Implementation of an Extracorporeal Cardiopulmonary Resuscitation Simulation Program Reduces Extracorporeal Cardiopulmonary Resuscitation Times in Real Patients*

Abstract

There are no standard guidelines of how a team should coordinate the efforts of nursing, physicians, extracorporeal membrane oxygenation specialists, surgeons, respiratory therapists, patient care technicians, and unit clerks to emergently execute this complex procedure. Because time is of the essence, it is essential to develop a highly functioning and well-coordinated team with a standardized method of the procedure, its documentation, and communication. Simulation accomplished this for our program. Following these simulation exercises, not only was there a subjectively observed improved coordination and smoother deployment of extracorporeal membrane oxygenation in real-life extracorporeal cardiopulmonary resuscitation, but we have also demonstrated a significantly faster deployment of extracorporeal membrane oxygenation as compared with the presimulation era.

Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care*

“…Multidisciplinary, high-fidelity, and serial simulation-based E-CPR training at Children’s National Health System reduced deployment time of ECMO in children with ongoing CPR after implementing an iterative in situ multidisciplinary simulation training program (44). The role of formal E-CPR training programs (both simulation and traditional) has yet to be fully elucidated in the current era, and our survey results confirm this notion as only half of respondents participate in simulation-based continuing education training for E-CPR.…”

Part 8: Education, Implementation, and Teams

“…117 We also found very-lowquality evidence (downgraded for risk of bias, inconsistency, indirectness, and imprecision) from 2 observational studies. 118,119 For the important outcome of skill performance at 4 months to 1 year (patient tasks), we found very-low-quality evidence (downgraded for risk of bias, inconsistency, and imprecision) from 2 randomized trials 110,120 that showed that team or leadership training improved CPR hands-on time and time to initiation of various patient tasks at follow-up assessment.…”

Rapid Deployment ECMO

“…Several subsequent reports from different centers around the world have followed a similar model, in which a rapid response team (RaRT) is alerted in the setting of cardiac arrest or emergent cannulation [40,41,42•, 43••, 44•]. The members of the RaRT have predefined roles and generally train with medical simulation to improve performance [45]. Different institutions have different members as part of their RaRT (i.e., general surgeons, cardiac surgeons, ECMO nurses, respiratory technologists, intensivists, and perfusionists), but there is still variation in the immediate availability of team members, whether staff are in-house or on-call from home.…”

“…There is no doubt that the training for and an introduction of a rapid deployment system for ECMO will decrease times to institute ECPR and potentially improve survival [45]. Hence, if rapid deployment ECMO can reduce the period of minimal or no cardiac output and end-organ damage, then early mechanical support might improve outcomes.…”