Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care
Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest presents significant medical and psychological challenges for healthcare providers. Beyond managing cardiac arrest and preparing for potential coro...
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Elsevier
2024-12-01
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| Series: | Resuscitation Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520424002510 |
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| author | Tharusan Thevathasan Sonia Lech Andreas Diefenbach Elisa Bechthold Tim Gaßmann Sebastian Fester Georg Girke Wulf Knie Benjamin T. Lukusa Sebastian Kühn Steffen Desch Ulf Landmesser Carsten Skurk |
| author_facet | Tharusan Thevathasan Sonia Lech Andreas Diefenbach Elisa Bechthold Tim Gaßmann Sebastian Fester Georg Girke Wulf Knie Benjamin T. Lukusa Sebastian Kühn Steffen Desch Ulf Landmesser Carsten Skurk |
| author_sort | Tharusan Thevathasan |
| collection | DOAJ |
| description | Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest presents significant medical and psychological challenges for healthcare providers. Beyond managing cardiac arrest and preparing for potential coronary angiography, the ECMO circuit must be assembled and primed under strictly sterile conditions, contributing to additional psychological stress and potential delays in ECMO cannulation. This pragmatic study thought to evaluate whether pre-assembled and pre-primed ECMO circuits (pre-primed group) maintain sterility over a 21-day period, expedite ECMO initiation in ECPR patients and alleviate the psychological burden on the ECPR team, compared to newly assembled and primed ECMO circuits (on-demand group). Methods: In a prospective manner, ECMO circuits were either pre-assembled and pre-primed under sterile conditions, maintained for 21 days with culture samples taken every seventh day, or newly assembled and primed during the acute emergency situation. The transition from on-demand assembly and priming of ECMO circuits to pre-primed ECMO circuits occurred on January 1st, 2021. The interval between patients’ arrival in the cardiac catheterization laboratory and the initiation of ECMO was recorded and retrospectively compared between the two treatment groups. The ECPR team, comprising experienced cardiologists and nurses, was prospectively surveyed using the modified Perceived Stress Questionnaire (PSQ-20). Results: All aseptically pre-assembled and pre-primed ECMO circuits demonstrated sterile cultures for aerobic and anaerobic microorganisms as well as fungal agents over the 21-day period: 0/120 positive cultures (0 %, 95 % CI for binomial probability 0–0.03). The time to ECMO initiation was significantly reduced in the pre-primed group compared to the on-demand group: 13 [IQR 9–17] versus 31 [IQR 27–44] minutes, P < 0.001. Responses from ECPR physicians and nurses on the PSQ-20 were similar across all items. With the use of pre-primed ECMO circuits, all ECPR professionals reported a greater sense of settled inner feeling, considerably less psychological tension, fewer worries and insecurities, as well as more effective ICU shifts with improved personal goal achievement. However, treating ECPR patients with pre-primed ECMO circuits did not lead to increased job satisfaction or higher physical energy levels. Conclusion: Aseptically pre-assembled and pre-primed ECMO circuits maintain sterility for multiple weeks, significantly reducing ECMO initiation times and alleviating psychological strain on the ECPR team. Consequently, implementing these circuits in ECPR centers could enhance both patient outcomes and healthcare provider well-being. |
| format | Article |
| id | doaj-art-bc5de11bffaa4361ac147d6f068e68b2 |
| institution | Kabale University |
| issn | 2666-5204 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj-art-bc5de11bffaa4361ac147d6f068e68b22024-12-21T04:29:54ZengElsevierResuscitation Plus2666-52042024-12-0120100800Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest careTharusan Thevathasan0Sonia Lech1Andreas Diefenbach2Elisa Bechthold3Tim Gaßmann4Sebastian Fester5Georg Girke6Wulf Knie7Benjamin T. Lukusa8Sebastian Kühn9Steffen Desch10Ulf Landmesser11Carsten Skurk12Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health (BIH), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany; Corresponding authors at: Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyDZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany; Department of Microbiology and Infection Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Deutsches Rheuma-Forschungszentrum (DRFZ), Virchowweg 12, 10117 Berlin, GermanyDepartment of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, GermanyDepartment of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, GermanyDepartment of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, GermanyDepartment of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, GermanyDepartment of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, GermanyDepartment of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, GermanyLabor Berlin – Charité Vivantes Services GmbH, Sylter Straße 2, 13353 Berlin, GermanyHeart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, Germany; Helios Health Institute, Leipzig, GermanyDepartment of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health (BIH), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, GermanyDepartment of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany; Corresponding authors at: Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest presents significant medical and psychological challenges for healthcare providers. Beyond managing cardiac arrest and preparing for potential coronary angiography, the ECMO circuit must be assembled and primed under strictly sterile conditions, contributing to additional psychological stress and potential delays in ECMO cannulation. This pragmatic study thought to evaluate whether pre-assembled and pre-primed ECMO circuits (pre-primed group) maintain sterility over a 21-day period, expedite ECMO initiation in ECPR patients and alleviate the psychological burden on the ECPR team, compared to newly assembled and primed ECMO circuits (on-demand group). Methods: In a prospective manner, ECMO circuits were either pre-assembled and pre-primed under sterile conditions, maintained for 21 days with culture samples taken every seventh day, or newly assembled and primed during the acute emergency situation. The transition from on-demand assembly and priming of ECMO circuits to pre-primed ECMO circuits occurred on January 1st, 2021. The interval between patients’ arrival in the cardiac catheterization laboratory and the initiation of ECMO was recorded and retrospectively compared between the two treatment groups. The ECPR team, comprising experienced cardiologists and nurses, was prospectively surveyed using the modified Perceived Stress Questionnaire (PSQ-20). Results: All aseptically pre-assembled and pre-primed ECMO circuits demonstrated sterile cultures for aerobic and anaerobic microorganisms as well as fungal agents over the 21-day period: 0/120 positive cultures (0 %, 95 % CI for binomial probability 0–0.03). The time to ECMO initiation was significantly reduced in the pre-primed group compared to the on-demand group: 13 [IQR 9–17] versus 31 [IQR 27–44] minutes, P < 0.001. Responses from ECPR physicians and nurses on the PSQ-20 were similar across all items. With the use of pre-primed ECMO circuits, all ECPR professionals reported a greater sense of settled inner feeling, considerably less psychological tension, fewer worries and insecurities, as well as more effective ICU shifts with improved personal goal achievement. However, treating ECPR patients with pre-primed ECMO circuits did not lead to increased job satisfaction or higher physical energy levels. Conclusion: Aseptically pre-assembled and pre-primed ECMO circuits maintain sterility for multiple weeks, significantly reducing ECMO initiation times and alleviating psychological strain on the ECPR team. Consequently, implementing these circuits in ECPR centers could enhance both patient outcomes and healthcare provider well-being.http://www.sciencedirect.com/science/article/pii/S2666520424002510Cardiac arrestExtracorporeal cardio-pulmonary resuscitationVeno-arterial extracorporeal membrane oxygenationHygienePsychologic stress |
| spellingShingle | Tharusan Thevathasan Sonia Lech Andreas Diefenbach Elisa Bechthold Tim Gaßmann Sebastian Fester Georg Girke Wulf Knie Benjamin T. Lukusa Sebastian Kühn Steffen Desch Ulf Landmesser Carsten Skurk Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care Resuscitation Plus Cardiac arrest Extracorporeal cardio-pulmonary resuscitation Veno-arterial extracorporeal membrane oxygenation Hygiene Psychologic stress |
| title | Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care |
| title_full | Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care |
| title_fullStr | Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care |
| title_full_unstemmed | Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care |
| title_short | Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care |
| title_sort | pre assembled ecmo enhancing efficiency and reducing stress in refractory cardiac arrest care |
| topic | Cardiac arrest Extracorporeal cardio-pulmonary resuscitation Veno-arterial extracorporeal membrane oxygenation Hygiene Psychologic stress |
| url | http://www.sciencedirect.com/science/article/pii/S2666520424002510 |
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