Extra corporeal circuits are incorporated into many forms of advanced organ support systems e.g. Extra Corporeal Lung Assist (ECLA), Renal Replacement Therapy. An important part of their implementation in any critical care setting is to develop the governance protocols that ensure the patient safety against the potential catastrophic consequences of circuit complications e.g. disconnection.

An inherent component of this is simulation to build team work and mitigate the effect of human factors. There are high definition simulators housed in simulation suites available on the market costing several thousand pounds. These systems are designed and have the capability of delivering a more real-life experience. However, when the issues are related to teaching the mechanics of safe aseptic cannulation, circuit set up, circuit connection and manipulation, simple circuit related troubleshooting and practising circuit complication drills, that level of complexity may not be wanted or required.

When a simulator was required to commission the ILA Activve® extracorporeal circuit purchased to use on patients with respiratory failure in the Critical Department at Queen Alexandra Hospital I developed the Extra corporeal circuit sumulator (ExCiS). It represents a cheap alternative to the high fidelity type simulators. It is a re-useable blood volume capacitor that can be repeatedly cannulated and used to demonstrate the setup and running of any kind of extracorporeal circuit (ECMO, ECCO2R, Cardiac Bypass, Renal dialysis, etc.) with components that can be purchased at any local hardware store and put together in your garage.

Though it was designed for simulation on the ilA Activve® an extracorporeal (primarily Carbon dioxide removal (ECCO2R)) device that requires simultaneous changes in ventilation and circuit modulation; it can be utilised to model the team-work and procedures needed to manage any extra corporeal circuit and is eminently configurable to the requirements at your institution.

This diagramatic instruction manual is made available under the FOAMed ethos and can be downloaded free from the Queen Alexandra Hospital Critical Care website (www.portsmouthicu.com). Due to to the support of the Portsmouth NHS Trust Innovation partnership I can also send out the components in a kit that you can assemble though this will necessarily result in a cost to you.

I encourage you to alter the system as you require. I still do.

Enjoy.