Oral Themed Presentation
Context: : Extracorporeal Cardiopulmonary Resuscitation (ECPR) is a lifesaving therapy performed in Cardiac Intensive Care Units (CICUs) nationwide. Several studies have shown that survival after ECPR is related to length of time to cannulation, and this in turn depends on quality interprofessional communication, role proficiency and minimization of CPR interruption. The CICU at Children’s National has performed ECPR simulations since 2012 and in 2014 Su, et al. showed a significant decrease in real-life cannulation times as related to these efforts. In the current study, we sought to assess the effect of timely debriefing on the quality of teamwork and provider communication during ECPR simulation.
Description: : Over a 6-week period, 103 nurses along with 27 fellows, training in either cardiology or critical care, participated in a total of 14 two-hour ECPR simulation sessions. For each session, the first simulation was followed by a 20-minute structured debrief which served as our intervention. Seven CICU faculty members, not affiliated with this study, observed the sessions and debriefed the participants; they were asked to focus the debrief on the presence or absence of leader identification, role establishment and clear communication during the exercise; but the participants themselves were not aware that they were being evaluated in this manner. The same members, then participated in a more complex, second simulation involving a different scenario. For each simulation, the observing faculty then completed items 1-8 of the Mayo High Performance Teamwork Scale (Mayo Tool) and responses were collected. The nurses were surveyed about relevance to practice and evaluation of the learning technique.
Observation/Evaluation: : Twenty two Mayo Tools were collected in all; 11 after the first simulation prior to the structured debrief and 11 after the second simulation. Scores were totaled per session; such as to compare overall pre- and post-debrief performance. There was a statistically significant increase in overall performance scores after the debrief (14.6 versus 10.5 out of a possible 16 points, p < 0.001, see attached figure). Scores were then totaled for each of the 8 items of the Mayo Tool to assess specific aspects of teamwork. There were statistically significant increases in performance, regarding the team leader's ability to balance authority versus participation (p = 0.039), the team's consistency in prompting each other to attend to significant clinical indicators (p = 0.009), and the team's use of repeating back instructions and asking for clarifications (p = 0.011).
Eighty four nurses completed evaluations. Ninety-five percent of those surveyed found the teaching technique very good in terms of identifying a patient that needs Extracorporeal Membrane Oxygenation (ECMO) therapy. Ninety-four percent found the teaching very good to practice the E-CPR process.
Discussion: : Structured debriefing correlates with enhanced team performance during ECPR simulations. This continues to be true even if teams participate in a second, more complex simulation following the debrief. In addition, the nursing staff conveyed that they found the teaching effective for practicing the E-CPR process and the ability to identify a patient for ECMO therapy.