Extended cardiopulmonary resuscitation: from high fidelity simulation scenario to the first clinical applications in Poznan out-of-hospital cardiac arrest program

Maciej Sip; Mateusz Puslecki; Marek Dabrowski; Tomasz Klosiewicz; Radoslaw Zalewski; Marcin Ligowski; Ewa Goszczynska; Christopher Paprocki; Marek Grygier; Maciej Lesiak; Marek Jemielity; Bartłomiej Perek

doi:10.1177/0267659120981811

Extended cardiopulmonary resuscitation: from high fidelity simulation scenario to the first clinical applications in Poznan out-of-hospital cardiac arrest program

Perfusion. 2022 Jan;37(1):46-55. doi: 10.1177/0267659120981811. Epub 2020 Dec 16.

Authors

Maciej Sip^{1

2}, Mateusz Puslecki^{1

2

3}, Marek Dabrowski^{2

4}, Tomasz Klosiewicz^{1

2}, Radoslaw Zalewski^{1

2}, Marcin Ligowski³, Ewa Goszczynska³, Christopher Paprocki², Marek Grygier⁵, Maciej Lesiak⁵, Marek Jemielity³, Bartłomiej Perek³

Affiliations

¹ Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland.
² Polish Society of Medical Simulation, Slupca, Poland.
³ Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Wielkopolskie, Poland.
⁴ Department of Medical Education, Poznan University of Medical Sciences, Poznan, Wielkopolskie, Poland.
⁵ First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Wielkopolskie, Poland.

PMID: 33325325
DOI: 10.1177/0267659120981811

Abstract

Background: The outcomes of out-of-hospital cardiac arrest (OHCA) patients are poor. In some OHCA cases, the reason is potentially reversible cardiac or aortic disease. It was suggested previously that high-quality cardiopulmonary resuscitation (CPR) followed by extracorporeal membrane oxygenation (ECMO) support may improve the grave prognosis of OHCA. However, extended CPR (ECPR) with ECMO application is an extremely invasive and cutting-edge procedure. The purpose of this article is to describe how high-fidelity medical simulation as a safe tool enabled implementation of the complex, multi-stage ECPR procedure.

Method: A high fidelity simulation of OHCA in street conditions was prepared and carried out as part of a ECPR procedure implemented in an in-hospital area. The simulation tested communication and collaboration of several medical teams from the pre-hospital to in-hospital phases along with optimal use of equipment in management of a sudden cardiac arrest (SCA) patient.

Results: The critical and weak points of an earlier created scenario were collected into a simulation scenario checklist of ECPR algorithm architecture. A few days later, two ECPR procedures followed by cardiologic interventions for OHCA patients (one pulmonary artery embolectomy for acute pulmonary thrombosis and one percutaneous coronary artery angioplasty with drug eluting stent implantation for acute occlusion of the left anterior descending artery), were performed for the first time in Poland. The protocol was activated five times in the first 2 months of the POHCA Program.

Conclusion: High fidelity medical simulation in real-life conditions was confirmed to be a safe, useful tool to test and then implement the novel and complex medical procedures. It enabled to find, analyze and solve the weakest points of the earlier developed theoretical protocol and eventually succeed in clinical application of complete ECPR procedure.

Keywords: extended cardiopulmonary resuscitation; extracorporeal membrane oxygenation; medical simulation; out-of-hospital cardiac arrest; outcome.

MeSH terms

Cardiopulmonary Resuscitation* / methods
Drug-Eluting Stents*
Extracorporeal Membrane Oxygenation* / methods
High Fidelity Simulation Training*
Humans
Out-of-Hospital Cardiac Arrest* / therapy