Insley Elena M, Geneslaw Andrew S, Choudhury Tarif A, Sen Anita I
Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
J Intensive Care Med. 2025 May;40(5):495-502. doi: 10.1177/08850666241301023. Epub 2024 Dec 4.
To quantify chest compression (CC) pauses during pediatric ECPR (CPR incorporating ECMO) and implement sustainable quality improvement (QI) initiatives to reduce CC pauses during ECMO cannulation. We retrospectively identified baseline CC pause characteristics during pediatric ECPR events (pre-intervention), deployed QI interventions to reduce CC pause length, and then prospectively quantified CC pause metrics post-QI interventions (post-intervention). Data were gathered from a single center review of CC-pause characteristics in children less than 18 years old with a PICU ECPR arrest. QI Interventions included: (1) sharing baseline CC data with ECPR stakeholders, (2) establishing consensus among providers regarding areas for improvement, and (3) creating a communication aid to encourage counting CC pauses out loud. Multidisciplinary ECPR simulations allowed for practice of these skills. Using telemetry data, CC pause metrics were analyzed in the medical (CPR before cannulation) and surgical (CPR during ECMO cannulation, demarcated by the sterile draping of the patient) phases of ECPR, pre- and post-intervention. Pre-intervention, 11 ECPR events (5 central cannulation, 6 peripheral cannulation) met inclusion criteria compared with 14 ECPR events (2 central, 12 peripheral) post-intervention. Pre-intervention analysis identified longer CC pauses and lower chest compression fraction (CCF) during the surgical versus medical phase of ECPR. Compared to pre-intervention data, CCF during the surgical phase of ECPR improved from 66% to 81% (73-85%) post-intervention ( = .02). Median CC pause length was significantly reduced from 20 s pre-intervention to 10.5 (9-13) seconds post-intervention ( = .01). There was no change in the surgical phase of ECPR duration (44 min pre- vs 41 min post-intervention, = .8) or survival to hospital discharge (45% vs 21%, = .4). Simple and feasible communication interventions during ECPR can minimize CC pauses, increase CCF and improve CPR quality without prolonging the time needed for ECMO cannulation.
量化小儿体外心肺复苏（将体外膜肺氧合纳入的心肺复苏）期间的胸外按压（CC）停顿时间，并实施可持续的质量改进（QI）措施以减少体外膜肺氧合插管期间的CC停顿时间。我们回顾性确定小儿体外心肺复苏事件（干预前）期间的基线CC停顿特征，部署QI干预措施以缩短CC停顿时间，然后前瞻性量化QI干预措施后的CC停顿指标（干预后）。数据来自对18岁以下因儿科重症监护病房体外心肺复苏骤停而进行的CC停顿特征的单中心回顾。QI干预措施包括：（1）与体外心肺复苏利益相关者分享基线CC数据；（2）就改进领域在医疗人员中达成共识；（3）创建一种沟通辅助工具以鼓励大声计数CC停顿次数。多学科体外心肺复苏模拟可用于这些技能的练习。利用遥测数据，在体外心肺复苏的医疗阶段（插管前的心肺复苏）和手术阶段（体外膜肺氧合插管期间的心肺复苏，以患者无菌铺巾为界）分析干预前后的CC停顿指标。干预前，11例体外心肺复苏事件（5例中心插管，6例外周插管）符合纳入标准，干预后为14例体外心肺复苏事件（2例中心插管，12例外周插管）。干预前分析发现，与体外心肺复苏的医疗阶段相比，手术阶段的CC停顿时间更长，胸外按压分数（CCF）更低。与干预前数据相比，体外心肺复苏手术阶段的CCF从66%提高到干预后的81%（73-85%）（P = 0.02）。CC停顿的中位数长度从干预前的20秒显著缩短至干预后的10.5（9-13）秒（P = 0.01）。体外心肺复苏手术阶段的持续时间（干预前44分钟 vs 干预后41分钟，P = 0.8）或出院生存率（45% vs 21%，P = 0.4）没有变化。体外心肺复苏期间简单可行的沟通干预措施可将CC停顿时间降至最低，提高CCF并改善心肺复苏质量，而不会延长体外膜肺氧合插管所需的时间。
