Increase situation awareness
5. Consolidate other skills like crisis management – poor
venous return/ air lock, aortic dissection etc.
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Conclusion
• Simulation will serve as an invaluable tool in
perfusion education.
• Its role in perfusion training & advancement of
techniques will certainly expand in the future
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