Oxygenator change-out times: the value of a written protocol and simulation exercises

A survey by our department revealed that most of the institutions in New England and New York have written protocols for low-volume, high-risk, emergency events but few of these centers formally practice these protocols through simulation. We hypothesized that hands-on experience with medical emergency protocols will significantly improve clinician performance. Two groups (n = 24 each) of third semester perfusion students with comparable clinical skills were enrolled in this study. The first group was surprised with an emergent oxygenator change-out drill during a simulation exercise, with no prior warning and without the benefit of a written protocol. The second group was asked to develop a written protocol before they were challenged with the change-out drill. Subsequently, both groups were given a week to practice a protocol for emergent change-out before re-testing. The times for all change-out drills were recorded and the groups were compared with a Student's t-test. A p-value < 0.05 was considered significant. The group without a written protocol (NP) had the longer time (559.7 +/- 84.9 sec) while the group with the written protocol (P) performed better (461.8 +/- 57.5 sec, p < 0.05). However, both groups achieved significantly better performance following repeated practice (NP = 167.8 +/- 34.8; P = 170.9+/-32.5 sec, p < 0 .05). While written protocols for emergent events will improve patient care, simulation and practice of emergency protocols is the most significant way to protect our patients. Based on this, we advocate for all perfusion groups to simulate emergency events and practice their crisis protocols.