Authors (including presenting author) :
Leung KY(1), Lam SM(1), Chan CY(2), Shum HP(1), Yeung KJ(1), Mui SY(1), Ng CP(1), Lee CH(1), LO WPJ(1), Kwan YF(1)
Affiliation :
(1)Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital (2)Department of Intensive Care, United Christian Hospital
Introduction :
Despite advancements, neurological survival rates for in- and out-of-hospital cardiac arrests remain concerningly low. Extracorporeal Cardiopulmonary Resuscitation (ECPR), which utilizes Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) during cardiopulmonary resuscitation (CPR), aims to restore circulation and potentially improve outcomes. However, ECPR demands substantial resources, skilled personnel, and advanced equipment. Studies indicate that shorter time-to-ECPR correlates with better neurological outcomes. Thus, precise execution and standardized decision making is essential, necessitating meticulous preparation and resuscitation. The ECPR protocol was redesigned to enhance efficiency in every aspect.
Objectives :
To improve ECPR outcomes through well-structured protocols and simulation practices.
Methodology :
The ECPR call pathway and workflow were redesigned in October 2022 to include: (1) Clear inclusion and exclusion criteria for case selection; (2) A direct ECPR operator calling system reaching both the Intensive Care Team (doctors and nurses) and Cardiologist; (3) Delineated team roles and responsibilities. (4) Bedside setup of ECMO equipment and consumables. (5) Checklists and decision-making algorithms to enhance efficiency for swift and successful ECMO initiation. A series of simulation exercises were conducted. Briefing and debriefing after each simulation exercise to increase team proficiency and fine-tune the protocols using the Plan-Do-Check-Act (PDCA) modality.
Result & Outcome :
Following three simulation exercises, the ECPR team’s performance improved significantly, reducing the procedure time from 75 to 60 and then to 40 minutes. These trials provided a low-risk environment for practicing high-stress scenarios. During debriefing sessions, the team identified and addressed bottlenecks in the ECPR process, including communication, workflow coordination and team role integration. Simulation training streamlined the complex ECPR procedure, equipping the team with the skills to navigate chaotic real-life situations effectively. Appropriate responses which were standardized within the team were also crucial to avoid confusion and misunderstanding when every second counts in critical care scenarios. Conclusion Well-structured ECPR protocols supplemented by simulations, provide standardized, high-quality ECPR while ensuring that all team members are well prepared to act swiftly and efficiently to enhance patient’s outcomes.