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

Minimizing chest compression pauses (CCPs) is critical for high-quality CPR and extracorporeal cardiopulmonary resuscitation (ECPR), yet little is known about modifiable factors affecting pause length in ECPR. We sought to identify tasks and communication patterns leading to CCP during simulated pediatric intrahospital cardiac arrest (IHCA) events progressing to ECPR.

In a single-center observational study, we conducted 10 high-fidelity, in situ simulated pediatric IHCA simulations involving interprofessional teams. All simulations were video/audio recorded. Two reviewers analyzed duration, frequency, and specific cause of each CCP and categorized communication patterns (verbal cues to stop and resume compressions). Pause characteristics were compared between the conventional and surgical phases.

Pauses were more frequent in the surgical phase (median: 15.5 vs. 2.5 per scenario). While chest compression fraction remained above the AHA 80% guideline in both phases, pause frequency and duration per 2-minute cycle were higher in the surgical phase. The most common causes for pause were pulse checks (26.5%) and surgical procedure/preparation (37.5%). Surgical procedures caused the longest pause (median: 12.0 s). Communication was inconsistent; only 48.6% of pauses had verbal cues for both stopping and resuming compressions, often from different team members.

CCP occurs more frequently and is lengthier during surgical tasks in ECPR. The identification of these specific tasks presents an opportunity to implement task-bundling strategies and improve closed-loop communication to minimize pause frequency and duration. Future efforts should address team communication inconsistencies, especially surrounding critical surgical tasks, to enhance patient safety.