Purpose: Cardiac arrest in the pediatric cardiac intensive care unit (CICU) leads to significant morbidity and mortality. Improving the quality of CPR, including decreased duration of chest compressions has been shown to improve post-arrest outcomes. Extracorporeal cardiopulmonary resuscitation (eCPR) is used frequently in the CICU to provide early return of circulation and perfusion to decrease cardiac ischemia and mitigate end organ damage. Minimizing the time to ECMO cannulation is a clinical target for improvement of patient outcomes.

Quality improvement efforts in our heart institute identified the time period from arrival of the offsite CTOR team to start time of ECMO procedure as a modifiable opportunity for improvement. Members of the nursing staff in the cardiothoracic operating room (CTOR) and CICU collaborated to develop and implement a process aimed at decreasing this time period. We hypothesized that the elimination of surgical preparation time upon arrival of CTOR staff would shorten the duration from activation to cannulation.

Project Design: This collaborative worked to create a new CICU nursing role that, upon activation of ECMO, is tasked with prepping the patient and environment enabling immediate surgical intervention upon arrival of CTOR staff. Specific tasks developed for this role included retrieval of predefined surgical equipment, placement of defibrillation and bovie pads on patient, and surgical site preparation. Additionally, this role entails coordination and supervision of sterile chest compressors utilized during the procedure.

CICU nurses with >2 years of experience were encouraged to apply. Successful applicants received education through module and simulation experience training facilitated by CTOR RNs. Mandatory continuing education is provided quarterly to maintain competencies and address practice changes.

This process empowered mandatory staffing of a CTOR trained CICU nurse when CTOR staff is offsite, including all nights, weekends, and holidays. Additionally, this nurse would be without a patient assignment, often functioning as a resource or charge nurse on the unit.

The targeted area of improvement was decreasing page to cannulation time. An 11 month baseline period was compared to an 18 month implementation period. Episodes in which return of circulation occurred before ECMO cannulation were not included.

Results: There were 11 eCPR episodes during the baseline period and 18 during the intervention period. There was a 28% decrease in mean page to cannulation time following CTOR nursing role implementation: 81 minutes ± 27 before and 58 minutes ± 26 after implementation, p = 0.03.

Conclusion: Implementation of the CTOR nursing role in the CICU was associated with reduction in time of page to cannulation in patients when eCPR was active. Further studies are necessary to see if this reduction in time is correlated with improved patient outcomes.