🔹 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.

 

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