Pauses in Compressions During ECPR​​​​​​: Using Simulation to Determine the Cause

Area of Science:

• Pediatric Critical Care Medicine
• Cardiopulmonary Resuscitation
• Extracorporeal Membrane Oxygenation

Background:

• Minimizing chest compression pauses (CCPs) is crucial for effective cardiopulmonary resuscitation (CPR) and extracorporeal cardiopulmonary resuscitation (ECPR).
• Factors influencing CCP duration during ECPR, particularly in pediatric settings, remain underexplored.
• Understanding these factors is essential for improving CPR quality in critical care scenarios.

Purpose of the Study:

• To identify specific tasks and communication patterns contributing to CCP during simulated pediatric intrahospital cardiac arrest (IHCA) events transitioning to ECPR.
• To quantify the impact of different phases of ECPR on CCP frequency and duration.

Main Methods:

• A single-center observational study involving 10 high-fidelity, in situ simulated pediatric IHCA scenarios.
• Interprofessional teams participated in simulations recorded for detailed analysis of CCPs.
• Reviewers analyzed CCP duration, frequency, causes, and communication patterns, comparing conventional and surgical phases.

Main Results:

• Chest compression pauses were significantly more frequent during the surgical phase (median 15.5 pauses/scenario) compared to the conventional phase (median 2.5 pauses/scenario).
• Pulse checks (26.5%) and surgical preparation/procedures (37.5%) were the primary causes of pauses, with surgical tasks causing the longest pauses (median 12.0s).
• Communication surrounding pauses was inconsistent, with only 48.6% of pauses featuring clear verbal cues for both stopping and resuming compressions.

Conclusions:

• Chest compression pauses are more frequent and prolonged during surgical tasks within the ECPR process.
• Implementing task-bundling strategies and enhancing closed-loop communication, especially around critical surgical interventions, can minimize CCPs.
• Addressing communication inconsistencies is paramount for improving patient safety during ECPR.