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Longitudinal effect of high frequency training on CPR performance during simulated and actual pediatric cardiac
Aaron Donoghue1,2,3, Debra Heard4, Russell Griffin5
1Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Insights
High-frequency CPR training improved pediatric emergency department provider skills in simulated and real events. More training sessions correlated with better adherence to compression rate guidelines during actual pediatric cardiac arrest resuscitation.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation Quality Improvement
Background:
- Pediatric cardiac arrest requires high-quality cardiopulmonary resuscitation (CPR).
- Continuous, high-frequency CPR training may enhance provider performance.
Purpose of the Study:
- To assess the impact of a high-frequency CPR training program on provider performance during simulated and actual pediatric resuscitation events.
Main Methods:
- Prospective observational study involving 159 pediatric emergency department providers.
- Implementation of the Resuscitation Quality Improvement (RQI) program with quarterly retraining.
- Analysis of CPR performance during quarterly sessions and 28 real patient events using video review and compression monitors.
Main Results:
- Significant improvement in all CPR task scores during retraining sessions over four quarters.
- A significant association between the number of RQI sessions and adherence to compression rate guidelines during real events (p=0.03).
- Limited exposure to actual patient events (fewer than 30% of providers).
Conclusions:
- High-frequency RQI training enhances CPR skills in simulated pediatric emergency settings.
- Increased RQI training is linked to improved compression rate adherence in real pediatric cardiac arrest events.
- Further multicenter studies are needed to validate findings on rare events.
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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