Table 1.

Simulation-based scenarios.

Scenario	Learning outcome	Action	Critical action
Accidental decannulation	ECMO Emergency management Technical skills Teamwork	Evaluate circuit and patient parameters	Provide prompt Backup ventilatory support Patient stabilization
Air in the circuit	ECMO Emergency management Circuit check Technical skills	Recognize presence of air (micro or macro bubbles, massive air) Identify leak source Chest X-ray to confirm cannula position	Cross-clamp (if air is post-oxy or if massive air) Prompt Backup ventilatory support (until complete air removal) Remove air (in all cases)
Clots in the membrane	Routine ECMO management Hemostasis evaluation Teamwork	Try to identify the clot Evaluate trans-membrane delta pressure Order coagulation tests Discuss with hematologist	Check anticoagulation strategy Circuit replacement
Oxygenator failure	Routine ECMO management Technical skills	Gas exchange evaluation (pre- post- membrane)	Discuss need for circuit replacement, based on clinical data
Blood recirculation	Routine ECMO management	Recognize saturation decrease with increasing blood flow Order Echocardiogram Chest X-Ray	Reduce flow Fix the cannula position
Circuit line kinking	Routine ECMO management Circuit check, pressure, and flow evaluation	Recognize kinking Identify possible cause of kinking and establish preventive measures	Provide line patency
Cannula kinking	Routine ECMO management Circuit pressure evaluation Teamwork	Order Echocardiogram Chest X-Ray Call surgeon	Increase ventilator's setting Cannula replacement
Hypovolemia	Routine ECMO patient management Circuit pressure evaluation	Order laboratory tests, echocardiogram	Fluid administration
Bleeding	Surgical emergency Hemostasis evaluation Circuit pressure evaluation Teamwork	Recognize presence and cause of bleeding Coagulation test	Stop the bleeding Blood administration
Pneumothorax	Patient emergency management Circuit pressure evaluation Teamwork	Order Echocardiogram Chest X-Ray Gas exchange	Pneumothorax decompression Patient stabilization

Outline of related learning outcomes, actions, and critical actions.