🔹 Overview:

• Topic rarely taught in medical schools: Human Factors in ECMO transport.

• Focuses on non-technical skills (NTS) vital for ECMO success.

• Goal: Equip clinicians to recognize and manage cognitive and teamwork-related limitations under pressure.

🔹 Human Limitations & Performance

• Humans are variable, unlike machines; performance fluctuates with fatigue, stress, and emotion.

• Stress-performance curve: from boredom → optimal performance → burnout.

• Under pressure, clinicians may experience:

  • Task fixation (e.g., focusing on cannulation while neglecting BP/saturation).

  • Tunnel vision, freezing, disengagement, speech impairment, aggression, or withdrawal.

🔹 Situational Awareness (SA)

• 1. Perception – Recognize current environment and vital data.

  2. Comprehension – Understand and contextualize what’s happening.

  3. Projection – Predict what may happen and act accordingly.

     Three components:

  • Poor communication

  • Fatigue

  • Task overload

  • Ambiguous information

    SA can be degraded by:

• Maintain SA via:

  • Minimizing distractions

  • Clear, closed-loop communication

  • Time management and anticipation

🔹 Communication & Team Dynamics

• Teamwork is critical: shared goals, mutual accountability, efficient coordination.

  • Example acronym: NETS (Nature, Expectation, Time, Special considerations).

  • Include all team members in planning and post-mission reflection.

    Use briefing and debriefing to align the team before and after missions:

• Use structured communication:

  • Avoid ambiguous language or unclear numbers.

  • Speak slowly, verify instructions, use readbacks and phonetics.

  • Adopt closed-loop communication to confirm receipt and understanding.

🔹 Decision-Making Under Pressure

• 1. Identify the problem

  2. Consider all options

  3. Make and implement a decision

  4. Evaluate effectiveness

     Use structured approach for problem-solving:

• Avoid impulsive decisions based on misdiagnosed issues (e.g., shocking a patient with V-fib on bypass).

• Build predefined safety checkpoints into ECMO missions—there’s often no turning back once transport begins.

🔹 Checklists

• Essential for safety in mobile ECMO.

• Use for equipment, briefing, transport, and retrieval steps.

• Effective checklists must be:

  • Relevant, specific, and practical.

  • Read aloud with challenge-response format.

  • Avoid assumptions or memory-based confirmations.

🔹 Professional Assertiveness

• 1. Gain attention

  2. Express concern

  3. State the issue

  4. Propose a solution

  5. Seek agreement

     Use assertiveness cycle to manage team errors or diverging actions:

• Encourage P.A.C.E. to challenge hierarchy: Probe, Alert, Challenge, Emergency stop.

🔹 Final Messages

• Human factors are central to safe, effective ECMO transport.

• Simulation and reflective practice are vital.

• Professional communication and structured teamwork save lives.

• Always listen to colleagues’ concerns—overconfidence kills.