The effect of a structured ECPR protocol aided by specific simulation training in a quaternary ECMO centre: A retrospective pre-post study

Andrew C Read; Stephen Morgan; Claire Reynolds; Jeff Breeding; Sean Scott; David A Lowe; Sally Newman; Rosemary Kennedy; Hergen Buscher

doi:10.1016/j.resplu.2022.100234

The effect of a structured ECPR protocol aided by specific simulation training in a quaternary ECMO centre: A retrospective pre-post study

Resusc Plus. 2022 Apr 22:10:100234. doi: 10.1016/j.resplu.2022.100234. eCollection 2022 Jun.

Authors

Andrew C Read¹, Stephen Morgan², Claire Reynolds², Jeff Breeding², Sean Scott³, David A Lowe², Sally Newman², Rosemary Kennedy², Hergen Buscher^{2

4}

Affiliations

¹ School of Medicine, Sydney, The University of Notre Dame Australia, 160 Oxford St, Darlinghurst, NSW 2010, Australia.
² St Vincent's Hospital, Sydney, 390 Victoria St, Darlinghurst, NSW 2010, Australia.
³ OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands.
⁴ Centre of Applied Medical Research, UNSW, 405 Liverpool St, Darlinghurst, NSW 2010, Australia.

Abstract

Background: There is limited literature exploring the relationship between simulation training and extracorporeal cardiopulmonary resuscitation (ECPR) outcomes. We examined whether there was an association between the implementation of an in situ simulation training program and ECPR utilisation, time to extracorporeal membrane oxygenation (ECMO), and neurologically intact survival.

Methods: In this retrospective pre-post study of in-hospital cardiac arrests (IHCA) and out-of-hospital cardiac arrests (OHCA), we analysed data for all patients recorded as receiving ECPR from September 2009 to December 2020 at our institution, relative to the implementation of an in situ ECPR simulation training program and a standardised procedure for high-quality ECPR. The primary outcome was Cerebral Performance Category (CPC) 1 or 2 at hospital discharge.

Results: There were 27 patients in the pre-intervention period and 39 patients in the post-intervention period. The median ECPR rate per year was 2 pre-intervention and 7 post-intervention (p = 0.073). There was an association between the implementation of the program and decreased median time from OHCA to ECMO flow, from 87 (IQR 78-95) minutes pre-intervention to 70 (IQR 69-72) minutes post-intervention (p = 0.002). Median time from IHCA to ECMO flow was 40 (IQR 20-75) minutes pre-intervention and 28 (IQR 16-41) minutes post-intervention (p = 0.134). Survival with CPC 1 or 2 was 7/27 (25.9%) pre-intervention and 15/39 (38.5%) post-intervention (p = 0.288).

Conclusion: We observed an association between the implementation of an ECPR-specific simulation program and decreased time from OHCA to ECMO flow. There was no association between the implementation of the program and neurologically intact survival at hospital discharge.

Keywords: Cardiac arrest; Education; Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Resuscitation; Simulation.