Beyond cannulation: the human factors shaping emergency department eCPR

Posted on August 28, 2026August 28, 2026 by Andrew Coggins

Extracorporeal cardiopulmonary resuscitation (eCPR) is one of emergency medicine’s most demanding interventions. It combines ongoing resuscitation with rapid ECMO cannulation, requiring a large multidisciplinary team to coordinate complex tasks under intense time pressure.

Our newly published exploratory study examined what happens to clinicians and teams during real-world eCPR. Across two Sydney hospitals, we observed six eCPR events involving 18 healthcare professionals and 155 minutes of team performance. We measured teamwork, clinician stress, ambient noise, crowding and workflow. Simulation and trauma cases were first used to test and refine the observation methods.

ECMO/eCPR Teamwork Download

Teamwork remained generally strong, with a median Mayo High Performance Teamwork Score of 12 out of 16. Predefined roles, team-leader summaries and designated crowd-control leadership were recurring features.

However, four of the six cases included episodes of loud or overlapping cross-talk, while closed-loop communication and explicit attention to safety threats were inconsistent.

These were crowded and noisy environments. The median team headcount was 20, with as many as 32 people attending one event. Mean ambient noise was 74.6 dB, with average peaks approaching 92 dB.

Paired salivary samples also suggested increased clinician cortisol after eCPR, although missing data and the small sample require cautious interpretation.

This study does not establish that particular team structures improve clinical outcomes. Rather, it shows that human factors can be studied during live eCPR and identifies practical targets for future research, training and system design: role clarity, communication, crowd control, noise and clinician stress…

Read the full open-access paper relating to teamwork – Click Here