Extracorporeal membrane oxygenation (ECMO) cannulation during refractory cardiac arrest has become a key therapeutic option in contemporary critical care medicine. When initiated in a timely manner, extracorporeal cardiopulmonary resuscitation (ECPR) may improve neurological outcomes and survival^1,2. Transesophageal echocardiography (TEE) guidance for ECMO cannulation has been shown to decrease intra-procedural complications such as vascular injury, bleeding, and thrombosis, as it facilitates real time visualization of correct guidewire and cannula positioning³. Obtaining TEE imaging during ECPR however, can be challenging given the unpredictable timing and nature of cardiac arrest, and availability of expert echocardiographers may not always be possible immediately at the bedside. Despite proliferation of commercially available courses and simulators to teach point of care TEE, there is a need to expand simulation-based learning (SBL) strategies to impart these skills specifically for ECPR scenarios. With the expansion of an ECPR program at our institution, we developed an educational SBL course aimed to teach TEE guidance for ECPR cannulation focused for critical care practitioners, which included didactics, TEE simulation, and integrated ECPR cannulation simulation scenarios.