13: Code Blue to Circuit Flow: Using In-Situ Simulation to Strengthen ECPR Response During Service Expansion

Background: Effective outcomes in extracorporeal cardiopulmonary resuscitation (ECPR) depend on early recognition of cardiac arrest, high-quality CPR, prompt defibrillation, and minimizing low-flow time before ECMO initiation. With Adan Hospital expanding its services to the new Women & Children Hospital (WCH), in-situ simulation became a vital tool to assess team readiness in newly established areas. These simulations aimed to identify learning gaps, system deficiencies, and training needs among multidisciplinary teams adapting to the expanded ECMO network. Methods: Six multidisciplinary in-situ simulations were conducted across Adan Hospital and WCH. Each scenario involved a 45-year-old postoperative patient experiencing cardiac arrest in different clinical areas. Participants included nurses, residents, obstetricians, anesthetists, and intensivists. Performance metrics included early recognition of cardiac arrest, initiation of BLS/ACLS, rhythm identification, defibrillation timing, and activation of cardiology and ECPR teams. Results: Despite Adan Hospital’s established ECMO program, notable performance gaps were identified in new areas. Cardiac arrest recognition was delayed by 5–10 minutes, CPR initiation by 4–9 minutes, and the first shock was delivered between 4–17 minutes. ECPR activation was inconsistent; only two simulations achieved activation within 10 minutes, with team arrival in 3–4 minutes once called. The Day Care PACU demonstrated the best performance, initiating CPR within 2 minutes and maintaining adherence to ACLS protocols. Conclusion: In-situ simulation proved effective in identifying readiness challenges during hospital expansion. Emphasizing regular ACLS training, frequent mock codes, and standardized ECPR activation pathways, particularly in new clinical areas, is crucial. Enhancing early recognition, communication, and awareness of ECPR indications among staff will strengthen system performance and improve outcomes across the expanding ECMO network.