Implementation of extended cardiopulmonary resuscitation procedure in in-hospital cardiac arrest: a preliminary simulated study
, 1, 23, 1, 4, 4, 56, 2, 4, 4
Abstract
INTRODUCTION: The survival rate of patients after in-hospital cardiac arrest (IHCA) is poor. The implementation of novel technologies to conventional cardio-pulmonary resuscitation (CPR) may improve clinical outcomes. Aim: To evaluate efficacy of extended CPR (ECPR) performed by physicians in the simulated scenario of IHCA. MATERIAL AND METHODS: High-fidelity simulations were performed in a simulation room equipped with a full spectrum of emergency devices. Earlier, the physicians (n = 60, five courses) participated in a threeday training in the use of extracorporeal techniques. Eventually, 12 participants were divided into 4-member teams that were involved in three stages (assessed in terms of duration and quality) of scenario such as 1. Advanced Life Support (ALS) activities; 2. preparation of the extracorporeal membrane oxygenation device (ECMO); 3. cannulation and activation of ECMO. RESULTS: All teams completed successfully scenario within recommended time of 60 minutes (ranged from 33 min. 55 sec. to 37 min.) after IHCA. In details, decision to activate ECMO team was taken between 8 min. 45 sec. and 14 min. 15 sec of scenario, ECMO device prepared within 10 min. 5 sec. to 15 min. 30 sec. whereas peripheral vessels cannulated in 4 min. 14 sec. to 6 min. 10 sec. Of note, all evaluated times were the shortest for teams with decisive leaders. CONCLUSIONS: Implementation of ECPR procedure is possible within recommended time after IHCA. It has also been shown that training with application of high-fidelity simulation techniques is of paramount importance in achievement and maintenance of ECPR skills, not only manual but also in effective communication.
Keywords: in-hospital cardiac arrestcardio-pulmonary resuscitationextended cardio-pulmonary resuscitationsimulationeducation
References
- Sandroni C, Nolan J, Cavallaro F, et al. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007; 33(2): 237–245.
- Yilmaz S, Omurlu I. Survival after cardiopulmonary arrest in a tertiary care hospital in Turkey. Annals of Saudi Medicine. 2019; 39(2): 92–99.
- Schluep M, Gravesteijn BY, Stolker RJ, et al. One-year survival after in-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2018; 132: 90–100.
- Girotra S, Nallamothu BK, Spertus JA, et al. American Heart Association Get with the Guidelines–Resuscitation Investigators. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012; 367(20): 1912–1920.
- Kim YS, Lee YJ, Won KiB, et al. Extracorporeal Cardiopulmonary Resuscitation with Therapeutic Hypothermia for Prolonged Refractory In-hospital Cardiac Arrest. Korean Circ J. 2017; 47(6): 939–948.
- Virdi G, Picton S, Fothergill R. London Ambulance Service NHS Trust Cardiac Arrest Annual Report. 2014; 15: 2015.
- Monsieurs KG, Nolan JP, Bossaert LL, et al. ERC Guidelines 2015 Writing Group. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015; 95: 1–80.
- Sip M, Puslecki M, Dabrowski M, et al. Extended cardiopulmonary resuscitation: from high fidelity simulation scenario to the first clinical applications in Poznan out-of-hospital cardiac arrest program. Perfusion. 2020 [Epub ahead of print]: 267659120981811.
- Czekajlo M, Dabrowski M, Puslecki M, et al. Using ECMO VV in the COVID-19 pandemic. Disaster and Emergency Medicine Journal. 2020.
- Smereka J, Puslecki M, Ruetzler K, et al. Extracorporeal membrane oxygenation in COVID-19. Cardiol J. 2020; 27(2): 216–217.
- Duerschmied D, Zotzmann V, Rieder M, et al. Myocardial infarction type 1 is frequent in refractory out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR). Sci Rep. 2020; 10(1): 8423.
- Witten L, Gardner R, Holmberg MJ, et al. Reasons for death in patients successfully resuscitated from out-of-hospital and in-hospital cardiac arrest. Resuscitation. 2019; 136: 93–99.
- Widestedt H, Giesecke J, Karlsson P, et al. In-hospital cardiac arrest resuscitation performed by the hospital emergency team: A 6-year retrospective register analysis at Danderyd University Hospital, Sweden. F1000Res. 2018; 7: 1013.
- Puślecki M, Ligowski M, Kiel M, et al. ECMO therapy simulator for extracorporeal life support. Am J Emerg Med. 2018; 36(3): 506–508.
- Puslecki M, Ligowski M, Kiel M, et al. Prototype of extracorporeal membrane oxygenation (ECMO) therapy simulator used in regional ECMO program. J Thorac Dis. 2018; 10(8): 5073–5079.
- Merchant RM, Yang L, Becker LB, et al. American Heart Association Get With The Guidelines-Resuscitation Investigators. Incidence of treated cardiac arrest in hospitalized patients in the United States. Crit Care Med. 2011; 39(11): 2401–2406.
- Girotra S, Nallamothu BK, Spertus JA, et al. American Heart Association Get with the Guidelines–Resuscitation Investigators. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012; 367(20): 1912–1920.
- Riley LE, Mehta HJ, Lascano J. Single-center In-hospital Cardiac Arrest Outcomes. Indian J Crit Care Med. 2020; 24(1): 44–48.
- Qazi AH, Kennedy K, Bradley SM, et al. American Heart Association Get With the Guidelines Resuscitation Investigators. Impact of timing of cardiac arrest during hospitalization on survival outcomes and subsequent length of stay. Resuscitation. 2017; 121: 117–122.
- Chan ML, Spertus JA, Tang F, et al. Missed opportunities in use of medical emergency teams prior to in-hospital cardiac arrest. Am Heart J. 2016; 177: 87–95.
- ) American Heart Association Life Support Algorithms. Bone Marrow Transplantation. 1998: 616–621.
- Nallamothu BK, Guetterman TC, Harrod M, et al. How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study. Circulation. 2018; 138(2): 154–163.
- Moskowitz A, Holmberg MJ, Donnino MW, et al. In-hospital cardiac arrest: are we overlooking a key distinction? Curr Opin Crit Care. 2018; 24(3): 151–157.
- Gershengorn HB, Garland A, Kramer A, et al. Variation of arterial and central venous catheter use in United States intensive care units. Anesthesiology. 2014; 120(3): 650–664.
- Gaspari R, Weekes A, Adhikari S, et al. et al.. A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscita-tion associated with improved survival to hospital admission. A REASON Study Resuscitation. 2017; 120: 103–7.
- Chen YS, Lin JW, Yu HY, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008; 372(9638): 554–561.
- Ahn C, Kim W, Cho Y, et al. Efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation for adult cardiac arrest patients: a systematic review and meta-analysis. Sci Rep. 2016; 6: 34208.
- Wang CH, Chou NK, Becker LB, et al. Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest--a comparison with that for extracorporeal rescue for in-hospital cardiac arrest. Resuscitation. 2014; 85(9): 1219–1224.
- Patricio D, Peluso L, Brasseur A, et al. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study. Crit Care. 2019; 23(1): 27.
- Lang CN, Schroth F, Zotzmann V, et al. Good long term quality of life after emergency extracorporeal life support for cardiogenic shock and extracorporeal cardiopulmonary resuscitation. Resuscitation. 2019; 143: 66–67.
- Kim H, Cho YH. Role of extracorporeal cardiopulmonary resuscitation in adults. Acute Crit Care. 2020; 35(1): 1–9.
- Hirlekar G, Karlsson T, Aune S, et al. Survival and neurological outcome in the elderly after in-hospital cardiac arrest. Resuscitation. 2017; 118: 101–106.