Emergency department eCPR: an exploratory observational study of human factors

Area of Science:

• Cardiology and Emergency Medicine
• Human Factors in Healthcare
• Critical Care Interventions

Background:

• Extracorporeal cardiopulmonary resuscitation (eCPR) is a complex, high-acuity intervention demanding skilled teams.
• Understanding human factors is crucial for optimizing eCPR performance.
• This study investigated teamwork, provider stress, and environmental influences during eCPR in the Emergency Department (ED).

Purpose of the Study:

• To explore and assess human factors outcomes during Emergency Department (ED) extracorporeal cardiopulmonary resuscitation (eCPR) events.
• To identify key elements of teamwork, provider stress, and environmental conditions impacting eCPR.
• To evaluate the feasibility of assessing human factors during eCPR.

Main Methods:

• An exploratory, two-phase study conducted over 32 months at two eCPR hospital sites.
• Observation of key eCPR team members during actual eCPR events, following simulation and non-eCPR observations.
• Assessment of patient outcomes (Utstein measures, timings), provider outcomes (heart rate, cortisol, psychometrics), teamwork (Mayo High-Performance Team Score), and environmental factors (noise, headcount, workflow).

Main Results:

• Six eCPR events involving 18 providers were observed; patients typically presented with shockable rhythms.
• Consistent system features included predefined roles, crowd control personnel, and team leader summaries.
• Providers experienced elevated salivary cortisol post-eCPR; teamwork scores were moderate to high (median 12).
• Environmental observations noted noisy EDs and crowding (median headcount 20).

Conclusions:

• Human factors outcomes can be feasibly assessed during ED eCPR.
• Predefined roles and structured communication were consistently observed.
• These elements warrant further investigation to improve eCPR delivery and patient outcomes.