Emergency department eCPR: an exploratory observational study of human factors

Extracorporeal cardiopulmonary resuscitation (eCPR) is a low-frequency, high-acuity intervention requiring technical skills and coordinated team performance. This exploratory study observed eCPR cases for elements of teamwork, provider stress, and environmental factors in the Emergency Department (ED). Reid's conceptual framework domains for human factors in healthcare teams were used as an analytical lens for interpreting the data.

An exploratory two-phase study was conducted across two eCPR hospital sites over 32 months, with an initial simulation and non-eCPR observation phase used to refine study methods. A subsequent eCPR case phase used convenience sampling of adult cardiac arrests to observe actual eCPR events. Following consent, eCPR team members allocated to key roles (such as team leadership and cannulation) were observed in detail during each case. Patient outcomes included Utstein measures and eCPR timings. Provider outcomes included mobile heart rate monitoring, salivary cortisol, and validated psychometric measures. Teamwork was assessed using the Mayo High-Performance Team Score (MHPTS). Environmental outcomes included measurements of ambient noise levels, team headcounts, and observations of eCPR workflow.

Eighteen providers were observed during six eCPR events. The mean case age was 44.7 years and most patients presented with a shockable rhythm. System features consistently observed in the eCPR cases included predefined roles, individuals assigned to crowd control, and team leader summaries. Causal interpretations are limited by the small sample size and risk of observational bias. Within these limitations, individual provider salivary cortisol measurements were higher after eCPR copared with paired baseline samples. Teamwork scores (MHPTS) were in a moderate to high range (median = 12; IQR 10-13) and environmental observations reflected noisy ED spaces and crowding (headcount median = 20; IQR 18-29).

This exploratory study found that human factors outcomes can be feasibly assessed during ED eCPR. Predefined roles and structured communication were observed and warrant further study.