Implementation of Extracorporeal Cardiopulmonary Resuscitation (eCPR) Guidelines for the Hospitalized Adult

Background Cardiac arrest is responsible for 436,000 deaths annually in the U.S. Despite the administration of high-quality CPR, only 25% of hospitalized adults survive. Mortality rates are particularly high in patient experiencing cardiac arrest, where conventional methods (chest compressions, defibrillation and medications) are deemed refractory. However, Extracorporeal Cardiopulmonary Resuscitation (ECPR) has emerged as a promising alternative.
Objective This initiative seeks to hardwire the ECPR Practice Guidelines through simulation-based training.
Methods ECPR guidelines based on the published literature were created to standardize the process. ECPR simulations were conducted to operationalize the guideline and provide pilot training. The process included an ECPR response bag, mechanical chest compressor, and high-fidelity ballistic mannequin. Simulations followed the PDSA cycle for quality improvement, with performance and time measures instrumental to the ECPR process as outcomes.
Results Across three-tiered simulations, adherence to roles was 67%, closed-loop communication was 33%, use of the ECPR Bag and mechanical chest compressor was 33%, and adherence to candidate selection was 66%. Simulation 3 had the greatest time spent on key elements, including ECPR activation (8 mins 20 secs) and ECMO initiation (45 mins). Favorable outcomes were seen in ECPR activation, role adherence, and candidate selection (66%). Continued training is needed in the use of the mechanical chest compressor, the ECPR response bag and closed-loop communication.
Conclusion This initiative demonstrates the initial training phases of the ECPR guidelines with consideration for simulation fatigue and enhanced cognitive recognition. Though ECPR is a promising alternative for RCA, standardized ECPR guidelines should continue to evolve, working towards standardization and automaticity in this high-risk, low-volume procedure.

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