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Garcia-Jorda D, Nikitovic D, Gilfoyle E. Video Review of Simulated Pediatric Cardiac Arrest to Identify Errors/Latent Safety Threats: A Mixed Methods Study. Simul Healthc 2023; 18:232-239. [PMID: 35618263 DOI: 10.1097/sih.0000000000000670] [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 Outcomes from pediatric in-hospital cardiac arrest depend on the treatment provided as well as resuscitation team performance. Our study aimed to identify errors occurring in this clinical context and develop an analytical framework to classify them. This analytical framework provided a better understanding of team performance, leading to improved patient outcomes. METHODS We analyzed 25 video recordings of pediatric cardiac arrest simulations from the pediatric intensive care unit at the Alberta Children's Hospital. We conducted a qualitative-dominant crossover mixed method analysis to produce a broad understanding of the etiology of errors. Using qualitative framework analysis, we identified and qualitatively described errors and transformed the data coded into quantitative data to determine the frequency of errors. RESULTS We identified 546 errors/error-related actions and behaviors and 25 near misses. The errors were coded into 21 codes that were organized into 5 main themes. Clinical task-related errors accounted for most errors (41.9%), followed by planning, and executing task-related errors (22.3%), distraction-related errors (18.7%), communication-related errors (10.1%), and knowledge/training-related errors (7%). CONCLUSIONS This novel analytical framework can robustly identify, classify, and describe the root causes of errors within this complex clinical context. Future validation of this classification of errors and error-related actions and behaviors on larger samples of resuscitations from various contexts will allow for a better understanding of how errors can be mitigated to improve patient outcomes.
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Affiliation(s)
- Dailys Garcia-Jorda
- From the Departments of Family Medicine (D.G.-J.) and Pediatrics (D.N.), Cumming School of Medicine, University of Calgary, Calgary; and Department of Critical Care Medicine (E.G.), The Hospital for Sick Children, Toronto, Canada
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O'Connell KJ, Sandler A, Dutta A, Ahmed R, Neubrand T, Myers S, Kerrey B, Donoghue A. The effect of hand position on chest compression quality during CPR in young children: Findings from the Videography in Pediatric Resuscitation (VIPER) collaborative. Resuscitation 2023; 185:109741. [PMID: 36805098 DOI: 10.1016/j.resuscitation.2023.109741] [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: 11/30/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To determine the effect of hand position on chest compression (CC) quality during CPR in young children. METHODS Prospective observational exploratory study. Patients < 8 years receiving CC for > 2 minutes were enrolled. Data was collected from video review and CC monitor device and analyzed in 'CC segments' (periods of CC by individual providers). Four techniques were compared: two thumbs (2 T), hands encircling the chest; two fingers (2F) on the sternum; one hand on sternum (1H); two hands on sternum (2H). Univariate analysis of CC rate and depth between hand positions was performed through nonparametric testing, stratified by age category. RESULTS 47 patients received 824 minutes of CC. Among 270 CC segments in infants < 1 yo, 2 T was used in 27%; 2F 3%; 1H 18%; 2H 26%. Among 189 CC segments in children aged 1 to 8 yo, 1H was used in 26%; 2H 74%. Across all segments, median CC rate was 117 cpm (IQR 110-125). Median depth was 2.92 cm (IQR 2.44 - 4.04) in infants < 1 yo, 3.56 cm (IQR 2.92 - 4.14) in children 1 to 8 yo. 1H achieved greater depth than 2 T in infants (p < 0.01), and 2H achieved greater depth than 1H in children > 1 (p < 0.001). CONCLUSIONS In infants, 1H resulted in greater CC depth than 2 T. In children 1 to 8 yo, 2H resulted in greater depth than 1H.. These data suggest that different hand position during CPR in young children from what is currently recommended may result in better CPR quality.
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Affiliation(s)
- Karen J O'Connell
- Division of Emergency Medicine, Department of Pediatrics, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Alexis Sandler
- Division of Emergency Medicine, Department of Pediatrics, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Anuj Dutta
- Division of Emergency Medicine, Department of Pediatrics, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Ramzy Ahmed
- Division of Emergency Medicine, Department of Pediatrics, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Tara Neubrand
- Division of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Sage Myers
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Benjamin Kerrey
- Division of Emergency Medicine, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Aaron Donoghue
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
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Comparison of cardiopulmonary resuscitation quality performed by a single rescue with a bag-valve mask device: Over the head or lateral position? CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Falco L, Timmons Z, Swing T, Luciano W, Bulloch B. Measuring the Quality of Cardiopulmonary Resuscitation in the Emergency Department at a Quaternary Children's Hospital. Pediatr Emerg Care 2022; 38:521-525. [PMID: 36173429 DOI: 10.1097/pec.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM OF STUDY The aim of this study was to evaluate the quality of cardiopulmonary resuscitation (CPR) as it relates to American Heart Association (AHA) guidelines during cardiac arrests in a pediatric emergency department at a quaternary children's hospital. BACKGROUND AND OBJECTIVES High-quality CPR increases the likelihood of survival from pediatric out-of-hospital cardiac arrest. However, optimal performance of high-quality CPR during transition of care between prehospital and pediatric emergency department providers is challenging, and survival without comorbidities remains extremely low for out-of-hospital cardiac arrest. METHODS This was a retrospective study of data collected from a free-standing children's hospital emergency department and level 1 trauma center. RESULTS There were 23 pediatric CPR events for subjects younger than 18 years in the emergency department during the time of the study. Median chest compression (CC) fraction was 85% overall with the AHA goal of 80%. Compliance with this recommendation was achieved in all age groups. The CC rate averaged 112 for the entire sample. Median depth was 2.06 cm in subjects younger than 1 year, 3.95 cm in subjects 1 year old to younger than 8 years, and 5.33 cm in subjects 8 years old to younger than 18 years. These compression depth rates fell below the AHA recommendations, with the exception of those 8 years and older. CONCLUSIONS In our study, CC fraction and CC rate were found to meet AHA targets for all age groups, whereas CC depth only met AHA targets for the 8- to 18-year-old group. The most difficult parameter was CC depth for the group of subjects younger than 1 year.
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Affiliation(s)
- Lucas Falco
- From the Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ
| | - Zebulon Timmons
- Department of Pediatric Emergency Medicine, Department of Pediatrics, Division of Emergency Medicine, Children's Hospital and Medical Center, Omaha, NE
| | - Ted Swing
- From the Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ
| | - William Luciano
- From the Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ
| | - Blake Bulloch
- From the Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ
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Jeon W, Kim J, Ko Y, Lee J. New chest compression method in infant resuscitation: Cross thumb technique. PLoS One 2022; 17:e0271636. [PMID: 35939436 PMCID: PMC9359570 DOI: 10.1371/journal.pone.0271636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background The two-thumb encircling technique (2TT) is superior to the two-finger technique (2FT) in infant cardiopulmonary resuscitation (CPR), but there are difficulties in providing ventilation as soon as possible. We modified the 2TT to the cross-thumb technique (CTT) to maintain good CPR performance at the same position as 2FT. We aimed to compare the quality of chest compression and brief hands-off times in 2FT, 2TT, and CTT by a single rescuer using an infant CPR manikin model. Methods This study was designed as a prospective randomized controlled simulation-based study. We used the Resusci® Baby QCPR (Laerdal Medical, Stavanger, Norway) as a simulated 3-month-old infant. Ventilation was performed by the mouth-to-mouth technique using a chest compression-to-ventilation ratio of 30:2 as a single rescuer. Data on CPR quality, such as locations, rates, depth and release of chest compressions, hands-off times, and proper ventilation, were recorded using the Resusci® Baby QCPR and SkillReporter. Also, the chest compression fraction (CCF) was automatically calculated. Results The depth of chest compression in 2FT, 2TT, and CTT were 40.0 mm (interquartile range [IQR] 39.0, 41.0), 42.0 mm (IQR 41.0, 43.0), and 42.0 mm (IQR 41.0, 43.0), respectively. The depth of chest compression in 2FT was shallower than that in the other two techniques (P<0.05). CCF in 2FT, 2TT, and CTT were 73.9% (IQR 72.2, 75.6), 71.2% (IQR 67.2, 72.2) and 71.3% (IQR 67.7, 74.1), respectively. CCF was higher in 2FT than in the other two techniques (P<0.05). Correct location in 2FT, 2TT, and CTT were 99.0% (IQR 86.0, 100.0), 100.0% (IQR 97.0, 100.0) and 100.0% (IQR 99.0, 100.0), respectively. Correct location in CTT and 2TT was higher than that in 2FT. Performing CTT, the subjective pain and fatigue score were lower than other two technique. Conclusion A new chest compression technique, CTT was better in chest compression depth compared with 2FT and may be helpful in maintaining correct chest compression location with less pain and fatigue in infant CPR.
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Affiliation(s)
- Woochan Jeon
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Jungeon Kim
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yura Ko
- Department of Emergency Medicine, Ajou University, School of Medicine, Suwon, Republic of Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University, School of Medicine, Suwon, Republic of Korea
- * E-mail:
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
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Donoghue A, Heard D, Griffin R, Abbadessa MK, Gaines S, Je S, Hanna R, Erbayri J, Myers S, Niles D, Nadkarni V. Longitudinal effect of high frequency training on CPR performance during simulated and actual pediatric cardiac arrest. Resusc Plus 2021; 6:100117. [PMID: 34223376 PMCID: PMC8244246 DOI: 10.1016/j.resplu.2021.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/01/2022] Open
Abstract
Study aim To determine the impact of high-frequency CPR training on performance during simulated and real pediatric CPR events in a pediatric emergency department (ED). Methods Prospective observational study. A high-frequency CPR training program (Resuscitation Quality Improvement (RQI)) was implemented among ED providers in a children's hospital. Data on CPR performance was collected longitundinally during quarterly retraining sessions; scores were analyzed between quarter 1 and quarter 4 by nonparametric methods. Data on CPR performance during actual patient events was collected by simultaneous combination of video review and compression monitor devices to allow measurement of CPR quality by individual providers; linear mixed effects models were used to analyze the association between RQI components and CPR quality. Results 159 providers completed four consecutive RQI sessions. Scores for all CPR tasks during retraining sessions significantly improved during the study period. 28 actual CPR events were captured during the study period; 49 observations of RQI trained providers performing CPR on children were analyzed. A significant association was found between the number of prior RQI sessions and the percent of compressions meeting guidelines for rate (β coefficient -0.08; standard error 0.04; p = 0.03). Conclusions Over a 15 month period, RQI resulted in improved performance during training sessions for all skills. A significant association was found between number of sessions and adherence to compression rate guidelines during real patient events. Fewer than 30% of providers performed CPR on a patient during the study period. Multicenter studies over longer time periods should be undertaken to overcome the limitation of these rare events.
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Affiliation(s)
- Aaron Donoghue
- Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States
| | - Debra Heard
- American Heart Association, Dallas, TX, United States
| | | | - Mary Kate Abbadessa
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Shannon Gaines
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Sangmo Je
- Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States
| | - Richard Hanna
- Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States
| | - John Erbayri
- Center for Life Support Education & Outreach, Children's Hospital of Philadelphia, United States
| | - Sage Myers
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Dana Niles
- Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States
| | - Vinay Nadkarni
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Center for Simulation, Innovation, and Advanced Education, Children's Hospital of Philadelphia, PA, United States
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
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