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Exploring the Feelings of Nurses during Resuscitation—A Cross-Sectional Study. Healthcare (Basel) 2021; 10:healthcare10010005. [PMID: 35052169 PMCID: PMC8774964 DOI: 10.3390/healthcare10010005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) is one of the most stressful situations in emergency medicine. Nurses involved in performing basic and advanced resuscitation procedures are therefore exposed to a certain amount of stress. The purpose of this study was to determine the stressors and the level of stress experienced by nurses during resuscitation. A cross-sectional quantitative study was done. The sample consisted of 457 nurses who worked in emergency units. First demographic data were collected, followed by a questionnaire regarding the effect of different situations that occur during and after resuscitation on nurses including Post-Code Stress Scale questionnaire. The most disturbing situations for respondents were resuscitation of young person (MV = 3.7, SD = 1.4), when they fail to establish an intravenous pathway (MV = 3.5, SD = 1.4), chaotic situation during resuscitation (MV = 3.4, SD = 1.4) and making decision about termination of resuscitation (MV = 3.1, SD = 1.5). Research has shown that nurses are exposed to a certain amount of stress during resuscitation, but most of them manage to compensate for stress effectively.
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2
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Stewart C, Shoemaker J, Keller-Smith R, Edmunds K, Davis A, Tegtmeyer K. Code Team Training: Demonstrating Adherence to AHA Guidelines During Pediatric Code Blue Activations. Pediatr Emerg Care 2021; 37:e1658-e1662. [PMID: 29040245 DOI: 10.1097/pec.0000000000001307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pediatric code blue activations are infrequent events with a high mortality rate despite the best effort of code teams. The best method for training these code teams is debatable; however, it is clear that training is needed to assure adherence to American Heart Association (AHA) Resuscitation Guidelines and to prevent the decay that invariably occurs after Pediatric Advanced Life Support training. The objectives of this project were to train a multidisciplinary, multidepartmental code team and to measure this team's adherence to AHA guidelines during code simulation. METHODS Multidisciplinary code team training sessions were held using high-fidelity, in situ simulation. Sessions were held several times per month. Each session was filmed and reviewed for adherence to 5 AHA guidelines: chest compression rate, ventilation rate, chest compression fraction, use of a backboard, and use of a team leader. After the first study period, modifications were made to the code team including implementation of just-in-time training and alteration of the compression team. RESULTS Thirty-eight sessions were completed, with 31 eligible for video analysis. During the first study period, 1 session adhered to all AHA guidelines. During the second study period, after alteration of the code team and implementation of just-in-time training, no sessions adhered to all AHA guidelines; however, there was an improvement in percentage of sessions adhering to ventilation rate and chest compression rate and an improvement in median ventilation rate. CONCLUSIONS We present a method for training a large code team drawn from multiple hospital departments and a method of assessing code team performance. Despite subjective improvement in code team positioning, communication, and role completion and some improvement in ventilation rate and chest compression rate, we failed to consistently demonstrate improvement in adherence to all guidelines.
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Affiliation(s)
- Claire Stewart
- From the Division of Critical Care, Nationwide Children's Hospital
| | - Jamie Shoemaker
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center
| | - Rachel Keller-Smith
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center
| | - Katherine Edmunds
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | | | - Ken Tegtmeyer
- Division of Critical Care, Cincinnati Children's Hospital Medical Center, Performed at Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Ehrler F, Sahyoun C, Manzano S, Sanchez O, Gervaix A, Lovis C, Courvoisier DS, Lacroix L, Siebert JN. Impact of a shared decision-making mHealth tool on caregivers' team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial. Trials 2021; 22:277. [PMID: 33849611 PMCID: PMC8042906 DOI: 10.1186/s13063-021-05170-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background Effective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR. Methods We will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication. Discussion This clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology. Trial registration ClinicalTrials.gov NCT04464603. Registered on 9 July 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05170-3.
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Affiliation(s)
- Frédéric Ehrler
- Department of Diagnostic, Geneva University Hospitals, Geneva, Switzerland
| | - Cyril Sahyoun
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Oliver Sanchez
- Division of Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Christian Lovis
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | | | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Johan N Siebert
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland. .,University of Geneva, Geneva, Switzerland.
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4
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Mittiga MR, Frey M, Kerrey BT, Rinderknecht AS, Eckerle MD, Sobolewski B, Johnson LH, Oehler JL, Bennett BL, Chan S, Frey TM, Krummen KM, Lindsay C, Wolfangel K, Richert A, Masur TJ, Bria CL, Hoehn EF, Geis GL. The Medical Resuscitation Committee: Interprofessional Program Development to Optimize Care for Critically Ill Medical Patients in an Academic Pediatric Emergency Department. Pediatr Emerg Care 2021; 37:167-171. [PMID: 30883536 DOI: 10.1097/pec.0000000000001742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACT Provision of optimal care to critically ill patients in a pediatric emergency department is challenging. Specific challenges include the following: (a) patient presentations are highly variable, representing the full breadth of human disease and injury, and are often unannounced; (b) care team members have highly variable experience and skills and often few meaningful opportunities to practice care delivery as a team; (c) valid data collection, for quality assurance/improvement and clinical research, is limited when relying on traditional approaches such as medical record review or self-report; (d) specific patient presentations are relatively uncommon for individual providers, providing few opportunities to establish and refine the requisite knowledge and skill; and (e) unscientific or random variation in care delivery. In the current report, we describe our efforts for the last decade to address these challenges and optimize care delivery to critically ill patients in a pediatric emergency department. We specifically describe the grassroots development of an interprofessional medical resuscitation program. Key components of the program are as follows: (a) a database of all medical patients undergoing evaluation in the resuscitation suite, (b) peer review and education through video-based case review, (c) a program of emergency department in situ simulation, and (d) the development of cognitive aids for high-acuity, low-frequency medical emergencies.
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Affiliation(s)
| | - Mary Frey
- From the Division of Emergency Medicine
| | | | | | | | | | | | | | | | | | | | - Kelly M Krummen
- Emergency Services, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Claire Lindsay
- Emergency Services, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Kelsey Wolfangel
- Emergency Services, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Alison Richert
- Emergency Services, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Tonya J Masur
- Emergency Services, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH
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Duff JP, Bhanji F, Lin Y, Overly F, Brown LL, Bragg EA, Kessler D, Tofil NM, Bank I, Hunt EA, Nadkarni V, Cheng A. Change in Cardiopulmonary Resuscitation Performance Over Time During Simulated Pediatric Cardiac Arrest and the Effect of Just-in-Time Training and Feedback. Pediatr Emerg Care 2021; 37:133-137. [PMID: 33651758 DOI: 10.1097/pec.0000000000002359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Effective cardiopulmonary resuscitation (CPR) is critical to ensure optimal outcomes from cardiac arrest, yet trained health care providers consistently struggle to provide guideline-compliant CPR. Rescuer fatigue can impact chest compression (CC) quality during a cardiac arrest event, although it is unknown if visual feedback or just-in-time training influences change of CC quality over time. In this study, we attempt to describe the changes in CC quality over a 12-minute simulated resuscitation and examine the influence of just-in-time training and visual feedback on CC quality over time. METHODS We conducted secondary analysis of data collected from the CPRCARES study, a multicenter randomized trial in which CPR-certified health care providers from 10 different pediatric tertiary care centers were randomized to receive visual feedback, just-in-time CPR training, or no intervention. They participated in a simulated cardiac arrest scenario with 2 team members providing CCs. We compared the quality of CCs delivered (depth and rate) at the beginning (0-4 minutes), middle (4-8 minutes), and end (8-12 minutes) of the resuscitation. RESULTS There was no significant change in depth over the 3 time intervals in any of the arms. There was a significant increase in rate (128 to 133 CC/min) in the no intervention arm over the scenario duration (P < 0.05). CONCLUSIONS There was no significant drop in CC depth over a 12-minute cardiac arrest scenario with 2 team members providing compressions.
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Affiliation(s)
| | | | - Yiqun Lin
- University of Calgary, Calgary, Canada
| | | | | | | | - David Kessler
- Columbia University Vagelos College of Physicians and Surgeons New York, NY
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Kuzma GDSP, Hirsch CB, Nau AL, Rodrigues AM, Gubert EM, Soares LCC. ASSESSMENT OF THE QUALITY OF PEDIATRIC CARDIOPULMONARY RESUSCITATION USING THE IN SITU MOCK CODE TOOL. ACTA ACUST UNITED AC 2020; 38:e2018173. [PMID: 31939509 PMCID: PMC6958535 DOI: 10.1590/1984-0462/2020/38/2018173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/23/2018] [Indexed: 11/25/2022]
Abstract
Objective: To evaluate the quality of individual and team care for cardiac arrest in a pediatric hospital using clinical surprise simulation (in situ mock code). Methods: We conducted an observational study with a sample of the hospital staff. Clinical simulations of cardiorespiratory arrest were performed in several sectors and work shifts. The mock code occurred in vacant beds of the sector without previous notification to the teams on call. One researcher conducted all mock codes and another evaluated individual and team attendance through a questionnaire contemplating recommendation for adequate cardiopulmonary resuscitation, based on the Pediatric Advanced Life Support (PALS) guidelines. At the end of the simulations, the research team provided a debriefing to the team tested. Results: Fifteen in situ mock code were performed with 56 nursing professionals (including nurses, nursing residents and technicians) and 11 physicians (including two pediatric residents and four residents of pediatric subspecialties). The evaluation showed that 46.7% of the professionals identified cardiac arrest checking for responsiveness (26.7%) and pulse (46.7%); 91.6% requested cardiac monitoring and venous access. In one case (8.3%) the cardiac compression technique was correct in depth and frequency, while 50% performed cardiopulmonary resuscitation correctly regarding the proportion of compressions and ventilation. According to PALS guidelines, the teams had a good performance in the work dynamics. Conclusions: There was low adherence to the PALS guidelines during cardiac arrest simulations. The quality of cardiopulmonary resuscitation should be improved in many points. We suggest periodical clinical simulations in pediatric services to improve cardiopulmonary resuscitation performance.
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Influence of Cardiopulmonary Resuscitation Coaching and Provider Role on Perception of Cardiopulmonary Resuscitation Quality During Simulated Pediatric Cardiac Arrest. Pediatr Crit Care Med 2019; 20:e191-e198. [PMID: 30951004 DOI: 10.1097/pcc.0000000000001871] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to describe the impact of a cardiopulmonary resuscitation coach on healthcare provider perception of cardiopulmonary resuscitation quality during simulated pediatric cardiac arrest. DESIGN Prospective, observational study. SETTING We conducted secondary analysis of data collected from a multicenter, randomized trial of providers who participated in a simulated pediatric cardiac arrest. SUBJECTS Two-hundred pediatric acute care providers. INTERVENTIONS Participants were randomized to having a cardiopulmonary resuscitation coach versus no cardiopulmonary resuscitation coach. Cardiopulmonary resuscitation coaches provided feedback on cardiopulmonary resuscitation performance and helped to coordinate key tasks. All teams used cardiopulmonary resuscitation feedback technology. MEASUREMENTS AND MAIN RESULTS Cardiopulmonary resuscitation quality was collected by the defibrillator, and perceived cardiopulmonary resuscitation quality was collected by surveying participants after the scenario. We calculated the difference between perceived and measured quality of cardiopulmonary resuscitation and defined accurate perception as no more than 10% deviation from measured quality of cardiopulmonary resuscitation. Teams with a cardiopulmonary resuscitation coach were more likely to accurately estimate chest compressions depth in comparison to teams without a cardiopulmonary resuscitation coach (odds ratio, 2.97; 95% CI, 1.61-5.46; p < 0.001). There was no significant difference detected in accurate perception of chest compressions rate between groups (odds ratio, 1.33; 95% CI, 0.77-2.32; p = 0.32). Among teams with a cardiopulmonary resuscitation coach, the cardiopulmonary resuscitation coach had the best chest compressions depth perception (80%) compared with the rest of the team (team leader 40%, airway 55%, cardiopulmonary resuscitation provider 30%) (p = 0.003). No differences were found in perception of chest compressions rate between roles (p = 0.86). CONCLUSIONS Healthcare providers improved their perception of cardiopulmonary resuscitation depth with a cardiopulmonary resuscitation coach present. The cardiopulmonary resuscitation coach had the best perception of chest compressions depth.
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Webber J, Moran K, Cumin D. Paediatric cardiopulmonary resuscitation: Knowledge and perceptions of surf lifeguards. J Paediatr Child Health 2019; 55:156-161. [PMID: 29943876 DOI: 10.1111/jpc.14097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/20/2018] [Accepted: 05/27/2018] [Indexed: 11/29/2022]
Abstract
AIM To conduct a comprehensive analysis of surf lifeguards' real and perceived ability in paediatric cardiopulmonary resuscitation (CPR), knowledge of child resuscitation protocols and technical competency during a simulated CPR scenario. METHODS Surf lifeguards aged 16 years and over were invited to complete a written survey and simulated test of five cycles of single-rescuer CPR on a paediatric manikin. In accordance with the latest Australia and New Zealand Committee on Resuscitation (ANZCOR) guidelines, practical skills were assessed by trained observers. A manikin fitted with electronic data-collection capability recorded technical compression and ventilation skills. RESULTS A total of 244 participants were entered into the study. Most previous CPR training did not include a paediatric component (53%). Lifeguards rated their ability to perform CPR on an adult as 'highly effective' or 'effective' in 56% of responses. Less than a quarter (23%), however, gave this response when compared to a child. Observed CPR skills were mostly compliant with ANZCOR guidelines (80-99%). Manikin data provided a median compression rate of 115.6 min-1 , compression depth of 3.7 cm and tidal volume of 220.0 mL. Almost half of ventilations were too little (45%), and around one fifth were too much (22%). CONCLUSIONS Surf lifeguards are less confident in paediatric CPR. The overall performance of observed and technical CPR skills, which were mostly ANZCOR guideline compliant, suggests that performance could be improved if paediatric-specific training is provided to supplement the adult-focused methods currently in use. The use of electronic feedback manikins is recommended to address the technical compression and ventilation issues identified in this study.
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Affiliation(s)
- Jonathon Webber
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.,Surf Life Saving New Zealand, Wellington, New Zealand.,International Drowning Researchers' Alliance
| | - Kevin Moran
- Surf Life Saving New Zealand, Wellington, New Zealand.,International Drowning Researchers' Alliance.,Faculty of Education, University of Auckland, Auckland, New Zealand
| | - David Cumin
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Santos-Folgar M, Otero-Agra M, Fernández-Méndez F, Hermo-Gonzalo MT, Barcala-Furelos R, Rodríguez-Núñez A. Ventilation during cardiopulmonary resuscitation in the infant. Mouth to mouth and nose, or bag-valve-mask? A quasi-experimental study. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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10
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Park JW, Jung JY, Kim J, Kwak YH, Kim DK, Lee JC, Ham EM, Hwang S, Kwon H. A Novel Infant Chest Compression Assist Device Using a Palm Rather Than Fingers: A Randomized Crossover Trial. PREHOSP EMERG CARE 2018; 23:74-82. [DOI: 10.1080/10903127.2018.1471559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Santos-Folgar M, Otero-Agra M, Fernández-Méndez F, Hermo-Gonzalo MT, Barcala-Furelos R, Rodríguez-Núñez A. [Ventilation during cardiopulmonary resuscitation in the infant. Mouth to mouth and nose, or bag-valve-mask? A quasi-experimental study]. An Pediatr (Barc) 2018; 89:272-278. [PMID: 29429863 DOI: 10.1016/j.anpedi.2017.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/26/2017] [Accepted: 12/30/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION It has been observed that health professionals have difficulty performing quality cardiopulmonary resuscitation (CPR). The aim of this study was to compare the quality of ventilations performed by Nursing students on an infant model using different methods (mouth-to-mouth-and-nose or bag-valve-mask). MATERIAL AND METHODS A quasi-experimental cross-sectional study was performed that included 46 second-year Nursing students. Two quantitative 4-minute tests of paediatric CPR were performed: a) mouth-to-mouth-and-nose ventilations, and b) ventilations with bag-valve-mask. A Resusci Baby QCPR Wireless SkillReporter® mannequin from Laerdal was used. The proportion of ventilations with adequate, excessive, and insufficient volume was recorded and analysed, as well as the overall quality of the CPR (ventilations and chest compressions). RESULTS The students were able to give a higher number of ventilations with adequate volume using the mouth-to-mouth-and-nose method (55±22%) than with the bag-valve-mask (28±16%, P<.001). The overall quality of the CPR was also significantly higher when using the mouth-to-mouth-and-nose method (60±19 vs. 48±16%, P<.001). CONCLUSIONS Mouth-to-mouth-and-nose ventilation method is more efficient than bag-valve-mask ventilations in CPR performed by nursing students with a simulated infant model.
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Affiliation(s)
- Myriam Santos-Folgar
- Facultad de Ciencias de la Educación y el Deporte, Universidad de Vigo, Pontevedra, España; Grupo de Investigación en Rendimiento y Motricidad del Salvamento y Socorrismo (REMOSS), Universidad de Vigo, Pontevedra, España
| | - Martín Otero-Agra
- Facultad de Ciencias de la Educación y el Deporte, Universidad de Vigo, Pontevedra, España; Grupo de Investigación en Rendimiento y Motricidad del Salvamento y Socorrismo (REMOSS), Universidad de Vigo, Pontevedra, España
| | - Felipe Fernández-Méndez
- Grupo de Investigación en Rendimiento y Motricidad del Salvamento y Socorrismo (REMOSS), Universidad de Vigo, Pontevedra, España; CLINURSID, Grupo de Investigación, Facultad de Enfermería, Universidad de Santiago de Compostela, Santiago de Compostela, España; Escuela de Enfermería de Pontevedra, Universidad de Vigo, Pontevedra, España.
| | - María Teresa Hermo-Gonzalo
- Grupo de Investigación en Rendimiento y Motricidad del Salvamento y Socorrismo (REMOSS), Universidad de Vigo, Pontevedra, España; Escuela de Enfermería de Pontevedra, Universidad de Vigo, Pontevedra, España
| | - Roberto Barcala-Furelos
- Facultad de Ciencias de la Educación y el Deporte, Universidad de Vigo, Pontevedra, España; Grupo de Investigación en Rendimiento y Motricidad del Salvamento y Socorrismo (REMOSS), Universidad de Vigo, Pontevedra, España; CLINURSID, Grupo de Investigación, Facultad de Enfermería, Universidad de Santiago de Compostela, Santiago de Compostela, España
| | - Antonio Rodríguez-Núñez
- CLINURSID, Grupo de Investigación, Facultad de Enfermería, Universidad de Santiago de Compostela, Santiago de Compostela, España
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Dispatcher-Assisted Telephone Cardiopulmonary Resuscitation Using a French-Language Compression-Ventilation Pediatric Protocol. Pediatr Emerg Care 2017; 33:679-685. [PMID: 28968304 DOI: 10.1097/pec.0000000000001266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Out-of-hospital cardiac arrest (OHCA) in pediatrics is a devastating event associated with poor survival rates. Although telephone dispatcher-assisted cardiopulmonary resuscitation (CPR; T-CPR) instructions improve the frequency and quality of bystander CPR for OHCA in adults, this support remains undeveloped in children. Our objective was to assess the effectiveness of a pediatric T-CPR protocol in untrained and trained bystanders. Secondarily, we sought to determine the feasibility and the effectiveness of ventilation in such a protocol. METHODS Eligible adults with no CPR experience were recruited in a movie theater in Liege, as well as bachelor nursing students in Liege. All volunteers were randomly assigned either to T-CPR or to no-T-CPR using randomization. The volunteers were exposed to a pediatric manikin model cardiac arrest. On the basis of Cardiff evaluation test, data were collected to evaluate CPR performance. RESULTS A total of 115 volunteers were assigned to 4 groups: untrained nonguided group (n = 27), untrained guided group (n = 32), trained nonguided group (n = 26), and trained guided group (n = 30). We found an improvement in CPR performance in the guided groups. Most volunteers (81.2%) in untrained guided group and 83.3% in the trained guided group were able to give 2 ventilations after each compressions cycle. CONCLUSIONS In a pediatric manikin model of OHCA, T-CPR instructions including mouth-to-mouth ventilations and chest compressions produced a significant increase in resuscitation performance not only among previously untrained but also among trained volunteers.
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13
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Haffner L, Mahling M, Muench A, Castan C, Schubert P, Naumann A, Reddersen S, Herrmann-Werner A, Reutershan J, Riessen R, Celebi N. Improved recognition of ineffective chest compressions after a brief Crew Resource Management (CRM) training: a prospective, randomised simulation study. BMC Emerg Med 2017; 17:7. [PMID: 28253848 PMCID: PMC5335734 DOI: 10.1186/s12873-017-0117-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 02/16/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chest compressions are a core element of cardio-pulmonary resuscitation. Despite periodic training, real-life chest compressions have been reported to be overly shallow and/or fast, very likely affecting patient outcomes. We investigated the effect of a brief Crew Resource Management (CRM) training program on the correction rate of improperly executed chest compressions in a simulated cardiac arrest scenario. METHODS Final-year medical students (n = 57) were randomised to receive a 10-min computer-based CRM or a control training on ethics. Acting as team leaders, subjects performed resuscitation in a simulated cardiac arrest scenario before and after the training. Team members performed standardised overly shallow and fast chest compressions. We analysed how often the team leader recognised and corrected improper chest compressions, as well as communication and resuscitation quality. RESULTS After the CRM training, team leaders corrected improper chest compressions (35.5%) significantly more often compared with those undergoing control training (7.7%, p = 0.03*). Consequently, four students have to be trained (number needed to treat = 3.6) for one improved chest compression scenario. Communication quality assessed by the Leader Behavior Description Questionnaire significantly increased in the intervention group by a mean of 4.5 compared with 2.0 (p = 0.01*) in the control group. CONCLUSION A computer-based, 10-min CRM training improved the recognition of ineffective of chest compressions. Furthermore, communication quality increased. As guideline-adherent chest compressions have been linked to improved patient outcomes, our CRM training might represent a brief and affordable approach to increase chest compression quality and potentially improve patient outcomes.
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Affiliation(s)
- Leopold Haffner
- DocLab, Faculty of Medicine, University of Tübingen, Elfriede-Aulhorn-Straße 10, 72076 Tübingen, Germany
| | - Moritz Mahling
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Alexander Muench
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Christoph Castan
- DocLab, Faculty of Medicine, University of Tübingen, Elfriede-Aulhorn-Straße 10, 72076 Tübingen, Germany
| | - Paul Schubert
- Department of Anesthesiology and Intensive Care Medicine, Passau Hospital, Innstraße 76, 94032 Passau, Germany
| | - Aline Naumann
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Silcherstraße 5, 72076 Tübingen, Germany
| | - Silke Reddersen
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Anne Herrmann-Werner
- DocLab, Faculty of Medicine, University of Tübingen, Elfriede-Aulhorn-Straße 10, 72076 Tübingen, Germany
- Department of Internal Medicine VI, Psychosomatic Medicine, University of Tübingen, Osianderstraße 5, 72076 Tübingen, Germany
| | - Jörg Reutershan
- Department of Anesthesiology and Intensive Care Medicine, Bayreuth Hospital, Preuschwitzer Straße 101, 95445 Bayreuth, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Nora Celebi
- PHV-Dialysezentrum Waiblingen, Beinsteiner Str. 8/3, 71334 Waiblingen, Germany
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Accuracy of instructor assessment of chest compression quality during simulated resuscitation. CAN J EMERG MED 2016; 18:276-82. [DOI: 10.1017/cem.2015.104] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectivesThe 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario.MethodsThis is a prospective observational study in which objective chest compression quality data (rate, depth, and fraction) were collected from the simulation manikin and compared to subjective instructor assessment. Data were collected during weekly simulation training sessions for residents, medical students, and nursing students.ResultsWe included data from 24 simulated resuscitation scenarios assessed by 1 of 15 instructors. Subjective assessment of chest compression quality identified an adequate compression rate (100–120 compressions per minute) with a sensitivity of 0.17 (confidence interval [CI] 0.02–0.32) and specificity of 0.06 (CI −0.04–0.15), adequate depth (>50 mm) with a sensitivity of 0 and specificity of 0.38 (CI 0.18–0.57), and adequate fraction (>80%) with a sensitivity of 1 and a specificity of 0.25 (CI 0.08–0.42).ConclusionInstructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators.
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Kim CH, Kim GW, Cha WC, Kang BR, Do HH, Seo JS. For how long can two emergency medical technicians perform high-quality cardiopulmonary resuscitation? J Int Med Res 2015; 43:841-50. [PMID: 26659259 DOI: 10.1177/0300060515595648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the duration and obstacles to prolonged on-scene cardiopulmonary resuscitation (CPR), and establish how long a pair of emergency medical technicians (EMTs) can provide high-quality CPR. METHOD Intermediate-level EMTs in Gyeonggi-do Province, Republic of Korea completed a survey regarding on-scene CPR. EMTs undergoing routine training took part in a simulation using mannequins. Parameters including compression depth, total number and rate of compressions; occurrence of incorrect hand position and incomplete chest recoil were collected over 16 2-min cycles of CPR (32 min total), with EMTs working in pairs. RESULT The simulation study included 43 EMTs. The median duration of on-scene CPR was 3.7 min. Fear of decrease in performance was the main obstacle to continued CPR (n = 188/254 [74.0%]). Standards for high-quality CPR were met at each of the 16 steps of the simulation. Compression rate increased significantly with time. There were no significant changes in any other parameter. CONCLUSION Pairs of EMTs maintained high-quality CPR for 16 cycles (32 min) with no decrease in performance. Our findings could provide evidence to recommend guidelines for duration of on-scene CPR for cardiac arrest, particularly in countries where the level and number of ambulance crews are limited.
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Affiliation(s)
- Chu Hyun Kim
- Department of Emergency Medicine, Inje University College of Medicine and Seoul Paik Hospital, Seoul, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Ajou University College of Medicine and Ajou University Hospital, Suwon, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Centre, Seoul, Republic of Korea
| | - Bo Ra Kang
- Department of Emergency Medicine, Ajou University College of Medicine and Ajou University Hospital, Suwon, Republic of Korea
| | - Han Ho Do
- Department of Emergency Medicine, Dongguk University College of Medicine and Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Jun Seok Seo
- Department of Emergency Medicine, Dongguk University College of Medicine and Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
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Na JU, Choi PC, Lee HJ, Shin DH, Han SK, Cho JH. A vertical two-thumb technique is superior to the two-thumb encircling technique for infant cardiopulmonary resuscitation. Acta Paediatr 2015; 104:e70-5. [PMID: 25382371 DOI: 10.1111/apa.12857] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 09/03/2014] [Accepted: 11/04/2014] [Indexed: 11/27/2022]
Abstract
AIM The two-thumb encircling (TTE) technique often results in suboptimal cardiac compression and does not meet the requirements of current resuscitation guidelines. We compared this technique with the vertical two-thumb (VTT) technique, our novel modification of the TTE technique. METHODS This was a prospective randomised crossover simulation study of out-of-hospital infant cardiopulmonary resuscitation (CPR). Participants who had completed a basic life support course performed 10 cycles of cardiac compressions on a manikin for each technique. RESULTS We enrolled 36 medical doctors who had applied for a hospital internship in this study. The VTT generated significantly higher pressure than the TTE and the pressure difference ranged from 26.8 to 62.9 mmHg for each cycle, with a mean difference of 43.5 mmHg (95% CI, 37.8-49.2). The difference in pressure showed a tendency to increase with increasing cycles of cardiac compressions. The participants' heart and respiratory rate was higher with the VTT, but they said that it was easier to perform cardiac compressions with this technique. CONCLUSION The VTT technique generated more pressure than the TTE technique in a simulated model of infant out-of-hospital CPR. It can provide an alternative compression technique for effective infant CPR, especially for the rescuers with small hands or a weak grip.
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Affiliation(s)
- Ji Ung Na
- Department of Emergency Medicine; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Emergency Medicine; Graduate School; College of Medicine; Kangwon National University; Chuncheon Korea
| | - Pil Cho Choi
- Department of Emergency Medicine; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Hyun Jung Lee
- Department of Emergency Medicine; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Emergency Medicine; Graduate School; College of Medicine; Kangwon National University; Chuncheon Korea
| | - Dong Hyuk Shin
- Department of Emergency Medicine; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Emergency Medicine; Graduate School; College of Medicine; Kangwon National University; Chuncheon Korea
| | - Sang Kuk Han
- Department of Emergency Medicine; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Emergency Medicine; Graduate School; College of Medicine; Kangwon National University; Chuncheon Korea
| | - Jun Hwi Cho
- Department of Emergency Medicine; Institute of Medical Sciences; School of Medicine; Kangwon National University Hospital; Kangwon National University; Chuncheon Korea
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Chalwin RP, Flabouris A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J 2014; 43:962-9. [PMID: 23611153 DOI: 10.1111/imj.12172] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/14/2013] [Indexed: 11/28/2022]
Abstract
Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. Some aspects of NTS have already achieved acceptance for cardiac arrest teams. Leadership skills are emphasised in advanced life support training and have shown favourable results when employed in simulated and clinical resuscitation scenarios. The application of NTS in medical emergency teams as part of a rapid response system attending medical emergencies is less certain; however, observations of simulations have also shown promise. This review highlights the potential benefits of NTS competency for cardiac arrest teams and, more importantly, medical emergency teams because of the diversity of clinical scenarios encountered. Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance.
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Affiliation(s)
- R P Chalwin
- Intensive Care Unit, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
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Chen MJ, Yu S, Chen IJ, Wang KWK, Lan YH, Tang FI. Evaluation of nurses' knowledge and understanding of obstacles encountered when administering resuscitation medications. NURSE EDUCATION TODAY 2014; 34:177-184. [PMID: 23660241 DOI: 10.1016/j.nedt.2013.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 03/08/2013] [Accepted: 04/08/2013] [Indexed: 06/02/2023]
Abstract
AIM The aim of the study was to develop and validate an instrument to evaluate nurses' knowledge and to understand the obstacles that they encounter when administering resuscitation medications. BACKGROUND Insufficient knowledge is a major factor in nurses' drug administration errors. Resuscitation involves situations in which doctors issue oral orders, and is inherently highly stressful. Sufficient knowledge is vital for nurses if they are to respond quickly and accurately when administering resuscitation medications. METHODS A cross-sectional study was conducted. A questionnaire (20 true-false questions) developed from literature and expert input, and validated by subject experts and one pilot study, was used to evaluate nurses' knowledge of resuscitation medications. Stratified sampling and descriptive statistics were applied. RESULTS A total of 188 nurses participated. The overall correct answer rate was 70.5% and the greater the nurse's work experience the higher the score. Only 8% of nurses considered themselves to have sufficient knowledge and 73.9% hoped to gain more training about resuscitation medications. The leading obstacle reported was "interruption of the drug administration procedure on resuscitation" (62.8%). Seventeen out of 20 questions achieved a discriminatory power of over 0.36, indicating good to excellent questions. In the study, a total of 16 resuscitation medication errors were reported by the participants, in which the errors involved atropine (five cases), epinephrine (three cases) and others (eight cases). The errors mainly involved misinterpretation of orders, insufficient knowledge and confusing certain drugs for other look-alike drugs. CONCLUSION Evidence-based results strongly suggest that nurses have insufficient knowledge and could benefit from longer working experience and additional training about resuscitation medications. Further research to validate the instrument is needed and the education of nurses regarding resuscitation medications is recommended.
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Affiliation(s)
| | - Shu Yu
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - I-Ju Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Wei K Wang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Hui Lan
- Tri-service General Hospital, Taipei, Taiwan
| | - Fu-In Tang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.
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Scholefield BR, Clinton RO. Push hard and fast, until I tell you not to. Resuscitation 2013; 84:1007-8. [PMID: 23711360 DOI: 10.1016/j.resuscitation.2013.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 11/28/2022]
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Fernandez Castelao E, Russo SG, Riethmüller M, Boos M. Effects of team coordination during cardiopulmonary resuscitation: a systematic review of the literature. J Crit Care 2013; 28:504-21. [PMID: 23602030 DOI: 10.1016/j.jcrc.2013.01.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 12/28/2012] [Accepted: 01/01/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study is to identify and evaluate to what extent the literature on team coordination during cardiopulmonary resuscitation (CPR) empirically confirms its positive effect on clinically relevant medical outcome. MATERIAL AND METHODS A systematic literature search in PubMed, MEDLINE, PsycINFO and CENTRAL databases was performed for articles published in the last 30 years. RESULTS A total of 63 articles were included in the review. Planning, leadership, and communication as the three main interlinked coordination mechanisms were found to have effect on several CPR performance markers. A psychological theory-based integrative model was expanded upon to explain linkages between the three coordination mechanisms. CONCLUSIONS Planning is an essential element of leadership behavior and is primarily accomplished by a designated team leader. Communication affects medical performance, serving as the vehicle for the transmission of information and directions between team members. Our findings also suggest teams providing CPR must continuously verbalize their coordination plan in order to effectively structure allocation of subtasks and optimize success.
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Training teams and leaders to reduce resuscitation errors and improve patient outcome. Resuscitation 2012; 83:13-5. [DOI: 10.1016/j.resuscitation.2011.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 10/25/2011] [Indexed: 01/09/2023]
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Niebauer JM, White ML, Zinkan JL, Youngblood AQ, Tofil NM. Hyperventilation in pediatric resuscitation: performance in simulated pediatric medical emergencies. Pediatrics 2011; 128:e1195-200. [PMID: 21969287 DOI: 10.1542/peds.2010-3696] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the hypothesis that pediatric resuscitation providers hyperventilate patients via bag-valve-mask (BVM) ventilation during performance of cardiopulmonary resuscitation (CPR), quantify the degree of excessive ventilation provided, and determine if this tendency varies according to provider type. METHODS A retrospective, observational study was conducted of 72 unannounced, monthly simulated pediatric medical emergencies ("mock codes") in a tertiary care, academic pediatric hospital. Responders were code team members, including pediatric residents and interns (MDs), respiratory therapists (RTs), and nurses (RNs). All sessions were video-recorded and reviewed for the rate of BVM ventilation, rate of chest compressions, and the team members performing these tasks. The type of emergency, location of the code, and training level of the team leader were also recorded. RESULTS Hyperventilation was present in every mock code reviewed. The mean rate of BVM ventilation for all providers in all scenarios was 40.6 ± 11.8 breaths per minute (BPM). The mean ventilation rates for RNs, RTs, and MDs were 40.8 ± 14.7, 39.9 ± 11.7, and 40.5 ± 10.3 BPM, respectively, and did not differ among providers (P = .94). All rates were significantly higher than the recommended rate of 8 to 20 BPM (per Pediatric Advanced Life Support guidelines, varies with patient age) (P < .001). The mean ventilation rate in cases of isolated respiratory arrest was 44.0 ± 13.9 BPM and was not different from the mean BVM ventilation rate in cases of cardiopulmonary arrest (38.9 ± 14.4 BPM; P = .689). CONCLUSIONS Hyperventilation occurred in simulated pediatric resuscitation and did not vary according to provider type. Future educational interventions should focus on avoidance of excessive ventilation.
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Affiliation(s)
- Julia M Niebauer
- Division of Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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Abstract
Solutions to improve care provided during cardiac arrest resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. In this article, new approaches to improving cardiac arrest resuscitation performance are reviewed. The focus is on a continuous quality improvement paradigm highlighting improving training methods before actual cardiac arrest events, monitoring quality during resuscitation attempts, and using quantitative debriefing programs after events to educate frontline care providers.
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A survey on training in pediatric cardiopulmonary resuscitation in Latin America, Spain, and Portugal. Pediatr Crit Care Med 2011; 12:e200-4. [PMID: 21057371 DOI: 10.1097/pcc.0b013e3181fe2579] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine how training in pediatric cardiopulmonary resuscitation is provided in the Iberoamerican countries. DESIGN Survey. SETTING Latin America, Spain, and Portugal. SUBJECTS Experts in pediatric cardiopulmonary resuscitation education. RESULTS A questionnaire was sent to experts in pediatric cardiopulmonary resuscitation training in 21 countries in Latin America, Spain, and Portugal; we received 15 replies. Pediatric cardiopulmonary resuscitation training is not included in medical undergraduate or nursing training in any of these countries and pediatric residents receive systematic cardiopulmonary resuscitation training in only four countries. Basic pediatric life support courses, pediatric advanced life support courses, and pediatric cardiopulmonary resuscitation instructors courses are given in 13 of 15, 14 of 15, and 11 of 15 respondent countries, respectively. Course duration and the number of hours of practical training were variable: basic life support, 5 hrs (range, 4-8 hrs); practical training, 4 hrs (range, 2-5 hrs); advanced life support, 18 hrs (range, 10-30 hrs); and practical training, 14 hrs (range, 5-18 hrs). Only nine countries (60%) had a national group that organized pediatric cardiopulmonary resuscitation training. Thirteen countries (86.6%) had fewer than five centers offering pediatric cardiopulmonary resuscitation training. Respondents considered the main obstacles to the expansion of training in pediatric cardiopulmonary resuscitation to be the shortage of instructors (28.5%), students' lack of financial resources (21.4%), and deficiencies in educational organization (21.4%). CONCLUSIONS Pediatric cardiopulmonary resuscitation training is not uniform across the majority of Iberoamerican countries, with poor organization and little institutional involvement. National groups should be created in each country to plan and coordinate pediatric cardiopulmonary resuscitation training and to coordinate with other Iberoamerican countries.
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Fernandez Castelao E, Russo SG, Cremer S, Strack M, Kaminski L, Eich C, Timmermann A, Boos M. Positive impact of crisis resource management training on no-flow time and team member verbalisations during simulated cardiopulmonary resuscitation: a randomised controlled trial. Resuscitation 2011; 82:1338-43. [PMID: 21664757 DOI: 10.1016/j.resuscitation.2011.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 05/04/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the impact of video-based interactive crisis resource management (CRM) training on no-flow time (NFT) and on proportions of team member verbalisations (TMV) during simulated cardiopulmonary resuscitation (CPR). Further, to investigate the link between team leader verbalisation accuracy and NFT. METHODS The randomised controlled study was embedded in the obligatory advanced life support (ALS) course for final-year medical students. Students (176; 25.35±1.03 years, 63% female) were alphabetically assigned to 44 four-person teams that were then randomly (computer-generated) assigned to either CRM intervention (n=26), receiving interactive video-based CRM-training, or to control intervention (n=18), receiving an additional ALS-training. Primary outcomes were NFT and proportions of TMV, which were subdivided into eight categories: four team leader verbalisations (TLV) with different accuracy levels and four follower verbalisation categories (FV). Measurements were made of all groups administering simulated adult CPR. RESULTS NFT rates were significantly lower in the CRM-training group (31.4±6.1% vs. 36.3±6.6%, p=0.014). Proportions of all TLV categories were higher in the CRM-training group (p<0.001). Differences in FV were only found for one category (unsolicited information) (p=0.012). The highest correlation with NFT was found for high accuracy TLV (direct orders) (p=0.06). CONCLUSIONS The inclusion of CRM training in undergraduate medical education reduces NFT in simulated CPR and improves TLV proportions during simulated CPR. Further research will test how these results translate into clinical performance and patient outcome.
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Affiliation(s)
- Ezequiel Fernandez Castelao
- Department of Social and Communication Psychology, Georg-August-University Göttingen, Gosslerstrasse 14, Germany.
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Lešnik D, Lešnik B, Golub J, Križmarić M, Mally S, Grmec S. Impact of additional module training on the level of basic life support knowledge of first year students at the University of Maribor. Int J Emerg Med 2011; 4:16. [PMID: 21609507 PMCID: PMC3095545 DOI: 10.1186/1865-1380-4-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 04/19/2011] [Indexed: 11/10/2022] Open
Abstract
AIM The aim of this study was to investigate the impact of additional (two versus one session) basic life support (BLS) training of university students on knowledge and attitude concerning the performance of cardiopulmonary resuscitation. METHODS A total of 439 students in three separate groups were tested: those with no prior BLS training; BLS training in high school (part of the driver's education course); and BLS training in high school (in the driver's education course) and additional BLS training at the university. RESULTS Our study showed the best results of BLS education in a group of university students who took an additional BLS module approximately half a year after the driver's education BLS course. In our study we observed equal levels of knowledge between the group with BLS training in high school and the group without any formal BLS education. The questionnaire revealed a disappointing level of knowledge about BLS in both groups. CONCLUSION Additional basic life support training (two BLS training sessions: high school and university) improves retention of knowledge and attitudes concerning performing CPR in first year university students.
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Affiliation(s)
- Damjan Lešnik
- Center for Emergency Medicine, Ulica talcev 9, 2000 Maribor, Slovenia.
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Duff JP, Joffe AR, Sevcik W, deCaen A. Autoresuscitation after pediatric cardiac arrest: is hyperventilation a cause? Pediatr Emerg Care 2011; 27:208-9. [PMID: 21378522 DOI: 10.1097/pec.0b013e31820d8e1e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are a number of reports of delayed return of spontaneous circulation after pulseless arrest (the Lazarus phenomenon) in adults. There are no published reports of this phenomenon in children. We report 2 pediatric cases of the Lazarus phenomenon, likely caused by unintentional hyperventilation during resuscitation.
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Affiliation(s)
- Jonathan P Duff
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Finn J. E-learning in resuscitation training – students say they like it, but is there evidence that it works? Resuscitation 2010; 81:790-1. [DOI: 10.1016/j.resuscitation.2010.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hamrick JT, Fisher B, Quinto KB, Foley J. Quality of external closed-chest compressions in a tertiary pediatric setting: Missing the mark. Resuscitation 2010; 81:718-23. [DOI: 10.1016/j.resuscitation.2010.01.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 01/10/2010] [Accepted: 01/18/2010] [Indexed: 10/19/2022]
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Udassi S, Udassi JP, Lamb MA, Theriaque DW, Shuster JJ, Zaritsky AL, Haque IU. Two-thumb technique is superior to two-finger technique during lone rescuer infant manikin CPR. Resuscitation 2010; 81:712-7. [PMID: 20227156 DOI: 10.1016/j.resuscitation.2009.12.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 12/02/2009] [Accepted: 12/30/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Infant CPR guidelines recommend two-finger chest compression with a lone rescuer and two-thumb with two rescuers. Two-thumb provides better chest compression but is perceived to be associated with increased ventilation hands-off time. We hypothesized that lone rescuer two-thumb CPR is associated with increased ventilation cycle time, decreased ventilation quality and fewer chest compressions compared to two-finger CPR in an infant manikin model. DESIGN Crossover observational study randomizing 34 healthcare providers to perform 2 min CPR at a compression rate of 100 min(-1) using a 30:2 compression:ventilation ratio comparing two-thumb vs. two-finger techniques. METHODS A Laerdal Baby ALS Trainer manikin was modified to digitally record compression rate, compression depth and compression pressure and ventilation cycle time (two mouth-to-mouth breaths). Manikin chest rise with breaths was video recorded and later reviewed by two blinded CPR instructors for percent effective breaths. Data (mean+/-SD) were analyzed using a two-tailed paired t-test. Significance was defined qualitatively as p< or =0.05. RESULT Mean % effective breaths were 90+/-18.6% in two-thumb and 88.9+/-21.1% in two-finger, p=0.65. Mean time (s) to deliver two mouth-to-mouth breaths was 7.6+/-1.6 in two-thumb and 7.0+/-1.5 in two-finger, p<0.0001. Mean delivered compressions per minute were 87+/-11 in two-thumb and 92+/-12 in two-finger, p=0.0005. Two-thumb resulted in significantly higher compression depth and compression pressure compared to the two-finger technique. CONCLUSION Healthcare providers required 0.6s longer time to deliver two breaths during two-thumb lone rescuer infant CPR, but there was no significant difference in percent effective breaths delivered between the two techniques. Two-thumb CPR had 4 fewer delivered compressions per minute, which may be offset by far more effective compression depth and compression pressure compared to two-finger technique.
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Affiliation(s)
- Sharda Udassi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32610, USA
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