.jpg "Matthew Stampfl, MD photo")
Daniel McCarthy, MD MBA
Assistant Professor
University of Wisconsin-UW Health, United States
Disclosure information not submitted.
Jillian Koch, RRT
ECMO Coordinator
University of Wisconsin-UW Health, United States
Disclosure information not submitted.
Micah Long, MD
Assistant Professor
University of Wisconsin-UW Health
Madison, Wisconsin, United States
Disclosure information not submitted.
Joshua Glazer, MD
Assistant Professor
University of Wisconsin-UW Health at The American Center, United States
Disclosure information not submitted.
Title: Novel Tool for ECPR Consult, Activation, and Automated Repository Generation
Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) holds promise to improve outcomes for out-of-hospital cardiac arrest but requires careful patient selection, timely application, and rigorous quality assurance (QA) to be effective. The initial ECPR process is critical for the individual patient; that is, neuro-intact survival is highly dependent on minimizing low-flow time. It is equally important for the longevity of the ECPR program itself, as preventable false activations erode both necessary multi-disciplinary stakeholder commitment and response time. Here-in we describe a novel tool developed to: 1) provide a maximally-rapid and sensitive ECPR consultation followed by a specific, robust, and expeditious ECPR activation; 2) generate an automated and accurate database of all ECPR consults and activations for QA purposes.
Methods: Consideration for ECPR at our academic medical center is initiated by the Emergency Medicine (EM) physician. The decision to activate ECPR is dependent on conversation between the EM attending and the cannulating physician (i.e. Thoracic surgeon). Emergency Department Coordinators (EDCs) facilitate a rapid phone conversation between these individuals. The EDC remains on the line, listens to the conversation, and populates an electronic medical record (EMR)-based navigator tool. If the outcome of the conversation is agreement on activation, the EDC clicks an “activate” button within the navigator. This sends a pre-populated page to all ECPR team members, after which they rapidly converge on the ED with all necessary resources. Separate “activate” options exist for adults vs adolescents, as the responding team members and disposition differ.
Results: Historical false-activation rate for ECPR was 55%. After implementing the above process and tool, false activation rate decreased to 10% (p = 0.0235). Monthly automated reports are now easily queried via the ECPR navigator. All ECPR consults and activations are reviewed to identify areas for further system improvement.
Conclusions: Our ECPR tool has improved efficiency, nearly eliminated false activations, and provided a reliable registry for QA efforts. The tool could easily adapted into virtually any EMR, and potentially adopted for other hyperacute critical disease states which require rapid multi-disciplinary response.