Training of Emergency Medicine Residents to Initiate Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation (ECPR)

Background: The objective of our study was to evaluate the ability of Emergency Medicine (EM) physicians who have completed an accelerated extracorporeal membrane oxygenation (ECMO) course and mannequin training to initiate extracorporeal cardiopulmonary resuscitation (ECPR) in a swine model. Methods: Twenty teams of two EM residents each were provided with 2 h of training on how to initiate ECPR using prerecorded instructional videos and hands-on training using an ECMO circuit, ECMO cannulas, and a task trainer model of a human pelvis. Following training, EM residents attempted to cannulate and initiate ECMO on anesthetized swine receiving cardiopulmonary resuscitation (CPR) after an electrically induced sudden cardiac arrest (SCA). The ability of and duration of time required for the two-resident teams to initiate veno-arterial ECMO on the swine was recorded. A knowledge assessment and survey were performed before and after course completion. Results: Forty EM residents participated in this study, for a total of 20 teams. Seventy-five percent (15/20) of the teams successfully initiated ECMO. The average time to successful initiation of ECMO was 22 min and 10 s (95% CI 17:25–26:54). Participants' knowledge assessment scores improved by 21.1%, from a mean of 46.8%–67.9% correct after study completion (95% CI 13.3%–28.8%). Confidence in competency improved across all survey categories. The most frequent reason for unsuccessful ECPR was the inability to obtain appropriate vascular access. Conclusions: An abbreviated two-hour ECPR training course for EM residents resulted in a 75% success rate of ECPR initiation on a swine SCA model. Training of EM physicians in ECPR may expand the number of hospitals capable of providing this therapy. Advanced engineering solutions or increased experience with ultrasound-guided vascular access during CPR may improve ECMO cannulation success rates.