High-fidelity simulation to train a multiprofessional team in prehospital extracorporeal cardiopulmonary resuscitation

Correspondence to Dr Amieth Yogarajah, Barts Health NHS Trust, London E1 1BB, UK; [email protected]

Introduction

There is an increasing interest in using venoarterial extracorporeal membrane oxygenation (VA-ECMO) to manage out-of-hospital cardiac arrest, termed extracorporeal cardiopulmonary resuscitation (E-CPR).¹ VA-ECMO, used in intensive care medicine for cardiorespiratory support, involves draining blood through a cannula sited in a large vein passage through a pump and a membrane oxygenator and returning it under pressure through another cannula sited in a large artery. The time between cardiac arrest and implementation of E-CPR is a major prognostic factor² with data suggesting improved survival if instituted within 30 min.³ UK practice for out-of-hospital cardiac arrest involves advanced life support on scene for 20 min seeking return of spontaneous circulation and transport of appropriate patients to secondary care if initial efforts fail. Thus, if VA-ECMO is only commenced in hospital, eligible patients might not be stabilised until after 30 min, reducing the chance of neurologically intact survival.

We performed a high-fidelity simulation to assess the possibility of implementing prehospital E-CPR for a simulated patient within 30 min of a call to emergency services and the logistics of transfer and handover to a heart attack centre. Our aim was to facilitate learning between prehospital, paramedic and ECMO teams to help coordinate future attempts at the intervention and plan a formal feasibility trial. We also hoped that this novel simulation would form a basis for future training in prehospital E-CPR. Learning points were generated through a debrief, questionnaire and review of recorded footage.

Methods

Manikin

We required a manikin that could withstand intubation, cannulation for VA-ECMO, mechanical chest compressions and transportation to another location. We modified a first generation simulation manikin to include a perfusion circuit and have described this in detail previously.⁴

Personnel

We assembled two teams. A prehospital team consisted of paramedics, an advanced paramedic practitioner, a prehospital medicine consultant and two ECMO consultants. A receiving cardiology team...