The effect of a structured ECPR protocol aided by specific simulation training in a quaternary ECMO centre: A...

Area of Science:

• Cardiology
• Medical Simulation
• Emergency Medicine

Background:

• Limited research exists on the impact of simulation training on extracorporeal cardiopulmonary resuscitation (ECPR) outcomes.
• ECPR is a critical intervention for refractory cardiac arrest, requiring specialized training and rapid implementation.

Purpose of the Study:

• To investigate the association between an in situ simulation training program and ECPR outcomes.
• To evaluate the program's effect on ECPR utilization, time to extracorporeal membrane oxygenation (ECMO) initiation, and neurologically intact survival.

Main Methods:

• Retrospective pre-post study analyzing ECPR cases from September 2009 to December 2020.
• Data compared before and after the implementation of an in situ ECPR simulation training program and standardized procedure.
• Primary outcome: Cerebral Performance Category (CPC) 1 or 2 at hospital discharge.

Main Results:

• The study included 27 patients pre-intervention and 39 post-intervention.
• A significant decrease in median time from out-of-hospital cardiac arrest (OHCA) to ECMO flow was observed post-intervention (87 to 70 minutes, p=0.002).
• No significant association was found between the simulation program and neurologically intact survival (25.9% pre vs. 38.5% post).

Conclusions:

• Implementation of an ECPR-specific simulation program is associated with reduced time to ECMO initiation for OHCA patients.
• The simulation program did not demonstrate a significant association with improved neurologically intact survival at hospital discharge.