(714) Pauses in Chest Compressions During ECPR: Using Simulation to Determine the Cause

Introduction: Minimizing pauses in chest compressions (CC) is critical for high-quality CPR in both pediatric CPR and extracorporeal cardiopulmonary resuscitation (ECPR), but little is known about modifiable factors affecting CC pause length in ECPR. We aimed to quantify and characterize CC pauses during pediatric ECPR using standardized in-hospital cardiac arrest (IHCA) simulated scenarios with pediatric ECMO teams.

Methods: In a single center prospective observational study, ECMO teams (PICU nurses, attendings and fellows, respiratory therapists, pharmacists, perfusionists and surgeons) were recorded performing peripheral ECMO cannulation during five (of ten planned) simulated pediatric IHCA scenarios. Audiovisual recordings were reviewed by two reviewers and data from every CC pause greater than or equal to two seconds was characterized for length and patterns of communication. We compared CC pause characteristics between both conventional CPR and cannulation phases to explore themes and modifiable factors.

Results: In preliminary data from five simulations, the longest CC pause was longer in the cannulation phase when compared to the conventional CPR phase (47s vs 21s). Arteriotomy, venotomy and cannula placement during the cannulation phase were associated with the longest duration pauses. Compressor swaps, pulse checks, and moving the patient account for most pauses overall. In the conventional CPR phase, the code leader and recorder prompted 100% of CC pauses and in the cannulation phase, the recorder and surgeon prompted 68% of CC pauses. Resumption of CC in the conventional CPR phase was prompted by the code leader 50% of the time and unprompted 50% of the time. Resumption of CC in the cannulation phase was unprompted 48% of the time and prompted by the surgeon 26% of the time.

Conclusions: The longest CC pauses during the cannulation phase occur for surgical procedures related to cannula placement. Communication surrounding starting and stopping CC during the cannulation phase was frequently suggested by surgeons. After completion of the remaining five simulations, we hope to identify modifiable factors leading to CC pauses during pediatric ECPR.