{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:50:25Z","timestamp":1791355825122,"version":"4.3.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate changes in resuscitation efficiency, patient outcomes, and nursing cognitive load associated with implementation of a standardized extracorporeal cardiopulmonary resuscitation (ECPR) activation protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter observational study included 103 consecutive patients with in-hospital cardiac arrest who underwent ECPR at three tertiary hospitals in Guangdong Province, China. The control group included 30 patients treated from September 2019 to December 2023, and the post-implementation group included 73 patients treated from January 2024 to December 2025. Outcomes included resuscitation-process measures, clinical outcomes, and perceived nursing workload assessed using the NASA Task Load Index (NASA-TLX), a multidimensional measure of perceived workload.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with the control group, the post-implementation group had shorter ECPR preparation time (2.87\u2009\u00b1\u20092.32 vs. 8.60\u2009\u00b1\u20091.34\u2005min), ECMO priming time (14.83\u2009\u00b1\u20092.88 vs. 19.07\u2009\u00b1\u20091.18\u2005min), and ECMO initiation time (35.01\u2009\u00b1\u20092.36 vs. 54.12\u2009\u00b1\u20093.55\u2005min), and a higher one-time readiness rate of disposable supplies (100% vs. 50.0%; all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). The total NASA-TLX score was lower after implementation (415\u2009\u00b1\u200926 vs. 452\u2009\u00b1\u200925,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Thirty-day survival was numerically higher in the post-implementation group but did not differ statistically (42.5% vs. 23.3%; crude OR 2.43, 95% CI 0.92\u20136.37;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.069). Favorable neurological outcome at discharge was more frequent after implementation (30.1% vs. 10.0%; crude OR 3.88, 95% CI 1.07\u201314.15;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.036), and the association persisted after adjustment for SAVE score and time-to-ECPR-decision (adjusted OR 3.79, 95% CI 1.02\u201314.08;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.047).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Implementation of the standardized ECPR activation protocol was associated with shorter ECPR preparation, priming, and initiation times, lower perceived nursing workload, and higher odds of favorable neurological outcome at discharge. Thirty-day survival was numerically higher but did not differ statistically. Given the retrospective pre-post design, these findings should be interpreted as associations rather than causal effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1899029","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:58:50Z","timestamp":1791352730000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A standardized ECPR activation protocol and resuscitation efficiency, patient outcomes, and nursing cognitive load: a retrospective multicenter study"],"prefix":"10.3389","volume":"13","author":[{"given":"Caiyan","family":"Qian","sequence":"first","affiliation":[{"name":"Cardiovascular Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minling","family":"Yang","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, Guangdong, China"]},{"name":"Cardiothoracic Surgery ICU, The First Affiliated Hospital, Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinyin","family":"Wu","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Mei","sequence":"additional","affiliation":[{"name":"ICU, Longgang Central Hospital of Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuoran","family":"Ma","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Libing","family":"Ning","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peidong","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiyang","family":"Li","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1097\/mat.0000000000001344","article-title":"Extracorporeal cardiopulmonary resuscitation in adults. Interim guideline consensus statement from the extracorporeal life support organization","volume":"67","author":"Richardson","year":"2021","journal-title":"ASAIO J"},{"key":"B2","first-page":"287","article-title":"White book of Chinese cardiovascular surgery and extracorporeal circulation in 2024","volume":"23","year":"2025","journal-title":"Chin JECC"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e254","DOI":"10.1161\/cir.0000000000001194","article-title":"2023 American Heart Association focused update on adult advanced cardiovascular life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"149","author":"Perman","year":"2024","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/0364-0213(88)90023-7","article-title":"Cognitive load during problem solving: effects on learning","volume":"12","author":"Sweller","year":"1988","journal-title":"Cogn Sci"},{"key":"B5","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1097\/acm.0000000000003524","article-title":"From theory to practice: the application of cognitive load theory to the practice of medicine","volume":"96","author":"Szulewski","year":"2021","journal-title":"Acad Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"413","DOI":"10.4037\/aacnacc2021511","article-title":"Clinical nurse specialist: a critical member of the ICU team","volume":"32","author":"Gabbard","year":"2021","journal-title":"AACN Adv Crit Care"},{"key":"B7","first-page":"734","article-title":"Chinesization, reliability and validity test of national aeronautics and space administration task load index","volume":"33","author":"Liling","year":"2019","journal-title":"Chinese Nurs Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e20191358","DOI":"10.1542\/peds.2019-1358","article-title":"2019 American Heart Association focused update on pediatric basic life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"145","author":"Duff","year":"2020","journal-title":"Pediatrics"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e740","DOI":"10.1161\/cir.0000000000000613","article-title":"2018 American Heart Association focused update on advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"138","author":"Panchal","year":"2018","journal-title":"Circulation"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e031697","DOI":"10.1136\/bmjopen-2019-031697","article-title":"Protocol for a multicentre randomised controlled trial evaluating the effects of moderate hypothermia versus normothermia on mortality in patients with refractory cardiogenic shock rescued by venoarterial extracorporeal membrane oxygenation (VA-ECMO) (HYPO-ECMO study)","volume":"9","author":"Jacquot","year":"2019","journal-title":"BMJ Open"},{"key":"B11","doi-asserted-by":"publisher","first-page":"349","DOI":"10.3760\/cma.j.cn121430-20201010-00663","article-title":"[Extracorporeal membrane oxygenation rapid response team building and management practice]","volume":"33","author":"Gai","year":"2021","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1979","DOI":"10.3390\/medicina60121979","article-title":"Establishing an extracorporeal cardiopulmonary resuscitation program","volume":"60","author":"Bertini","year":"2024","journal-title":"Medicina (Kaunas)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e23411","DOI":"10.1016\/j.heliyon.2023.e23411","article-title":"Impact of independent early stage extracorporeal cardiopulmonary resuscitation in the emergency department following the establishment of an extracorporeal life support team","volume":"10","author":"Liu","year":"2024","journal-title":"Heliyon"},{"key":"B14","doi-asserted-by":"publisher","first-page":"4922","DOI":"10.3390\/jcm12154922","article-title":"The beginning of an ECLS center: first successful ECPR in an emergency department in Romania-case-based review","volume":"12","author":"Nedelea","year":"2023","journal-title":"J Clin Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.aucc.2021.12.003","article-title":"Nursing workforce, education, and training challenges to implementing extracorporeal membrane oxygenation services in Australian intensive care units: a qualitative substudy","volume":"36","author":"Ross","year":"2023","journal-title":"Aust Crit Care"},{"key":"B16","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1177\/0267659114534288","article-title":"A cost-reducing extracorporeal membrane oxygenation (ECMO) program model: a single institution experience","volume":"30","author":"Cavarocchi","year":"2015","journal-title":"Perfusion"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e0449","DOI":"10.1097\/cce.0000000000000449","article-title":"The implementation and outcomes of a nurse-run extracorporeal membrane oxygenation program, a retrospective single-center study","volume":"3","author":"Odish","year":"2021","journal-title":"Crit Care Explor"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e10634","DOI":"10.1002\/aet2.10634","article-title":"An exploratory investigation of the measurement of cognitive load on shift: application of cognitive load theory in emergency medicine","volume":"5","author":"Vella","year":"2021","journal-title":"AEM Educ Train"},{"key":"B19","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/s10648-010-9128-5","article-title":"Element interactivity and intrinsic, extraneous, and germane cognitive load","volume":"22","author":"Sweller","year":"2010","journal-title":"Educ Psychol Rev"},{"key":"B20","doi-asserted-by":"publisher","first-page":"57","DOI":"10.2147\/amep.S441405","article-title":"Relationship between cognitive load theory, intrinsic motivation and emotions in healthcare professions education: a perspective on the missing link","volume":"15","author":"Patel","year":"2024","journal-title":"Adv Med Educ Pract"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1016\/j.chest.2023.12.029","article-title":"Extraneous load, patient census, and patient acuity correlate with cognitive load during ICU rounds","volume":"165","author":"Held","year":"2024","journal-title":"Chest"},{"key":"B22","doi-asserted-by":"publisher","first-page":"20190009","DOI":"10.1515\/ijnes-2019-0009","article-title":"A cognitive load theory simulation design to assess and manage deteriorating patients","volume":"16","author":"Say","year":"2019","journal-title":"Int J Nurs Educ Scholarsh"},{"key":"B23","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1111\/jonm.12638","article-title":"A review of the role of nurse leadership in promoting and sustaining evidence-based practice","volume":"26","author":"Bianchi","year":"2018","journal-title":"J Nurs Manag"},{"key":"B24","doi-asserted-by":"publisher","first-page":"93","DOI":"10.37526\/1526-744X.2022.49.2.93","article-title":"Quality improvement\u2014every nurse\u2019s responsibility","volume":"49","author":"Ulrich","year":"2022","journal-title":"Nephrol Nurs J"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1899029\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:58:53Z","timestamp":1791352733000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1899029\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":24,"alternative-id":["10.3389\/fcvm.2026.1899029"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1899029","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1899029"}}