Cardiac Arrest: An Adult eCPR Simulation Case.

Abstract

Introduction: Extracorporeal cardiopulmonary resuscitation (eCPR) has demonstrated patient outcome-driven benefits for those with out-of-hospital cardiac arrest in refractory ventricular fibrillation/pulseless ventricular tachycardia but remains an infrequent procedure requiring hands-on training.

Methods: We created a high-fidelity simulation utilizing a cannulation manikin to simulate cardiac arrest in a 57-year-old patient in ventricular fibrillation refractory to standard resuscitation. Participants (consisting of emergency medicine and critical care resident and attending physicians, critical care fellows, advanced practice providers, nurses, pharmacists, and respiratory therapists) were instructed to respond to the simulation by recognizing the indication for eCPR and performing ultrasound-guided percutaneous extracorporeal membrane oxygenation (ECMO) cannulation to facilitate patient transfer to the cardiac catheterization lab. Participants rated their comfort level with various aspects of eCPR on a 5-point Likert scale, both presimulation (N = 27) and postsimulation (n = 17).

Results: A total of 27 participants with varied levels of training completed the simulation, with positive feedback from all respondents on the postsimulation survey. A statistically significant increase in comfort scores from pre- to postsimulation was observed across all domains, including knowledge of eCPR candidacy (p < .001), cannulation procedures (p < .001), and overall process (p = .001).

Discussion: Simulation is a valuable tool for ensuring procedural competency, especially for rarely performed and high-risk procedures such as ECMO cannulation. As eCPR becomes more prevalent, it is vital that simulation models be available and practiced on a multidisciplinary level to ensure general knowledge of the indications, procedures, and overall process of eCPR.