Ripal Patel
University of Maryland School of Medicine
Baltimore, MD
Disclosure information not submitted.
Cortney Foster, DO
Pediatric Critical Care Attending
University of Maryland Medical Center
Baltimore, Maryland, United States
Disclosure information not submitted.
Nan Garber, MD
Pediatric Critical Care Attending
University of Maryland Medical Center, United States
Disclosure information not submitted.
Jenni Day, RN, PhD
Director of Nursing Inquiry
University of Maryland Medical Center, United States
Disclosure information not submitted.
Dayanand Bagdure, MD
Pediatric Critical Care Attending
University of Maryland Medical Center, United States
Disclosure information not submitted.
Title: Impact of pediatric E-CPR simulation on compliance with CPR measures and ECMO activation times
Introduction:
Extracorporeal cardiopulmonary resuscitation (ECPR) is initiated during cardiac arrest as a rescue strategy when conventional resuscitation does not yield return of spontaneous circulation (ROSC). Initiation of CPR to placement onto extracorporeal membrane oxygenation (ECMO) within 30 minutes is associated with increased survival and takes a well-coordinated team. High fidelity simulation training is recommended to maintain a successful ECMO program. A study by Sawyer et al showed improvement in subjective measures of learning, adherence to ECPR activation protocols, and shorter activation times with monthly two hour high fidelity large scale simulation training. We hypothesized that the addition of monthly in- situ E-CPR high fidelity, 30 minute, simulation training would improve compliance with CPR quality measures and decrease time to performing vital steps in CPR and ECMO preparation within our mixed cardiac and medical intensive care unit.
Methods:
Ten, thirty minute, ECPR simulations were performed monthly between September 2020 and July 2021. Facilitator observations were used to collect data including time to first dose of epinephrine, time to ECMO activation, and adherence to CPR quality measures.
Results:
Time to application of an AED, first dose of epinephrine, and establishment of an airway improved after 10 simulations. Compliance with CPR measures improved by 11%. There was no decrease in time to ECMO activation during the study period (average time to ECMO activation was 397 seconds).
Conclusions:
Monthly E-CPR simulations led to improvement in times to performing vital steps in E-CPR and adherence to quality measures of CPR. They did not lead to a decrease in the time from CPR onset to the activation of ECMO. Further simulations will be needed to see if we can achieve our goal of shortening time to ECMO activation.