New Trend In To Cardiopulmonary Resuscitation Training: High-Fidelity Simulation

Background: The outcomes of out-of-hospital cardiac arrest (OHCA) patients are poor. In some OHCA cases, the reason is potentially reversible cardiac or aortic disease. It was suggested previously that high-quality cardiopulmonary resuscitation (CPR) followed by extracorporeal membrane oxygenation (ECMO) support may improve the grave prognosis of OHCA. However, extended CPR (ECPR) with ECMO application is an extremely invasive and cutting-edge procedure. The purpose of this article is to describe how high-fidelity medical simulation as a safe tool enabled implementation of the complex, multi-stage ECPR procedure. Method: A high fidelity simulation of OHCA in street conditions was prepared and carried out as part of a ECPR procedure implemented in an in-hospital area. The simulation tested communication and collaboration of several medical teams from the pre-hospital to in-hospital phases along with optimal use of equipment in management of a sudden cardiac arrest (SCA) patient. Results: The critical and weak points of an earlier created scenario were collected into a simulation scenario checklist of ECPR algorithm architecture. A few days later, two ECPR procedures followed by cardiologic interventions for OHCA patients (one pulmonary artery embolectomy for acute pulmonary thrombosis and one percutaneous coronary artery angioplasty with drug eluting stent implantation for acute occlusion of the left anterior descending artery), were performed for the first time in Poland. The protocol was activated five times in the first 2 months of the POHCA Program. Conclusion: High fidelity medical simulation in real-life conditions was confirmed to be a safe, useful tool to test and then implement the novel and complex medical procedures. It enabled to find, analyze and solve the weakest points of the earlier developed theoretical protocol and eventually succeed in clinical application of complete ECPR procedure.

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Abstract 263: Emergencies and Resuscitation in the Catheter Laboratory: High-Fidelity Simulation as a Training Tool to Improve Multidisciplinary Team Communication and Confidence

Circulation ◽

10.1161/circ.130.suppl_2.263 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Charles J Butcher ◽

Zubair Sarang ◽

Rebecca Green ◽

Oscar Duke ◽

Timothy Knowles ◽

...

Keyword(s):

Primary Angioplasty ◽

Professional Relationships ◽

Lead Extraction ◽

High Fidelity ◽

High Fidelity Simulation ◽

Clinical Knowledge ◽

Training Tool ◽

Resuscitation Training ◽

Catheter Laboratory

Purpose: Multi disciplinary team (MDT) emergency and resuscitation training for acute device related complications in the catheter laboratory commonly takes the form of didactic instruction or post event debriefing. High fidelity simulation offers the opportunity to role-play clinical emergencies in a controlled environment in a dynamic and interactive setting. This technique allows for immersive training whilst protecting patients from unnecessary risk and may enhance performance. Methods: Two sessions, each with two high fidelity in-situ resuscitation scenarios, using a simulation manikin, were run as a pilot (Session 1 - pacing failure during device generator change; tamponade during lead extraction, Session 2 - Primary angioplasty with cardio pulmonary arrest, Primary angioplasty requiring acute temporary pacing). These were viewed by other members of the department on a live video feed. 45 members of the MDT (including Cardiologists, Anesthetists, Radiographers, Nurses and Physiologists of all levels) participated in each the session, attending a formal facilitated debrief after each scenario. The debrief outcome of scenario 1 was designed to influence the behavioral strategy during the conduct of scenario 2. Anonymous pre and post scenario questionnaires measured improvement in confidence, clinical knowledge and inter-professional relationships. Results: We collected 72 pre-course and 67 post-course questionnaires in total. 92% agreed or strongly agreed that the session enhanced inter-professional working relationships and communication skills. 73% felt their clinical knowledge was increased. The number of people who felt ‘confident’ or ‘very confident’ in ‘speaking up about something they disagreed with in a clinical emergency’ increased from 45% to 65% (p<0.05). All respondents would recommend the session to a colleague & attend themselves again. Conclusions: High fidelity in-situ simulation may be a useful tool to actively engage the MDT in improving clinical knowledge and communication in emergency resuscitation situations, whilst enhancing inter-professional relationships. This may have important implications for patient safety in the Catheter Laboratory.

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