1163: QUALITY IMPROVEMENT INITIATIVES REDUCE CHEST COMPRESSION PAUSES DURING PEDIATRIC ECPR

Abstract

Introduction: Prolonged chest compression (CC) pauses in cardiopulmonary resuscitation (CPR) are associated with worse survival during in-hospital cardiac arrests. Procedures necessary to gain access for extracorporeal CPR (ECPR) can potentially prolong CC pauses during extracorporeal membrane oxygenation (ECMO) cannulation. Implementation of targeted quality improvement initiatives to improve team communication may reduce CC pauses during pediatric ECPR. Methods: Baseline data from a pediatric intensive care unit (PICU) in a tertiary care children’s hospital demonstrated significantly longer CC pauses and lower CC fraction (CCF) during ECMO cannulation when compared to similar metrics pre-cannulation. An intervention designed to improve CC metrics during ECPR was implemented, including: 1. Sharing of baseline CC data with ECPR stakeholders 2. Standardization of counting CC pauses out loud to improve team awareness of pause length 3. Creation of a reporting aid to assist with ECPR documentation and 4. Interdisciplinary ECPR simulation sessions every other month to practice communication during cannulation. CC pause characteristics were compared pre- and post- intervention using unpaired t-tests. Results: Eleven ECPRs were analyzed pre-intervention and five ECPRs post-intervention. CC pause characteristics (mean duration of pauses, individual longest pause, and CCF) improved in both pre- and during ECMO cannulation epochs post-intervention when compared to their pre-intervention counterparts. During ECMO cannulation, mean length of CC pauses was 30 seconds (pre-intervention) vs 13 seconds (post-intervention) (p < 0.02). The longest CC pause during ECMO cannulation was 337 seconds (pre-intervention) compared with 69 seconds (post-intervention) (p = 0.03). CCF during ECMO cannulation pre-intervention and post-intervention was 68% vs 83% respectively (p = 0.03). Conclusions: CC pause metrics during the cannulation phase of pediatric ECPR improved significantly after quality improvement interventions including baseline CC data review, verbal communication of CC pause length and interdisciplinary ECPR simulations. Future aims include correlating CC pause characteristics with clinical outcomes.