CICU Attending / Director of Education Children's National Hospital Washington, District of Columbia, United States
Abstract:
Background:
The Cardiac Intensive Care Unit (CICU) at Children’s National Hospital has been facilitating annual Extracorporeal Cardiopulmonary Resuscitation (ECPR) simulations incorporating the entire surgical procedure since 2019. Recent data suggests that long pauses in chest compressions during pediatric ECPR cannulations are associated with decreased rates of patient survival and favorable neurological outcome (1). In 2021, the CICU education team broadened the role of the recorder during the resuscitation to include “CPR monitoring”, specifically quantifying and communicating pauses in CPR during the ECPR simulations. The value of a CPR monitor in limiting pauses in resuscitation during ECPR deployments is unknown but is hypothesized to improve patient outcomes.
Methods:
Over a 6-week period in 2019, a series of interprofessional ECPR simulations were conducted. Participants included nurses, intensivists, surgeons and ECMO specialists and involved an ECMO trainer consisting of a synthetic carotid sheath with overlying skin and neck fascia. This setup provided for simulated neck exploration, vascular identification and access, and both arterial and venous cannula insertion (see attached figure). Simulations proceeded until ECMO flows of 1L/min were established and sterile CPR was continued through the entire cannulation procedure. In 2021, an additional series of ECPR simulations were conducted using the same ECMO trainer and with the same interprofessional participation described above, but for these exercises the resuscitation recorder was asked to chart the length of each CPR pause as well as to inform the team of each ongoing pause in 10-second increments. The time per pause as well as the total CPR pause time were collected for both the 2019 and 2021 simulation series.
Results:
Data were collected for 6 ECPR simulations conducted in 2019 which did not involve a CPR monitor and for 4 ECPR simulations conducted in 2021 which did involve a CPR monitor. There was a decrease in mean time per CPR pause (9.9 seconds versus 14.0 seconds, p=0.013) and mean total time without CPR per simulation (80.5 seconds versus 158.3 seconds, p=0.035) for the exercises in which a CPR monitor was present.
Conclusions:
The presence of a CPR monitor during interprofessional ECPR simulations decreased the mean time of each pause in CPR as well as the total time off the chest. Expanding the role of the recorder was feasible during simulations and can be readily translated into practice. Studies examining the effect of a CPR monitor on actual ECPR events are warranted.
---------------------------------------------------------------------------- 1 Lauridsen et al. Association of Chest Compression Pause Duration Prior to E-CPR Cannulation with Cardiac Arrest Survival Outcomes. Resuscitation. 2022 May 16. PMID: 35588971
