title: Implementation of an extracorporeal cardiopulmonary resuscitation simulation program reduces extracorporeal cardiopulmonary resuscitation times in real patients.
abstract: OBJECTIVE
  To determine if development of an extracorporeal cardiopulmonary resuscitation simulation program reduced extracorporeal cardiopulmonary resuscitation times in real patients
  
  
  METHODS
  : Before-after study.
  
  
  METHODS
  Twenty-six bed pediatric cardiac ICU in a tertiary urban hospital.
  
  
  METHODS
  Forty-three cardiac patients (aged 1 d to 16 yr) who received extracorporeal cardiopulmonary resuscitation.
  
  
  METHODS
  An interdisciplinary team collaborated to define the roles and clarify responsibilities of each individual involved in extracorporeal cardiopulmonary resuscitation. An "ideal rapid deployment" was defined and tested using simulation sessions. This included a task analysis, role creation, and multidisciplinary simulations, including structured debriefings and video review and the creation of a master checklist.
  
  
  RESULTS
  There were a total of 43 episodes of extracorporeal cardiopulmonary resuscitation during the study period, 16 (37%) of which occurred during the preintervention time period (from February 2009 to March 2010) and 27 (63%) during the postintervention time period (April 2010 to March 2013). The median deployment time in the preintervention time period was 51 minutes (interquartile range, 43-62 min), whereas the median deployment time in the postintervention time period was 40 minutes (interquartile range, 23-52 min) (p = 0.018).
  
  
  CONCLUSIONS
  There are no standard guidelines of how a team should coordinate the efforts of nursing, physicians, extracorporeal membrane oxygenation specialists, surgeons, respiratory therapists, patient care technicians, and unit clerks to emergently execute this complex procedure. Because time is of the essence, it is essential to develop a highly functioning and well-coordinated team with a standardized method of the procedure, its documentation, and communication. Simulation accomplished this for our program. Following these simulation exercises, not only was there a subjectively observed improved coordination and smoother deployment of extracorporeal membrane oxygenation in real-life extracorporeal cardiopulmonary resuscitation, but we have also demonstrated a significantly faster deployment of extracorporeal membrane oxygenation as compared with the presimulation era.
authors.affiliation: 1Division of Critical Care Medicine, Children's National Health System, Washington, DC. 2Division of Cardiovascular Surgery, Children's National Health System, Washington, DC. 3Division of Critical Care Medicine and Cardiology, Children's National Health System, Washington, DC. 4Children's National Heart Institute, Children's National Health System, Washington, DC.
authors.forename: Lillian
authors.initials: L
authors.lastname: Su
authors.forename: Michael C
authors.initials: MC
authors.lastname: Spaeder
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Jones
authors.forename: Pranava
authors.initials: P
authors.lastname: Sinha
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
authors.forename: Parag N
authors.initials: PN
authors.lastname: Jain
authors.forename: John T
authors.initials: JT
authors.lastname: Berger
authors.forename: Lisa
authors.initials: L
authors.lastname: Williams
authors.forename: Venkat
authors.initials: V
authors.lastname: Shankar
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007318:Inservice Training / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D008297:Male; D016544:Patient Simulation; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome