Simulation-Based Training of Extracorporeal Membrane Oxygenation During H1N1 Influenza Pandemic: The Italian Experience Luca Brazzi, MD, PhD; Alfredo Lissoni, MD; Mauro Panigada, MD; Nicola Bottino, MD; Nicolo ` Patroniti, MD; Federico Pappalardo, MD; Luciano Gattinoni, MD, FRCP On November 2009, the Italian health authorities set up a network of selected intensive care unit (ICU) centers (ECMOnet) to prepare for the treatment of the sickest patients of influenza A (H1N1) by means of extracorporeal membrane oxygenation (ECMO). To quickly and efficaciously train all the physicians working in the ICUs of the ECMOnet on ECMO use, we decided to take advantages of the opportunity provided by simulation technology. Simulation proved efficacious in providing adequate training and education to participants as confirmed by the survival results obtained by the group of ICUs of the ECMOnet. Our experience supports the use of simulation as a valuable alternative to animal laboratory sessions proposed by traditional ECMO training programs providing partici- pants with cognitive, technical, and behavioral skills and allowing a proficient transfer of those skills to the real medical domain. (Sim Healthcare 7:32Y34, 2012) Key Words: ECMO, Laerdal SimMan, Influenza A (H1N1), ICU, Simulation. S imulation can help clinicians recognize and treat uncom- mon and highly complex clinical problems. Four advantages of simulation-based training have been highlighted 1 : (1) the training program can be modeled according to individual needs, (2) trainees can learn from their mistakes and explore the limits of each technique, (3) skills can be objectively assessed, and (4) immediate feedback can further improve individual and collaborative learning. Moreover, simulation- based training provides a unique opportunity to learn within a group and practice important clinical, communication, lead- ership, and interpersonal skills. We report our experience with simulation-based training of extracorporeal membrane oxygenation (ECMO) during the H1N1 influenza pandemic in winter 2009 to 2010. The Influenza A (H1N1) Pandemic On April 2009, an outbreak of influenza A (H1N1) occurred in Mexico, whereas 7 other cases were almost concurrently reported in the United States. Rapidly, it be- came clear that the 2 episodes were related, and the World Health Organization issued advice on the outbreak of an ‘‘influenza-like illness in the United States and Mexico.’’ The disease spread very rapidly, and on June 11, 2009, the World Health Organization declared the H1N1 pandemic, the first global pandemic since the 1968 Hong Kong flu, moving alert level up to phase 6. A number of authors have reported on risk factors, clinical course, and outcome of the disease: severe hypox- emia, refractory to conventional mechanical ventilation, has been repeatedly described. 2Y8 Because ECMO may be effective in saving patients with life-threatening acute respiratory distress syndrome (ARDS), 9 its use for the treatment of H1N1-related disease was proposed as early as October 12, 2009, by Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators. 10 These authors reported of adult and pediatric patients with H1N1 influenza, treated with ECMO from June 1 to August 31, 2009, in 15 intensive care units (ICUs) in Australia and New Zealand, to conclude that ‘‘IUnited States and the European Union might (have expected) to provide ECMO to approximately 800 and 1300 patients during the 2009Y2010 winter, respectively.’’ The ECMOnet Project Based on this estimate, on November 5, 2009, the Italian Ministry of Health established a network of selected ICUs (ECMOnet) and identified 2 major urgencies: (1) every ICU in the ECMOnet had to have all the equipment needed to proficiently perform ECMO support, and (2) all the physi- cians working in the same ICUs had to be quickly and ef- ficaciously trained on how to use ECMO. Special Article 32 ECMO During H1N1 Pandemic: The Italian Experience Simulation in Healthcare From the Dipartimento di Anestesiologia (L.B., L.G.), Terapia Intensiva e Scienze Dermatologiche, Universita ` degli Studi di Milano; Dipartimento di Anestesia (L.B., A.L., M.P., N.B., L.G.), Rianimazione e Terapia del Dolore, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Dipartimento di Medicina Sperimentale (N.P.), Universita ` degli Studi di Milano Bicocca; Unita ` Operativa di Anestesia e Rianimazione Cardio-Toraco-Vascolare (F.P.), Fondazione San Raffaele del Monte Tabor, Milano; and Dipartimento di Medicina Perioperatoria e Terapie Intensive (N.P.), Azienda Ospedaliera San Gerardo, Monza (MB), Italy. The project has been completely supported by Ministero del Lavoro della Salute e delle Politiche sociali. The authors declare no conflict of interest. Reprints: Luca Brazzi, MD, PhD, Dipartimento di Anestesia, Rianimazione, e Terapia del Dolore, Fondazione IRCCS Ca ` Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy (e-mail: brazzi@policlinico.mi.it; luca.brazzi@unimi.it). Copyright * 2012 Society for Simulation in Healthcare DOI: 10.1097/SIH.0b013e31823ebccb Copyright © 2012 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.