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Singer Harel D, Lin Y, Lo CY, Cheng A, Davidson J, Chang TP, Matava C, Buyck M, Neveu G, Collia N, Fayyaz J, Manshadi K, Levy A, Pellerin S, Pirie J. Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY) Study: Secondary Workload and Provider Outcomes in a Simulation-Based Trial. Pediatr Crit Care Med 2024:00130478-990000000-00352. [PMID: 38836694 DOI: 10.1097/pcc.0000000000003535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVES An aerosol box aims to reduce the risk of healthcare provider (HCP) exposure to infections during aerosol generating medical procedures (AGMPs), but little is known about its impact on workload of team members. We conducted a secondary analysis of data from a prospective, multicenter, randomized controlled trial evaluating the impact of aerosol box use on patterns of HCP contamination during AGMPs. The objectives of this study are to: 1) evaluate the effect of aerosol box use on HCP workload, 2) identify factors associated with HCP workload when using an aerosol box, and 3) describe the challenges perceived by HCPs of aerosol box use. DESIGN Simulation-based randomized trial, conducted from May to December 2021. SETTING Four pediatric simulation centers. SUBJECTS Teams of two HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box). INTERVENTIONS Each team performed three scenarios requiring different pediatric airway management (bag-valve-mask [BVM] ventilation, laryngeal mask airway [LMA] insertion, and endotracheal intubation [ETI] with video laryngoscopy) on a simulated COVID-19 patient. National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a standard tool that measures subjective workload with six subscales. MEASUREMENTS AND MAIN RESULTS A total of 64 teams (128 participants) were recruited. The use of aerosol box was associated with significantly higher frustration during LMA insertion (28.71 vs. 17.42; mean difference, 11.29; 95% CI, 0.92-21.66; p = 0.033). For ETI, there was a significant increase in most subscales in the intervention group, but there was no significant difference for BMV. Average NASA-TLX scores were all in the "low" range for both groups (range: control BVM 23.06, sd 13.91 to intervention ETI 38.15; sd 20.45). The effect of provider role on workloads was statistically significant only for physical demand (p = 0.001). As the complexity of procedure increased (BVM → LMA → ETI), the workload increased in all six subscales (p < 0.05). CONCLUSIONS The use of aerosol box increased workload during ETI but not with BVM and LMA insertion. Overall workload scores remained in the "low" range, and there was no significant difference between airway provider and assistant.
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Affiliation(s)
- Dana Singer Harel
- Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, ON, Canada
| | - Yiqun Lin
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Carl Y Lo
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA
| | - Adam Cheng
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, KidSIM-ASPIRE Research Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jennifer Davidson
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Todd P Chang
- Department of Emergency Medicine, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Buyck
- Department of Mother and Child Medicine, Division of Pediatric Emergency Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Guylaine Neveu
- Department of Respiratory Therapy, Sainte-Justine Hospital Mother-child Simulation Center, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Natasha Collia
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jabeen Fayyaz
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Keya Manshadi
- Department of Emergency Medicine, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA
| | - Arielle Levy
- Departments of Pediatrics and Emergency Medicine, Sainte-Justine Hospital Mother-child Simulation Center, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Stephanie Pellerin
- Department of Emergency Medicine, Sainte-Justine Hospital Mother-child Simulation Center, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Jonathan Pirie
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Sumera K, Ilczak T, Bakkerud M, Lane JD, Pallas J, Martorell SO, Sumera A, Webster CA, Quinn T, Sandars J, Niroshan Siriwardena A. CPR Quality Officer role to improve CPR quality: A multi-centred international simulation randomised control trial. Resusc Plus 2024; 17:100537. [PMID: 38261942 PMCID: PMC10796959 DOI: 10.1016/j.resplu.2023.100537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Background An out-of-hospital cardiac arrest requires early recognition, prompt and quality clinical interventions, and coordination between different clinicians to improve outcomes. Clinical team leaders and clinical teams have high levels of cognitive burden. We aimed to investigate the effect of a dedicated Cardio-Pulmonary Resuscitation (CPR) Quality Officer role on team performance. Methods This multi-centre randomised control trial used simulation in universities from the UK, Poland, and Norway. Student Paramedics participated in out-of-hospital cardiac arrest scenarios before randomisation to either traditional roles or assigning one member as the CPR Quality Officer. The quality of CPR was measured using QCPR® and Advanced Life Support (ALS) elements were evaluated. Results In total, 36 teams (108 individuals) participated. CPR quality from the first attempt (72.45%, 95% confidence interval [CI] 64.94 to 79.97) significantly increased after addition of the CPR Quality role (81.14%, 95% CI 74.20 to 88.07, p = 0.045). Improvement was not seen in the control group. The time to first defibrillation had no significant difference in the intervention group between the first attempt (53.77, 95% CI 36.57-70.98) and the second attempt (48.68, 95% CI 31.31-66.05, p = 0.84). The time to manage an obstructive airway in the intervention group showed significant difference (p = 0.006) in the first attempt (168.95, 95% CI 110.54-227.37) compared with the second attempt (136.95, 95% CI 87.03-186.88, p = 0.1). Conclusion A dedicated CPR Quality Officer in simulated scenarios improved the quality of CPR compressions without a negative impact on time to first defibrillation, managing the airway, or adherence to local ALS protocols.
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Affiliation(s)
- Kacper Sumera
- East Midlands Ambulance Service NHS Trust, Education, Nottingham NG11 8NS, UK
- European Pre-hospital Research Network, United Kingdom
| | - Tomasz Ilczak
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biała, Poland
- European Pre-hospital Research Network, United Kingdom
| | - Morten Bakkerud
- Oslo Metropolitan University, Department of Nursing and Health Promotion, Pilestredet 32, 0166 Oslo, Norway
- European Pre-hospital Research Network, United Kingdom
| | - Jon Dearnley Lane
- Edge Hill University, Allied Health, Social Work & Wellbeing, Ormskirk L39 4QP, UK
| | - Jeremy Pallas
- John Hunter Hospital, Emergency Department, NSW 2305, Australia
| | - Sandra Ortega Martorell
- Liverpool John Moores University, School of Computer Science and Mathematics, Liverpool L3 5UX, UK
| | - Agnieszka Sumera
- University of Chester, Faculty of Health, Medicine & Society, Chester CH1 1SL, UK
- European Pre-hospital Research Network, United Kingdom
| | - Carl A. Webster
- Nottingham Trent University, Institute of Health and Allied Professions, Nottingham NG11 8NS, UK
- European Pre-hospital Research Network, United Kingdom
| | - Tom Quinn
- Kingston University & St George’s, University of London, Centre for Health and Social Care Research, London KT2 7LB, UK
- European Pre-hospital Research Network, United Kingdom
| | - John Sandars
- Edge Hill University, Allied Health, Social Work & Wellbeing, Ormskirk L39 4QP, UK
| | - A. Niroshan Siriwardena
- University of Lincoln, School of Health and Social Care, Lincoln LN6 7TS, UK
- European Pre-hospital Research Network, United Kingdom
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3
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Neveln NK, Khattab M, Hagan JL, Fortunov RM, Sundgren NC. A recorder/time coach decreases time errors during neonatal resuscitation: A randomized, simulation-based clinical trial. Resusc Plus 2023; 15:100411. [PMID: 37363126 PMCID: PMC10285630 DOI: 10.1016/j.resplu.2023.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Aim To evaluate the effects of a hands-off recorder/time coach versus an additional hands-on healthcare provider on Neonatal Resuscitation Program (NRP) algorithm compliance and team member workload in neonatal resuscitations. Methods Two interventions were studied using a 2 × 2 factorial design: an additional hands-on team member and the presence of a designated, hands-off recorder/time coach. The recorder/time coach documented interventions and delivered pre-specified prompts at defined points during the resuscitation. The primary outcome was cumulative time error. Secondary outcomes were time to first dose of IV epinephrine, overall team performance as assessed by the Neonatal Resuscitation Performance Evaluation (NRPE) score, and workload assessed by the NASA Task Load Index (NASA TLX). Results 64 teams were studied. Teams with a recorder had a significantly lower cumulative time error compared to teams without a recorder (p < 0.001). An additional hands-on team member did not change cumulative time error. There was no difference in time to first dose of IV epinephrine or NRPE score in these comparisons. Ad-hoc analysis did reveal a significant increase in time to IV epinephrine in teams with the minimum of four total members (p = 0.025). A recorder/time coach increased team leader NASA TLX overall workload score (p = 0.047), but an additional hands-on team member did not. Conclusion A designated, hands-off recorder/time coach improved compliance by decreasing cumulative time error in teams performing complex simulated neonatal resuscitations.
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Affiliation(s)
| | | | | | | | - Nathan C. Sundgren
- Corresponding author at: Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, One Baylor Dr., Houston, TX 77030, United States.
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Weiss KE, Kolbe M, Nef A, Grande B, Kalirajan B, Meboldt M, Lohmeyer Q. Data-driven resuscitation training using pose estimation. Adv Simul (Lond) 2023; 8:12. [PMID: 37061746 PMCID: PMC10105636 DOI: 10.1186/s41077-023-00251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/29/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) training improves CPR skills while heavily relying on feedback. The quality of feedback can vary between experts, indicating a need for data-driven feedback to support experts. The goal of this study was to investigate pose estimation, a motion detection technology, to assess individual and team CPR quality with the arm angle and chest-to-chest distance metrics. METHODS After mandatory basic life support training, 91 healthcare providers performed a simulated CPR scenario in teams. Their behaviour was simultaneously rated based on pose estimation and by experts. It was assessed if the arm was straight at the elbow, by calculating the mean arm angle, and how close the distance between the team members was during chest compressions, by calculating the chest-to-chest distance. Both pose estimation metrics were compared with the expert ratings. RESULTS The data-driven and expert-based ratings for the arm angle differed by 77.3%, and based on pose estimation, 13.2% of participants kept the arm straight. The chest-to-chest distance ratings by expert and by pose estimation differed by 20.7% and based on pose estimation 63.2% of participants were closer than 1 m to the team member performing compressions. CONCLUSIONS Pose estimation-based metrics assessed learners' arm angles in more detail and their chest-to-chest distance comparably to expert ratings. Pose estimation metrics can complement educators with additional objective detail and allow them to focus on other aspects of the simulated CPR training, increasing the training's success and the participants' CPR quality. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Kerrin E Weiss
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland.
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Andrina Nef
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Institute of Anaesthesiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Bravin Kalirajan
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
| | - Quentin Lohmeyer
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
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Ghaderi MS, Malekzadeh J, Mazloum S, Pourghaznein T. Comparison of real-time feedback and debriefing by video recording on basic life support skill in nursing students. BMC MEDICAL EDUCATION 2023; 23:62. [PMID: 36698121 PMCID: PMC9878936 DOI: 10.1186/s12909-022-03951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cardiopulmonary resuscitation skill have a direct impact on its success rate. Choosing the right method to acquire this skill can lead to effective performance. This investigation was conducted to compare the effect of Real-time feedback and debriefing by video recording on basic life support skill in nursing students. METHODS This quasi-experimental study was performed on 67 first year nursing students. First, a theoretical basic life support (BLS) training session was held for the all participants, at the end of session the pre-test was taken. Students were randomly assigned to two groups. A 4-hour practical BLS training session was conducted in the real - time feedback group as well as the debriefing by video recording group, and at the end of the training, a post-test was taken from each group. Each group received a post-test. Data were analyzed using SPSS 25 software. RESULTS Results showed a significant difference between mean (SD) of debriefing by video recording group in pre-test and post-test (p < 0.001) and in the real-time feedback group there was a significant difference between mean (SD) in pre-test and post-test (p < 0.001), respectively. In addition, there was no significant difference between the mean score of basic life support skill in real-time feedback and debriefing by video recording. CONCLUSIONS Both real-time feedback and debriefing by video recording were effective on basic life support skill.
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Affiliation(s)
- Mohammad Sajjad Ghaderi
- Department of Nursing, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Razavi Khorasan Province, Iran
- Clinical Research Development Unit, Sajjadieh Hospital, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Razavi Khorasan Province, Iran
| | - Javad Malekzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedreza Mazloum
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tayebe Pourghaznein
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Jeffers JM, Schreurs BA, Dean JL, Scott B, Canares T, Tackett S, Smith B, Billings E, Billioux V, Sampathkumar HD, Kleinman K. Paediatric chest compression performance improves via novel augmented-reality cardiopulmonary resuscitation feedback system: A mixed-methods pilot study in a simulation-based setting. Resusc Plus 2022; 11:100273. [PMID: 35844631 PMCID: PMC9283661 DOI: 10.1016/j.resplu.2022.100273] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 12/21/2022] Open
Abstract
Aim More than 20,000 children experience a cardiac arrest event each year in the United States. Most children do not survive. High-quality cardiopulmonary resuscitation (CPR) has been associated with improved outcomes yet adherence to guidelines is poor. We developed and tested an augmented reality head mounted display chest compression (CC) feedback system (AR-CPR) designed to provide real-time CC feedback and guidance. Methods We conducted an unblinded randomized crossover simulation-based study to determine whether AR-CPR changes a user's CC performance. A convenience sample of healthcare providers who perform CC on children were included. Subjects performed three two-minute cycles of CC during a simulated 18-minute paediatric cardiac arrest. Subjects were randomized to utilize AR-CPR in the second or third CC cycle. After, subjects participated in a qualitative portion to inquire about their experience with AR-CPR and offer criticisms and suggestions for future development. Results There were 34 subjects recruited. Sixteen subjects were randomly assigned to have AR-CPR in cycle two (Group A) and 18 subjects were randomized to have AR-CPR in cycle three (Group B). There were no differences between groups CC performance in cycle one (baseline). In cycle two, subjects in Group A had 73% (SD 18%) perfect CC epochs compared to 17% (SD 26%) in Group B (p < 0.001). Overall, subjects enjoyed using AR-CPR and felt it improved their CC performance. Conclusion This novel AR-CPR feedback system showed significant CC performance change closer to CC guidelines. Numerous hardware, software, and user interface improvements were made during this pilot study.
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Affiliation(s)
- Justin M. Jeffers
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States,Corresponding author at: Bloomberg Children’s Center, 1800 Orleans St, Suite G-1509, United States.
| | - Blake A. Schreurs
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, 11100 Johns Hopkins Rd, Laurel, MD 20723, United States
| | - James L. Dean
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, 11100 Johns Hopkins Rd, Laurel, MD 20723, United States
| | - Brandon Scott
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, 11100 Johns Hopkins Rd, Laurel, MD 20723, United States
| | - Therese Canares
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, United States
| | - Brittany Smith
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
| | - Emma Billings
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
| | - Veena Billioux
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
| | - Harshini D. Sampathkumar
- Department of International Health, Johns Hopkins University School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Keith Kleinman
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
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Janssens S, Clipperton S, Simon R, Lowe B, Beckmann M, Marshall S. Clinicians' attitudes towards a co-leadership structure for maternity emergency teams: An interview study. J Interprof Care 2022:1-9. [PMID: 35687023 DOI: 10.1080/13561820.2022.2070607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/08/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
Shared leadership improves team performance in many domains and is present in some interprofessional healthcare teams. Despite the dominant paradigm of a singular obstetrician leader in maternity emergencies, co-leadership, a specific form of shared leadership, has been identified as a potentially beneficial to clinical care. This qualitative interview study addresses the gaps in knowledge regarding clinician attitudes toward co-leadership and how a co-leadership structure might be implemented within a maternity care setting. Twenty-five clinicians (midwives, obstetricians and anaesthetists) working in the birthing units of two tertiary maternity units were interviewed and a conventional content analysis conducted. Clinicians viewed co-leadership as potentially beneficial to patient care through improved leadership performance and co-leader back up behavior. Implementation of co-leadership was thought to require a supportive organizational culture, agreed patient management protocols and the participation in simulation training. Enacting co-leadership required adaptable leadership sharing practices, effective communication, and high levels of trust between the co-leaders. These findings inform the future implementation strategies for co-leadership in interprofessional healthcare teams.
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Affiliation(s)
- Sarah Janssens
- Mothers Babies and Womens' Health Services, Mater Misericordiae Brisbane Ltd, Brisbane, Australia
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | | | - Robert Simon
- Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Belinda Lowe
- Department of Obstetrics and Gynaecology, Gold Coast University Hospital, Southport, Australia
- Faculty of Health Sciences and Medicine, Bond University, Southport, Australia
| | - Michael Beckmann
- Mothers Babies and Womens' Health Services, Mater Misericordiae Brisbane Ltd, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Mater Research, University of Queensland, Brisbane, Australia
| | - Stuart Marshall
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Australia
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Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study. Pediatr Res 2022; 91:1762-1768. [PMID: 34290385 PMCID: PMC9270220 DOI: 10.1038/s41390-021-01653-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate the effect of feedback devices on visual attention and the quality of pediatric resuscitation. METHODS This was a randomized cross-over simulation study at the Medical University of Vienna. Participants were students and neonatal providers performing four resuscitation scenarios with the support of feedback devices randomized. The primary outcome was the quality of resuscitation. Secondary outcomes were total dwell time (=total duration of visit time) on areas of interest and the workload of participants. RESULTS Forty participants were analyzed. Overall, chest compression (P < 0.001) and ventilation quality were significantly better (P = 0.002) when using a feedback device. Dwell time on the feedback device was 40.1% in the ventilation feedback condition and 48.7% in the chest compression feedback condition. In both conditions, participants significantly reduced attention from the infant's chest and mask (72.9 vs. 32.6% and 21.9 vs. 12.7%). Participants' subjective workload increased by 3.5% (P = 0.018) and 8% (P < 0.001) when provided with feedback during a 3-min chest compression and ventilation scenario, respectively. CONCLUSIONS The quality of pediatric resuscitation significantly improved when using real-time feedback. However, attention shifted from the manikin and other equipment to the feedback device and subjective workload increased, respectively. IMPACT Cardiopulmonary resuscitation with feedback devices results in a higher quality of resuscitation and has the potential to lead to a better outcome for patients. Feedback devices consume attention from resuscitation providers. Feedback devices were associated with a shift of visual attention to the feedback devices and an increased workload of participants. Increased workload for providers and benefits for resuscitation quality need to be balanced for the best effect.
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Kim GW, Moon HJ, Lim H, Kim YJ, Lee CA, Park YJ, Lee KM, Woo JH, Cho JS, Jeong WJ, Choi HJ, Kim CS, Choi HJ, Choi IK, Heo NH, Park JS, Lee YH, Park SM, Jeong DK. Effects of Smart Advanced Life Support protocol implementation including CPR coaching during out-of-hospital cardiac arrest. Am J Emerg Med 2022; 56:211-217. [DOI: 10.1016/j.ajem.2022.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 01/23/2023] Open
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Chun MJ, Zhang Y, Toraih EA, McGrew PR. Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation. Am Surg 2021:31348211047507. [PMID: 34645331 DOI: 10.1177/00031348211047507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Mechanical chest compression has been shown to be equivalent to manual chest compression in providing survival benefits to patients experiencing cardiac arrest. There has been a growing need for a contemporary review of iatrogenic injuries caused by mechanical in comparison with manual chest compression. Our study aims to analyze the studies that document significant life-threatening iatrogenic injuries caused by mechanical and manual chest compression. METHODS A systematic review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. All studies published after January 1st, 2000 were reviewed using inclusion/exclusion criteria and completed by May 2020. A total of 7202 patients enrolled in 15 studies were included in our meta-analysis. RESULTS Significant life-threatening iatrogenic injuries had higher odds of occurring when mechanical chest compression was used compared to manual chest compression, especially for hemothorax and liver lacerations. Mechanical chest compression involves consistently deeper compression depths compared to manual chest compression, potentially resulting in more injuries. In the mechanical chest compression cohort, chest wall fractures had the highest incidence rate (55.7%), followed by sternal fracture (28.3%), lung injuries (3.7%), liver (1.0%), and diaphragm (.2%) lacerations. CONCLUSIONS Mechanical chest compression was associated with more iatrogenic injuries as compared to manual chest compression. Further research is needed to define the appropriate application of mechanical in comparison with manual chest compression in different scenarios. Levels of provider training, different mechanical chest compression device types, patient demographics, and compression duration/depth may all play roles in influencing outcomes.
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Affiliation(s)
- Magnus J Chun
- Department of Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA
| | - Yichi Zhang
- Department of Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA
| | - Eman A Toraih
- Department of Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA
| | - Patrick R McGrew
- Department of Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA
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Roitsch CM, Hagan JL, Patricia KE, Jain S, Chen X, Arnold JL, Devaraj S, Sundgren NC. Effects of Team Size and a Decision Support Tool on Healthcare Providers' Workloads in Simulated Neonatal Resuscitation: A Randomized Trial. Simul Healthc 2021; 16:254-260. [PMID: 34398113 DOI: 10.1097/sih.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Optimal resuscitation team size for workload distribution among team members is not known. In addition, decision support tools (DSTs) are available to improve team performance, but the effect on workload is not known. Because increased workload can impair performance, we aimed to determine whether team size or use of a DST alters workload in healthcare providers (HCPs) while performing neonatal resuscitation. METHODS We report a substudy of a randomized, 2 × 2 factorial design study using 109 Neonatal Resuscitation Program-trained HCPs. Healthcare providers were randomized to 1 of 4 permutations, including team size of 2 versus 3 and using DST versus memory alone while performing 2 simulated neonatal resuscitations. The HCPs' workload was assessed by the National Aeronautics and Space Administration Task Load Index obtained after each scenario. Mixed effects linear models compared the effect of team size and DST use on National Aeronautics and Space Administration Task Load Index scores. RESULTS When all team members were combined, there was an increased workload in teams of 2 HCPs compared with teams of 3 and was primarily due to an increase in workload on the team leaders. Decision support tool use increased workload for the other team members in the first of the 2 scenarios but did not increase workload in the second scenario. CONCLUSIONS Teams of 2 HCPs reported a higher workload compared with teams of 3 HCPs. Decision support tool use can increase workload for other team members when first introduced as a new task. This study highlights the need to consider factors that negatively affect mental workload when determining the composition of a resuscitation team.
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Affiliation(s)
- Charles M Roitsch
- From the Section of Neonatology, Department of Pediatrics (C.M.R., J.L.H., K.E.P., N.C.S.), Section of Pediatric Diabetes and Endocrinology (S.J.), Department of Pediatrics, and Department of Pathology and Immunology (X.C., S.D.), Baylor College of Medicine, Texas Children's Hospital, Houston, TX; and Center for Medical Simulation and Innovative Education (J.L.A.), Johns Hopkins All Children's Hospital, St. Petersburg, FL
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12
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Lemke DS, Young AL, Won SK, Rus MC, Villareal NN, Camp EA, Doughty C. Rapid-cycle deliberate practice improves time to defibrillation and reduces workload: A randomized controlled trial of simulation-based education. AEM EDUCATION AND TRAINING 2021; 5:e10702. [PMID: 34901686 PMCID: PMC8637872 DOI: 10.1002/aet2.10702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/10/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The optimal structure of simulation to train teams to perform pediatric advanced life support (PALS) requires further research. Most simulation is structured with an uninterrupted scenario with postsimulation debriefing (PSD). Rapid-cycle deliberate practice (RCDP) is structured with a series of simulations with microdebriefing quickly switching within action targeting specific performance goals. OBJECTIVE The objective was to compare team performance immediately after training, as well as learner workload, for teams trained using either PSD or RCDP. METHODS In 2018-2019, a total of 41 interprofessional teams of 210 residents and nurses were recruited from 250 eligible participants (84%) and randomized into either arm (RCDP or PSD) teaching the same objectives of resuscitation of a patient in PEA arrest, in the same time frame. The structure of the simulation varied. Demographic surveys were collected before training, the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) was administered immediately after training to assess workload during training and performance was assessed immediately after training using a pulseless ventricular tachycardia arrest with the primary outcome being time to defibrillation. RESULTS Thirty-nine teams participated over a 16-month time span. Performance of teams randomized to RCDP showed significantly better time to defibrillation, 100 s (95% confidence interval [CI] = 90-111), compared to PSD groups, 163 s (95% CI = 120-201). The workload of the groups also showed a lower total NASA-TLX score for the RCDP groups. CONCLUSIONS For team-based time-sensitive training of PALS, RCDP outperformed PSD. This may be due to a reduction in the workload faced by teams during training.
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Affiliation(s)
- Daniel S. Lemke
- Division of Emergency MedicineDepartment of PediatricsBaylor College of MedicineTexas Children’s HospitalHoustonTexasUSA
| | - Ann L Young
- Division of Emergency MedicineBoston Children’s HospitalBostonMassachusettsUSA
| | - Sharon K. Won
- Division of Emergency MedicineDepartment of PediatricsBaylor College of MedicineTexas Children’s HospitalHoustonTexasUSA
| | - Marideth C. Rus
- Division of Emergency MedicineDepartment of PediatricsBaylor College of MedicineTexas Children’s HospitalHoustonTexasUSA
| | | | | | - Cara Doughty
- Division of Emergency MedicineDepartment of PediatricsBaylor College of MedicineTexas Children’s HospitalHoustonTexasUSA
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Pallas JD, Smiles JP, Zhang M. Cardiac Arrest Nurse Leadership (CANLEAD) trial: a simulation-based randomised controlled trial implementation of a new cardiac arrest role to facilitate cognitive offload for medical team leaders. Emerg Med J 2021; 38:572-578. [PMID: 33500268 DOI: 10.1136/emermed-2019-209298] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/20/2020] [Accepted: 12/24/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Medical team leaders in cardiac arrest teams are routinely subjected to disproportionately high levels of cognitive burden. This simulation-based study explored whether the introduction of a dedicated 'nursing team leader' is an effective way of cognitively offloading medical team leaders of cardiac arrest teams. It was hypothesised that reduced cognitive load may allow medical team leaders to focus on high-level tasks resulting in improved team performance. METHODS This randomised controlled trial used a series of in situ simulations performed in two Australian emergency departments in 2018-2019. Teams balanced on experience were randomised to either control (traditional roles) or intervention (designated nursing team leader) groups. No crossover between groups occurred with each participant taking part in a single simulation. Debriefing data were collected for thematic analysis and quantitative evaluation of self-reported cognitive load and task efficiency was evaluated using the NASA Task Load Index (NTLX) and a 'task time checklist' which was developed for this trial. RESULTS Twenty adult cardiac arrest simulations (120 participants) were evaluated. Intervention group medical team leaders had significantly lower NTLX scores (238.4, 95% CI 192.0 to 284.7) than those in control groups (306.3, 95% CI 254.9 to 357.6; p=0.02). Intervention group medical team leaders working alongside a designated nursing leader role had significantly lower cognitive loads than their control group counterparts (206.4 vs 270.5, p=0.02). Teams with a designated nurse leader role had improved time to defibrillator application (23.5 s vs 59 s, p=0.004), faster correction of ineffective compressions (7.5 s vs 14 s, p=0.04), improved compression fraction (91.3 vs 89.9, p=0.048), and shorter time to address reversible causes (107.1 s vs 209.5 s, p=0.002). CONCLUSION Dedicated nursing team leadership in simulation based cardiac arrest teams resulted in cognitive offload for medical leaders and improved team performance.
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Affiliation(s)
- Jeremy David Pallas
- Emergency Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - John Paul Smiles
- Emergency Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Michael Zhang
- Emergency Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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Young AL, Doughty CB, Williamson KC, Won SK, Rus MC, Villarreal NN, Camp EA, Lemke DS. Workload of learners during simulated paediatric cardiopulmonary resuscitation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:338-344. [PMID: 35515742 PMCID: PMC8936742 DOI: 10.1136/bmjstel-2020-000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/03/2022]
Abstract
IntroductionLearner workload during simulated team-based resuscitations is not well understood. In this descriptive study, we measured the workload of learners in different team roles during simulated paediatric cardiopulmonary resuscitation.MethodsPaediatric emergency nurses and paediatric and emergency medicine residents formed teams of four to eight and randomised into roles to participate in simulation-based, paediatric resuscitation. Participant workload was measured using the NASA Task Load Index, which provides an average workload score (from 0 to 100) across six subscores: mental demand, physical demand, temporal demand, performance, frustration and mental effort. Workload is considered low if less than 40, moderate if between 40 and 60 and high if greater than 60.ResultsThere were 210 participants representing 40 simulation teams. 138 residents (66%) and 72 nurses (34%) participated. Team lead reported the highest workload at 65.2±10.0 (p=0.001), while the airway reported the lowest at 53.9±10.8 (p=0.001); team lead had higher scores for all subscores except physical demand. Team lead reported the highest mental demand (p<0.001), while airway reported the lowest. Cardiopulmonary resuscitation coach and first responder reported the highest physical demands (p<0.001), while team lead and nurse recorder reported the lowest (p<0.001).ConclusionsWorkload for learners in paediatric simulated resuscitation teams was moderate to high and varied significantly based on team role. Composition of workload varied significantly by team role. Measuring learner workload during simulated resuscitations allows improved processes and choreography to optimise workload distribution.
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Affiliation(s)
- Ann L Young
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cara B Doughty
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Kaitlin C Williamson
- Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon K Won
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Marideth C Rus
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Nadia N Villarreal
- Pediatric Emergency Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth A Camp
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Daniel S Lemke
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
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Corazza F, Snijders D, Arpone M, Stritoni V, Martinolli F, Daverio M, Losi MG, Soldi L, Tesauri F, Da Dalt L, Bressan S. Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study. JMIR Mhealth Uhealth 2020; 8:e19070. [PMID: 32788142 PMCID: PMC7563631 DOI: 10.2196/19070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 01/22/2023] Open
Abstract
Background Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its usability and effectiveness in guiding the management of PCA. Objective To develop a new audiovisual interactive app for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. Methods A research team at the University of Padova (Italy) and human–machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design–prototyping–evaluation iterative loops). In October–November 2019, a single-center nonrandomized controlled simulation–based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable PCA scenario was managed by 11 teams with and 5 without the app. The app user’s experience and interaction patterns were documented through video recording of scenarios, debriefing sessions, and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from –3 to +3 for each scale) and open-ended questions, whereas participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX). Results Users’ difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (SD 1.43), perspicuity 1.75 (SD 0.88), efficiency 1.93 (SD 0.93), dependability 1.57 (SD 1.10), stimulation 1.60 (SD 1.33), and novelty 2.21 (SD 0.74). Team leaders’ perceived workload was comparable (P=.57) between the 2 groups; median NASA RTLX score was 67.5 (interquartile range [IQR] 65.0-81.7) for the control group and 66.7 (IQR 54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015). Conclusions The PediAppRREST app received a good usability evaluation and did not appear to increase team leaders’ workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Deborah Snijders
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marta Arpone
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Valentina Stritoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Francesco Martinolli
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | | | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
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Pulse rate as an alternative, real-time feedback indicator for chest compression rate: a porcine model of cardiac arrest. J Clin Monit Comput 2020; 35:1159-1167. [PMID: 32780354 PMCID: PMC7418281 DOI: 10.1007/s10877-020-00576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022]
Abstract
Feedback indicators can improve chest compression quality during cardiopulmonary resuscitation (CPR). However, the application of feedback indicators in the clinic practice is rare. Pulse oximetry has been widely used and reported to correlate spontaneous circulation restoration during CPR. However, it is unclear if pulse oximetry can monitor the quality of chest compression. We hypothesized that pulse rate monitored by pulse oximetry can be used as a feedback indicator of the chest compression rate during CPR in a porcine model of cardiac arrest. Seven domestic male pigs (30–35 kg) were utilized in this study. Eighteen intermittent chest compression periods of 2 min were performed on each animal. Chest compression and pulse oximetry plethysmographic waveforms were recorded simultaneously. Chest compression and pulse rates were calculated based on both waveforms. Compression interruption and synchronous pulse interruption times were also measured. Agreement was analyzed between pulse rates and synchronous chest compression rates, as well as between compression interruption times and synchronous pulse interruption times. A total of 126 compression periods of 2 min were performed on seven animals. Interclass correlation coefficients and Bland–Altman analysis revealed reliable agreement between pulse rates and synchronous chest compression rates. Similarly, compression interruption and synchronous pulse interruption times obtained also showed high agreement. Pulse rate can be used as an alternative indicator of chest compression rate during CPR in a porcine model of cardiac arrest. Pulse interruption time also can be used to reflect compression interruption time precisely in this model.
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Effect of a Cardiopulmonary Resuscitation Coach on Workload During Pediatric Cardiopulmonary Arrest: A Multicenter, Simulation-Based Study. Pediatr Crit Care Med 2020; 21:e274-e281. [PMID: 32106185 DOI: 10.1097/pcc.0000000000002275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Optimal cardiopulmonary resuscitation can improve pediatric outcomes but rarely is cardiopulmonary resuscitation performed perfectly despite numerous iterations of Basic and Pediatric Advanced Life Support. Cardiac arrests resuscitation events are complex, often chaotic environments with significant mental and physical workload for team members, especially team leaders. Our primary objective was to determine the impact of a cardiopulmonary resuscitation coach on cardiopulmonary resuscitation provider workload during simulated pediatric cardiac arrest. DESIGN Multicenter observational study. SETTING Four pediatric simulation centers. SUBJECTS Team leaders, cardiopulmonary resuscitation coach, and team members during an 18-minute pediatric resuscitation scenario. INTERVENTIONS National Aeronautics and Space Administration-Task Load Index. MEASUREMENTS AND MAIN RESULTS Forty-one teams (205 participants) were recruited with one team (five participants) excluded from analysis due to protocol violation. Demographic data revealed no significant differences between the groups in regard to age, experience, distribution of training (nurse, physician, and respiratory therapist). For most workload subscales, there were no significant differences between groups. However, cardiopulmonary resuscitation providers had a higher physical workload (89.3 vs 77.9; mean difference, -11.4; 95% CI, -17.6 to -5.1; p = 0.001) and a lower mental demand (40.6 vs 55.0; mean difference, 14.5; 95% CI, 4.0-24.9; p = 0.007) with a coach (intervention) than without (control). Both the team leader and coach had similarly high mental demand in the intervention group (75.0 vs 73.9; mean difference, 0.10; 95% CI, -0.88 to 1.09; p = 0.827). When comparing the cardiopulmonary resuscitation quality of providers with high workload (average score > 60) and low to medium workload (average score < 60), we found no significant difference between the two groups in percentage of guideline compliant cardiopulmonary resuscitation (42.5% vs 52.7%; mean difference, -10.2; 95% CI, -23.1 to 2.7; p = 0.118). CONCLUSIONS The addition of a cardiopulmonary resuscitation coach increases physical workload and decreases mental workload of cardiopulmonary resuscitation providers. There was no change in team leader workload.
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Rad RF, Sadrabad AZ, Rezaeian S. Randomized Controlled Trial of Simulation vs Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation: The Methodological Issue. West J Emerg Med 2019; 20:974-975. [PMID: 31738728 PMCID: PMC6860394 DOI: 10.5811/westjem.2019.8.43700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/06/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Reza Farahmand Rad
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Akram Zolfaghari Sadrabad
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Smereka J, Szarpak L, Czekajlo M, Abelson A, Zwolinski P, Plusa T, Dunder D, Dabrowski M, Wiesniewska Z, Robak O, Frass M, Sivrikaya G. U, Ruetzler K. The TrueCPR device in the process of teaching cardiopulmonary resuscitation: A randomized simulation trial. Medicine (Baltimore) 2019; 98:e15995. [PMID: 31277091 PMCID: PMC6635263 DOI: 10.1097/md.0000000000015995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND International resuscitation guidelines emphasize the importance of high quality chest compressions, including correct chest compression depth and rate and complete chest recoil. The aim of the study was to assess the role of the TrueCPR device in the process of teaching cardiopulmonary resuscitation in nursing students. METHODS A prospective randomized experimental study was performed among 94 first year students of nursing. On the next day, the participants were divided into 2 groups-the control group practiced chest compressions without the use of any device for half an hour, and the experimental group practiced with the use of TrueCPR. Further measurement of chest compressions was performed after a month. RESULTS The chest compression rate achieved the value of 113 versus 126 (P < .001), adequate chest compression rate (%) was 86 versus 68 (P < .001), full chest release (%) 92 versus 69 (P = .001), and correct hand placement (%) 99 versus 99 (P, not significant) in TrueCPR and standard BLS groups, respectively. As for the assessment of the confidence of chest compression quality, 1 month after the training, the evaluation in the experimental group was statistically significantly higher (91 vs 71; P < .001) than in the control group. CONCLUSIONS Cardiopulmonary resuscitation training with the use of the TrueCPR device is associated with better resuscitation skills 1 month after the training. The participants using TrueCPR during the training achieved a better chest compression rate and depth with in international recommendations and better full chest release percentage and self-assessed confidence of chest compression quality comparing with standard cardiopulmonary resuscitation training.
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Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw
| | - Lukasz Szarpak
- Lazarski University, Warsaw
- Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, Virginia
| | - Michael Czekajlo
- Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, Virginia
| | - Anna Abelson
- Department of Health Science, Karlstad University, Karlstad, Sweden
| | | | | | | | - Marek Dabrowski
- Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Frass
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulufer Sivrikaya G.
- Academy of Interventional Medicine, Education and Simulation (RMK AIMES), Istanbul, Turkey
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
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Abstract
PURPOSE OF REVIEW The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change. RECENT FINDINGS Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in resuscitation. SUMMARY Striving toward a learning healthcare system model in resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the resuscitation environment, all providers who could possibly face a resuscitation event - no matter how rare - should consider how they are evaluating the quality of their care delivery in this arena.
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Cheng A, Duff JP, Kessler D, Tofil NM, Davidson J, Lin Y, Chatfield J, Brown LL, Hunt EA. Optimizing CPR performance with CPR coaching for pediatric cardiac arrest: A randomized simulation-based clinical trial. Resuscitation 2018; 132:33-40. [PMID: 30149088 DOI: 10.1016/j.resuscitation.2018.08.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/09/2018] [Accepted: 08/22/2018] [Indexed: 11/15/2022]
Abstract
AIM To determine if integrating a trained CPR Coach into resuscitation teams can improve CPR quality during simulated pediatric cardiopulmonary arrest (CPA). METHODS We conducted a multicenter, prospective, randomized trial. An 18-minute simulated CPA scenario was run for resuscitation teams comprised of CPR-certified professionals from four International Network for Simulation-based Pediatric Innovation, Research & Education (INSPIRE) institutions. Forty teams (200 participants) were randomized to having a trained CPR Coach vs. no CPR Coach. CPR Coaches were responsible for providing real-time verbal feedback of CPR performance to compressors. All teams utilized CPR feedback technology. We report the proportion of overall excellent CPR, proportion of chest compressions (CC) with depth 50-60 mm, the proportion of CC with rate 100-120 per minute, CC fraction, and pre-, post-, and peri-shock pause duration. RESULTS CPR coached teams compared with teams without a CPR Coach resulted in an absolute improvements in overall excellent CPR by 31.8% (95% CI, 17.7, 35.9; p < 0.001), mean CC depth compliance by 31.5% (15.7, 47.4; p < 0.001), mean CC depth by 4.6 mm (1.6, 7.5; p < 0.001), mean CC fraction by 5.4% (0.2, 10.6; p = 0.04), and mean pre-, post- and peri-shock pause duration by -2.7 s (-5.1, -0.4; p = 0.02), -1.0 s (-1.8, -0.2; p = 0.01); and -3.8 (-6.6, -1.0; p = 0.008), respectively. Changes in mean CC rate compliance and mean CC rate were not statistically significant. CONCLUSIONS In the presence of CPR feedback technology, the integration of a trained CPR coach into resuscitation teams enhances CPRquality metrics associated with improved survival outcomes from pediatric cardiac arrest.
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Affiliation(s)
- Adam Cheng
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, KidSIM-ASPIRE Research Program, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada.
| | - Jonathan P Duff
- Stollery Children's Hospital, University of Alberta, Canada.
| | - David Kessler
- Columbia University College of Physicians and Surgeons, United States.
| | - Nancy M Tofil
- Children's of Alabama, University of Alabama at Birmingham, United States.
| | - Jennifer Davidson
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Canada.
| | - Yiqun Lin
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Canada.
| | - Jenny Chatfield
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Canada.
| | - Linda L Brown
- Hasbro Children's Hospital, Alpert Medical School of Brown University, United States.
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