(1087) Training of Emergency Nurses in Support of an Extracorporeal Cardiopulmonary Resuscitation Program

Introduction: Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an emerging process of care within the chain of survival following out of hospital cardiac arrest (OHCA). Multiple randomized controlled trials have demonstrated the feasibility of ECPR, leading to the expansion of ECPR in local systems, with some featuring Emergency Department (ED) based cannulation. In our system, ED nurses activate the ECMO pump and serve as first assist to the cannulating physician. We describe the training program and load experienced by ED nurses in support of an ED based ECPR program.

Methods: Description of nurses trained, means of training delivery, and cumulative hours of pump and in situ ECPR simulation are described since the inception of an ED-based ECPR program in 2021. ED nurses are instructed by clinical perfusion coaches on how to turn on, zero, and clamp a pre-primed ECMO circuit. Further, ED nurses are coached by surgical first assists’ on how to provide instrument assistance during bedside cannulation. Lastly, these skills are practiced during a bimonthly high-fidelity in-situ cannulation simulation of a refractory ventricular tachycardia OHCA with the entire cannulation team. Nurses who have been trained and hours spent training within and outside of simulations are maintained by Nurse Educators to prove maintenance of competency.

Results: From 6/2021-8/2023, 64 individual nurses have undergone training with 32 being onboarded after one year of program existence. Training occurred within 32 one-on-one sessions with perfusion, surgical first assist and ED educator peer coaches as well as 15 in-situ simulations with the entire cannulation team. The average training load per nurse is 4.6 hours. ECPR training is now mandatory for all charge and trauma eligible nurses as of 2023. Over the 26 Months, there have been 21 ECPR activations and 4 ED-based cannulations with 75% (3/4) surviving to hospital discharge with good neurological outcome

Conclusions: ED-based ECPR programs are feasible with nursing led ECMO pump initiation and cannulation assistance. The training resources required for achievement and maintenance of competency are high.