Abstract 14313: Simulation Training Enables Emergency Medicine Providers to Rapidly and Safely Initiate Extracorporeal Cardiopulmonary Resuscitation During Simulated Cardiac Arrest
Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as an effective strategy for managing refractory out-of-hospital cardiac arrest (OHCA). Emergency department (ED) provider training is a barrier to widespread implementation. ECPR simulation training is a potential solution, but published evidence of effectiveness is limited.
Hypothesis: A 2-day simulation course will enable ED physician-nurse teams to safely and rapidly initiate ECPR in a high-fidelity simulated OHCA scenario.
Methods: In this single center, IRB-approved study at a U.S. academic medical center, 9 ED physicians and 9 ED nurses were divided into 3 teams and participated in a 2-day simulation course. The course included didactics, hands-on practice with ultrasound-guided percutaneous vascular cannulation, circuit priming, and simulated ECPR resuscitations. Each team was tested in 3 sequential simulations on Day 1 after didactics and a brief practice session, on Day 2 after the simulation course, and at 3 months. Primary outcome was the proportion of simulations in which ECPR was initiated within 30 minutes. Intervals from patient arrival to 1) ECPR cannula placement, 2) primed ECPR circuit, and 3) initiation of ECPR flow were also recorded. Safety data was prospectively collected using a checklist.
Results: ECPR flow was initiated within 30 minutes in 6/9 simulations (66.7% [95% CI: 36-97]) at baseline; 9/9 (100% [95% CI: 70-100]) on Day 2; and 9/9 (100% [95% CI: 70-100]) at 3 months. Significant improvements between baseline and subsequent simulations were seen (table). No failure to cannulate, failure to heparinize, mismatched connections, or air embolism during connection occurred.
Conclusions: Our simulation course enabled ED providers to rapidly and safely initiate ECPR in a high-fidelity OHCA simulation and retain these skills at 3 months. These results demonstrate the value of simulation training in the clinical implementation of ED provider ECPR.
Author Disclosures: S.P. Whitmore: None. K.J. Gunnerson: None. J.W. Haft: None. W.R. Lynch: None. D.M. Rooney: Honoraria; Modest; $500.00. Simulation Showcase, St. John Providence Health System Speaker. J.A. Waldvogel: None. P. Baldridge: None. R.W. Neumar: Research Grant; Significant; Funding for ECPR research from NIH (R44 HL091606) and American Heart Association (15GRNT25890002).
- © 2016 by American Heart Association, Inc.