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Awadhare P, Barot K, Frydson I, Balakumar N, Doerr D, Bhalala U. Impact of Quality Improvement Bundle on Compliance with Resuscitation Guidelines during In-Hospital Cardiac Arrest in Children. Crit Care Res Pract 2023; 2023:6875754. [PMID: 36937742 PMCID: PMC10019965 DOI: 10.1155/2023/6875754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction Various quality improvement (QI) interventions have been individually assessed for the quality of cardiopulmonary resuscitation (CPR). We aimed to assess the QI bundle (hands-on training and debriefing) for the quality of CPR in our children's hospital. We hypothesized that the QI bundle improves the quality of CPR in hospitalized children. Methods We initiated a QI bundle (hands-on training and debriefing) in August 2017. We conducted a before-after analysis comparing the CPR quality during July 2013-May 2017 (before) and January 2018-December 2020 (after). We collected data from the critical events logbook on CPR duration, chest compressions (CC) rate, ventilation rate (VR), the timing of first dose of epinephrine, blood pressure (BP), end-tidal CO2 (EtCO2), and vital signs monitoring during CPR. We performed univariate analysis and presented data as the median interquartile range (IQR) and in percentage as appropriate. Results We compared data from 58 CPR events versus 41 CPR events before and after QI bundle implementation, respectively. The median (IQR) CPR duration for the pre- and post-QI bundle was 5 (1-13) minutes and 3 minutes (1.25-10), and the timing of the first dose of epinephrine was 2 (1-2) minutes and 2 minutes (1-5), respectively. We observed an improvement in compliance with the CC rate (100-120 per minute) from 72% events before versus 100% events after QI bundle implementation (p=0.0009). Similarly, there was a decrease in CC interruptions and hyperventilation rates from 100% to 50% (p=0.016) and 100% vs. 63% (p=<0.0001) events before vs. after QI bundle implementation, respectively. We also observed improvement in BP monitoring from 36% before versus 60% after QI bundle (p=0.014). Conclusion Our QI bundle (hands-on training and debriefing) was associated with improved compliance with high-quality CPR in children.
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Affiliation(s)
| | - Karma Barot
- 2Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ingrid Frydson
- 3Children's Hospital of San Antonio, San Antonio, TX, USA
| | | | - Donna Doerr
- 3Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Utpal Bhalala
- 1Driscoll Children's Hospital, Corpus Christi, TX, USA
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Barcala-Furelos R, Barcala-Furelos M, Cano-Noguera F, Otero-Agra M, Alonso-Calvete A, Martínez-Isasi S, Aranda-García S, López-García S, Rodríguez-Núñez A. A Comparison between Three Different Techniques Considering Quality Skills, Fatigue and Hand Pain during a Prolonged Infant Resuscitation: A Cross-Over Study with Lifeguards. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060910. [PMID: 35740847 PMCID: PMC9221895 DOI: 10.3390/children9060910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/25/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
Abstract
The aim of the study was to compare the quality of CPR (Q-CPR), as well as the perceived fatigue and hand pain in a prolonged infant cardiopulmonary resuscitation (CPR) performed by lifeguards using three different techniques. A randomized crossover simulation study was used to compare three infant CPR techniques: the two-finger technique (TF); the two-thumb encircling technique (TTE) and the two-thumb-fist technique (TTF). 58 professional lifeguards performed three tests in pairs during a 20-min period of CPR. The rescuers performed compressions and ventilations in 15:2 cycles and changed their roles every 2 min. The variables of analysis were CPR quality components, rate of perceived exertion (RPE) and hand pain with numeric rating scale (NRS). All three techniques showed high Q-CPR results (TF: 86 ± 9%/TTE: 88 ± 9%/TTF: 86 ± 16%), and the TTE showed higher values than the TF (p = 0.03). In the RPE analysis, fatigue was not excessive with any of the three techniques (values 20 min between 3.2 for TF, 2.4 in TTE and 2.5 in TTF on a 10-point scale). TF reached a higher value in RPE than TTF in all the intervals analyzed (p < 0.05). In relation to NRS, TF showed significantly higher values than TTE and TTF (NRS minute 20 = TF 4.7 vs. TTE 2.5 & TTF 2.2; p < 0.001). In conclusion, all techniques have been shown to be effective in high-quality infant CPR in a prolonged resuscitation carried out by lifeguards. However, the two-finger technique is less efficient in relation to fatigue and hand pain compared with two-thumb technique (TF vs. TTF, p = 0.01).
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Affiliation(s)
- Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, 36005 Pontevedra, Spain; (R.B.-F.); (M.O.-A.); (A.A.-C.)
| | - Martín Barcala-Furelos
- Faculty of Health Sciences, Universidad Europea del Atlántico, 39011 Santander, Spain
- Faculty of Education, Pontifical University of Salamanca, 37002 Salamanca, Spain;
- Correspondence:
| | - Francisco Cano-Noguera
- INGESPORT Research Group, Department of Physical Activity and Sports, University of Murcia, 30720 San Javier, Spain;
| | - Martín Otero-Agra
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, 36005 Pontevedra, Spain; (R.B.-F.); (M.O.-A.); (A.A.-C.)
| | - Alejandra Alonso-Calvete
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, 36005 Pontevedra, Spain; (R.B.-F.); (M.O.-A.); (A.A.-C.)
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
| | - Santiago Martínez-Isasi
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15071 A Coruña, Spain;
| | - Silvia Aranda-García
- National Institute of Physical Education of Catalonia, Barcelona University, 08038 Barcelona, Spain;
| | - Sergio López-García
- Faculty of Education, Pontifical University of Salamanca, 37002 Salamanca, Spain;
| | - Antonio Rodríguez-Núñez
- Paediatric Intensive Care, Paediatric Intermediate Care and Palliative Care Units, Department of Paediatrics, Hospital Clínico Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
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Lee JE, Lee J, Oh J, Park CH, Kang H, Lim TH, Yoo KH. Comparison of two-thumb encircling and two-finger technique during infant cardiopulmonary resuscitation with single rescuer in simulation studies: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17853. [PMID: 31702646 PMCID: PMC6855637 DOI: 10.1097/md.0000000000017853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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 The recommended chest compression technique for a single rescuer performing infant cardiopulmonary resuscitation is the two-finger technique. For 2 rescuers, a two-thumb-encircling hands technique is recommended. Several recent studies have reported that the two-thumb-encircling hands technique is more effective for high-quality chest compression than the two-finger technique for a single rescuer performing infant cardiopulmonary resuscitation. We undertook a systematic review and meta-analysis of infant manikin studies to compare two-thumb-encircling hands technique with two-finger technique for a single rescuer. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for eligible randomized controlled trials published prior to December 2017, including cross-over design studies. The primary outcome was the mean difference in chest compression depth (mm). The secondary outcome was the mean difference in chest compression rate (counts/min). A meta-analysis was performed using Review Manager (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). RESULTS Six studies that had reported data concerning both chest compression depth and chest compression rate were included. The two-thumb-encircling hands technique was associated with deeper chest compressions compared with two-finger technique for mean chest compression depth (mean difference, 5.50 mm; 95% confidence interval, 0.32-10.69 mm; P = .04), but no significant difference in the mean chest compression rate (mean difference, 7.89 counts/min; 95% confidence interval, to 0.99, 16.77 counts/min; P = .08) was noted. CONCLUSION This study indicates that the two-thumb-encircling hands technique is a more appropriate technique for a single rescuer to perform high-quality chest compression in consideration of chest compression depth than the two-finger technique in infant manikin studies.
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Affiliation(s)
- Ji Eun Lee
- Department of Emergency Medicine, College of Medicine
| | - Juncheol Lee
- Department of Emergency Medicine, Armed Forces Capital Hospital, Seongnam
- Graduate School, College of Medicine, Hanyang University, Seoul
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine
| | - Kyung Hun Yoo
- Department of Emergency Medicine, College of Medicine
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The Pillow Project, Infant Choking, and Basic Life Support Training for Prospective Parents: A Low-Cost Intervention for Widespread Application. J Perinat Neonatal Nurs 2019; 33:260-267. [PMID: 31335856 DOI: 10.1097/jpn.0000000000000397] [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: 11/25/2022]
Abstract
Dissemination of pediatric basic life support skills, while recommended, is not done routinely for pregnant women and their partners within the maternity services. This study evaluates an e-learning program coupled with the use of a novel infant pillow mannequin to determine whether a low-cost intervention with potential for widespread application could enable training in the event of an infant choking and the provision of basic life support. A prospective cohort study with an uncontrolled pre- and posttest design was used following institutional ethical approval. A 4-week cycle of antenatal education classes in a regional Maternity Hospital in Ireland and a purposive sample of pregnant women and their partners attending the antenatal education classes were used. The following measures were assessed: (1) confidence in knowing what to do in the event of an infant choking; (2) confidence in performing infant cardiopulmonary resuscitation (CPR); (3) ability to perform the requisite skills; and (4) the perceived acceptability of the infant pillow mannequin as a means of practice. Twenty-four individuals completed a pre- and postprogram questionnaire. The e-learning program along with practice on the pillow mannequin significantly affected confidence (P < .001) in the actions to take in the event of an infant choking and in performing infant CPR. Forty-four participants used the pillow mannequin for practice and volunteered to have their skills assessed. More than 90% demonstrated correct positioning of the infant in the event of choking, correctly identified the correct ratio of chest compressions to breaths, and conducted chest compressions to the required depth. Three distinct categories of comment were identified: usefulness of the program; simplicity of the program/pillow mannequin; and accessibility for practice at home. A self-instructional e-learning program coupled with an infant pillow mannequin enables parents to learn the procedure in the event of an infant choking and to demonstrate basic life support. This low-cost intervention has the potential for widespread application within developed and developing countries.
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Day E, Hort JR. Out-of-hospital arrests attending an Australian tertiary paediatric emergency department over 13 years: An observational study. Emerg Med Australas 2018; 30:687-693. [DOI: 10.1111/1742-6723.13127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/31/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Elisabeth Day
- Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Jason R Hort
- Children's Hospital at Westmead; Sydney New South Wales Australia
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Quraishi MK, - Khateeb Hanif U, Parmar R. Improvement in Confidence Levels for the Management of Paediatric Cardiac Arrests in Medical Students Following a Training Course. Anesth Pain Med 2018; 8:e14867. [PMID: 30214880 PMCID: PMC6119218 DOI: 10.5812/aapm.14867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 03/04/2018] [Accepted: 04/23/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Newly qualified doctors lack competency in handling a cardiopulmonary resuscitation. The ability to recall CPR fundamentals have been shown to be inadequate. Of greater concern is that medical students over - estimate their ability to deliver such aid in a real - world setting. As most medical students are only taught adult BLS they are often unskilled and/or unhelpful in managing paediatric specific emergencies. This fact is supported by the poor outcomes demonstrated in delivering successful Paediatric Basic Life Support (PBLS). OBJECTIVES Our aim was to evaluate the baseline confidence levels of medical students in dealing with a paediatric cardiac arrest (PCA) and the improvement seen following a PBLS training course. METHODS A prospective study was conducted on 51 medical students who attended an established one - day PBLS and first aid course at one UK medical school. Participants were requested to complete a questionnaire directly prior to and after the course. RESULTS Following the delivery of the training, the cohort reported a statistically significant (P < 0.05) increase in mean confidence with PCA from 2.2/10 (2.2 out of 10) to 7.5/10. A pre - training mean confidence score of 2.6/10 was observed for Year 4 and 5 students who are close to graduating. CONCLUSIONS Our findings clearly demonstrate very poor confidence among medical students with PCA at all stages of their training. We would strongly advocate the inclusion of a PBLS component in medical school curriculums so that future doctors are adequately prepared to deliver PBLS with confidence.
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Affiliation(s)
| | | | - Rinesh Parmar
- Department of Anaesthesia, Russells Hall Hospital, Dudley, UK
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Dufourq N, Nicole Goldstein L, Botha M. Competence in performing emergency skills: How good do doctors really think they are? Afr J Emerg Med 2017; 7:151-156. [PMID: 30456130 PMCID: PMC6234142 DOI: 10.1016/j.afjem.2017.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/05/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction Despite the differences in exposure and experience in dealing with medical emergencies, all doctors should nevertheless be competent to assist a patient in need of resuscitation. The objective of this study was to describe the level of self-assessed emergency skill competence that specialist trainees in various disciplines possessed as well as to identify factors that may have contributed to their level of self-perceived competence. Methods A prospective, cross-sectional, questionnaire study of various specialist trainees’ self-perceived levels of competence in emergency skills was conducted across three academic hospitals in Johannesburg, South Africa. Trainees from General Surgery and Internal Medicine (Clinical) and Psychiatry and Radiology (Non-Clinical) rated their self-perceived level of competence in a list of basic, intermediate and advanced emergency skills according to a five-point Likert ranking scale. Results Ninety-four specialist trainees participated in the study – a response rate of 36%. The overall median competence rating for cardiac arrest resuscitation was 3.0 [IQR 3.0, 4.0] (i.e. intermediate). The median competence rating for cardiac arrest resuscitation in the clinical group (4.0) [IQR 3.0, 4.0] was higher than in the non-clinical group (3.0) [IQR 2.0, 3.0] (p < 0.001). Current or expired certification in Paediatric Advanced Life Support (PALS) or Advanced Paediatric Life Support (APLS) courses increased perceived competence and delays in starting specialisation resulted in a decrease in overall competence composite scores for each year of delay after internship. Discussion General Surgery and Internal Medicine trainees had a higher level of self-perceived competence in various emergency skills than their non- clinical counterparts. Current certification in advanced life support courses had a positive impact on trainees’ self- perceived levels of competence in emergency skills. Specialist trainees who had less delay before starting their specialist training also demonstrated higher levels of perceived competence.
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Research Poster Presentations. J Intensive Care Soc 2014. [DOI: 10.1177/17511437140151s107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lowry AW, Morales DLS, Graves DE, Knudson JD, Shamszad P, Mott AR, Cabrera AG, Rossano JW. Characterization of extracorporeal membrane oxygenation for pediatric cardiac arrest in the United States: analysis of the kids' inpatient database. Pediatr Cardiol 2013; 34:1422-30. [PMID: 23503928 DOI: 10.1007/s00246-013-0666-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 02/09/2013] [Indexed: 10/27/2022]
Abstract
To characterize the overall use, cost, and outcomes of extracorporeal membrane oxygenation (ECMO) as an adjunct to cardiopulmonary resuscitation (CPR) among hospitalized infants and children in the United States, retrospective analysis of the 2000, 2003, and 2006 Kids' Inpatient Database (KID) was performed. All CPR episodes were identified; E-CPR was defined as ECMO used on the same day as CPR. Channeling bias was decreased by developing propensity scores representing the likelihood of requiring E-CPR. Univariable, multivariable, and propensity-matched analyses were performed to characterize the influence of E-CPR on survival. There were 8.6 million pediatric hospitalizations and 9,000 CPR events identified in the database. ECMO was used in 82 (0.9 %) of the CPR events. Median hospital charges for E-CPR survivors were $310,824 [interquartile range (IQR) 263,344-477,239] compared with $147,817 (IQR 62,943-317,553) for propensity-matched conventional CPR (C-CPR) survivors. Median LOS for E-CPR survivors (31 days) was considerably greater than that of propensity-matched C-CPR survivors (18 days). Unadjusted E-CPR mortality was higher relative to C-CPR (65.9 vs. 50.9 %; OR 1.9, 95 % confidence interval 1.2-2.9). Neither multivariable analysis nor propensity-matched analysis identified a significant difference in survival between groups. E-CPR is infrequently used for pediatric in-hospital cardiac arrest. Median LOS and charges are considerably greater for E-CPR survivors with C-CPR survivors. In this retrospective administrative database analysis, E-CPR did not significantly influence survival. Further study is needed to improve outcomes and to identify patients most likely to benefit from this resource-intensive therapy.
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Affiliation(s)
- Adam W Lowry
- Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Rd, Suite 325, Palo Alto, CA 94306, USA.
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Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States. Crit Care Med 2012; 40:2940-4. [DOI: 10.1097/ccm.0b013e31825feb3f] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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