Oral Themed Presentation
Discussant: Cailyn Rood
Extracorporeal membrane oxygenation (ECMO) is a complex, high-risk therapy used to support children with life-threatening cardiac or respiratory failure that is refractory to conventional therapy. Placement on ECMO (cannulation) often occurs under significant time pressure in an unstable patient or even during cardiopulmonary resuscitation, known as ECPR. ECMO teams are unique multi-disciplinary teams in that they are made up of three micro-teams—the Intensive Care Unit (ICU) resuscitation team, the surgical team, and the perfusionist team—that perform separate but highly-related tasks. While the ICU team performs CPR and resuscitation, the surgical team prepares the surgical field and cannulates to ECMO, and the perfusionist team prepares the ECMO circuit. Each of these teams’ tasks is critical, and fully dependent upon the others. We theorize that members of an individual micro-team often use the same language codification, and therefore have fewer errors in communication. However, communication across the three teams is imperative given the interdependent nature of their tasks. Inadequate communication may delay critical interventions.
Research Question/Proposed Approach:
Our overarching goal is to study communication patterns during ECPR events and ECMO emergencies. We hypothesize that: 1) certain communication strategies, such as the use of directed communication, are more likely to lead to “closed-loop” communication and a clinical intervention as requested; and 2) miscommunication/indirect communication among ECMO micro-teams will lead to adverse patient safety outcomes. We currently do not have the ability to video record emergencies live, but simulated ECPR events involving the full native team provide an opportunity to study these communication patterns and look for correlation with performance of key clinical interventions. We will review archived videos of simulation events to code all communications. The coding structure will include elements such as: 1) if communication is directed to a specific individual; 2) the role of the speaker; 3) if there is verbal acknowledgement of the statement/command; and 4) if there is an action in response to the communication.
Conundrum/ Difficulty Encountered:
Pauses in CPR are often required during ECPR events to facilitate ECMO cannulation, but prolonged pauses reduce the chances of recovery or positive neurologic outcome. Surgeons typically ask for CPR to be held, but may not request resumption of compressions, requiring prompts by other team members. Thus, duration of CPR pauses may be one clinical performance metric that is impacted by how communication occurs. We are challenged to identify other concrete clinical performance metrics.
Questions for discussion:
1) What additional performance metrics can be evaluated for correlation with communication patterns?
2) How can data be used to identify areas for improvement that can be integrated into future simulation curricula?