Stentz Michael J, Wiepking Matthew D, Hodge Kiley A, Ramonell Richard P, Jabaley Craig S
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI.
Department of Emergency Medicine and Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
Crit Care Explor. 2021 Apr 26;3(4):e0404. doi: 10.1097/CCE.0000000000000404. eCollection 2021 Apr.
Extracorporeal membrane oxygenation-related complications are potentially catastrophic if not addressed quickly. Because complications are rare, high-fidelity simulation is recommended as part of the training regimen for extracorporeal membrane oxygenation specialists. We hypothesized that the use of standardized checklists would improve team performance during simulated extracorporeal membrane oxygenation emergencies.
Randomized simulation-based trial.
A quaternary-care academic hospital with a regional extracorporeal membrane oxygenation referral program.
Extracorporeal membrane oxygenation specialists and other healthcare providers.
We designed six read-do checklists for use during extracorporeal membrane oxygenation emergencies using a modified Delphi process. Teams of two to three providers were randomized to receive the checklists or not. All teams then completed four simulated extracorporeal membrane oxygenation emergencies.
Simulation sessions were video-recorded, and the number of critical tasks performed and time-to-completion were compared between groups. A survey instrument was administered before and after simulations to assess participants' attitudes toward the simulations and checklists. We recruited 36 subjects from a single institution, randomly assigned to 15 groups. The groups with checklists completed more critical tasks than participants in the control groups (90% vs 75%; p < 0.001). The groups with checklists performed a higher proportion of both nontechnical tasks (71% vs 44%; p < 0.001) and extracorporeal membrane oxygenation-specific technical tasks (94% vs 86%; p < 0.001). Both groups reported an increase in reported self-efficacy after the simulations (p = 0.003). After adjusting for multiple comparisons, none of the time-to-completion measures achieved statistical significance.
The use of checklists resulted in better team performance during simulated extracorporeal membrane oxygenation emergencies. As extracorporeal membrane oxygenation use continues to expand, checklists may be an attractive low-cost intervention for centers looking to reduce errors and improve response to crisis situations.
体外膜肺氧合相关并发症若不迅速处理，可能会带来灾难性后果。由于并发症较为罕见，因此建议将高保真模拟作为体外膜肺氧合专家培训方案的一部分。我们假设使用标准化检查表可改善模拟体外膜肺氧合紧急情况期间的团队表现。
基于模拟的随机试验。
一家设有区域体外膜肺氧合转诊项目的四级医疗学术医院。
体外膜肺氧合专家及其他医疗服务提供者。
我们采用改良的德尔菲法设计了六份用于体外膜肺氧合紧急情况的读做检查表。两到三名医疗服务提供者组成的团队被随机分为接受检查表组和不接受检查表组。然后，所有团队完成四次模拟体外膜肺氧合紧急情况。
模拟过程进行视频记录，比较两组完成的关键任务数量和完成时间。在模拟前后使用一份调查问卷评估参与者对模拟和检查表的态度。我们从单一机构招募了36名受试者，随机分为15组。使用检查表的组比对照组完成了更多关键任务（90%对75%；p<0.001）。使用检查表的组在非技术任务（71%对44%；p<0.001）和体外膜肺氧合特定技术任务（94%对86%；p<0.001）方面的完成比例都更高。两组均报告模拟后自我效能感有所提高（p = 0.003）。在对多重比较进行校正后，所有完成时间测量指标均未达到统计学显著性。
在模拟体外膜肺氧合紧急情况期间，使用检查表可带来更好的团队表现。随着体外膜肺氧合的应用不断扩大，对于希望减少错误并改善对危机情况反应的中心而言，检查表可能是一种有吸引力的低成本干预措施。
