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      Virtual reality device training for extracorporeal membrane oxygenation

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          Extracorporeal membrane oxygenation (ECMO) is a last resort therapy for patients with terminal respiratory failure. In the current worldwide surge of critically ill patients with novel coronavirus disease (COVID-19), ECMO demand for the sickest of them is unprecedentedly high and management is very complex [1]. Highly trained healthcare personnel is essential to safely prime, implant, and operate ECMO devices [2]. Acquisition of such complex skillsets has always been difficult—especially for smaller hospitals with lower ECMO case counts [3]. During the pandemic, traditional face-to-face instructor-led training is additionally complicated by social distancing measures. Alternative and complementary ways of delivering high-quality training are thus desirable to increase personnel resources for ECMO services. Virtual reality (VR) simulators are emerging as next-generation options in digital health to complement traditional training: VR training is largely independent of resources, location, and person-to-person contact; it integrates both teaching theory and practical application and allows unlimited repetition. Our research collaboration currently develops a prototype for VR training on an ECMO device (Fig. 1a): using a VR headset with controllers (Fig. 1b), trainees are immersed in a digital VR environment with a Getinge Cardiohelp® ECMO device (Fig. 1c+d). The virtual device is responsive to manual user input by movement of the body, head, and hands in the virtual space. A digital coach leads the trainee through a multi-layered didactic digital teaching program: beginners go through step-by-step video instructions and manually imitate each step on the ECMO device (Video 1); experts must perform tasks without any support (Video 2). Training includes sessions of the priming procedure of the device for use (Fig. 1c and Video 1) and configuring its program options (Fig. 1d and Video 2), each a complex sequence of single steps requiring specialized knowledge and manual skillsets. This VR prototype is ready to be evaluated for the ECMO priming procedure. It may be expanded to further content in the future, e.g., device troubleshooting or implantation. We are looking forward to reporting results of this innovative technology soon. Fig. 1 Virtual reality setup and Getinge Cardiohelp® ECMO training environment. Schematic drawing (a) and real-world shot (b) of a virtual reality setup, with scenes from the VR environment of priming (c) and controlling (d) the ECMO device Virtual reality device training for extracorporeal membrane oxygenation promises to be a very valuable tool for health care personnel training—both during the pandemic and beyond. Supplementary information Additional file 1: Video 1. Priming the device, beginner mode: Step-by-step instruction and manual repetition in Virtual Reality. Additional file 2: Video 2. Controlling the device, expert mode: Configuring device options in Virtual Reality.

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          ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: mortality and ECMO-learning curve over a 6-year period

          Background Based on promising results over the past 10 years, the method of extracorporeal membrane oxygenation (ECMO) has developed from being used as a ‘rescue therapy’ to become an accepted treatment option for patients with acute lung failure (ARDS). Subsequently, the indication was extended also to patients suffering from cardiogenic and septic shock. Our aim was to evaluate hospital mortality and associated prognostic variables in patients with lung failure, cardiogenic, and septic shock undergoing ECMO. Furthermore, a cumulative sum (CUSUM) analysis was used to assess the learning curve of ECMO-treatment in our department. Methods We retrospectively analysed the data of 131 patients undergoing ECMO treatment in the intensive care unit of the Asklepios Hospital of Langen over the time period from April 2011 to July 2016. We categorised the patients into three groups: lung failure (n = 54); cardiogenic shock (n = 58); and septic shock (n = 19). The primary outcome variable was hospital mortality along with identification of prognostic variables on mortality before initiating ECMO using logistic regression. Second outcome variable was the learning curve of our department in patients with ECMO. Results 6-year hospital mortality was 54% in patients with lung failure, 59% in patients with cardiogenic shock, and 58% in patients with septic shock. The CUSUM analysis revealed a typical learning curve with a point of inflection in the year 2014. Patients treated before 2014 had a worse outcome (p = 0.04 whole cohort; p = 0.03 for lung failure). Furthermore, less than 20 treatments per year respectively treatment before 2014 were associated negatively with hospital mortality of lung failure patients showing an odds ratio of 4.04, as well as in the entire cohort with an odds ratio of 3.19. Conclusion For the first time, a steep ECMO-learning curve using the CUSUM tool has been described. Obviously, the experience with ECMO has to be taken into account when defining the role of ECMO in ARDS, cardiogenic, and septic shock.

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            Crit Care
            Critical Care
            BioMed Central (London )
            2 July 2020
            2 July 2020
            : 24
            [1 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty, , Heinrich-Heine University, ; Moorenstr. 5, 40225 Düsseldorf, Germany
            [2 ]Getinge Group, Maquet GmbH, Kehlerstr. 31, 76437 Rastatt, Germany
            [3 ]Weltenmacher GmbH, Binterimstraße 8, 40223 Düsseldorf, Germany
            © The Author(s) 2020

            Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

            Funded by: Getinge
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            © The Author(s) 2020

            Emergency medicine & Trauma

            virtual reality, ecmo, cardiohelp, vr, priming


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