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Association of CPR simulation program characteristics with simulated and actual performance during paediatric
Katherine Cashen1, Robert M Sutton2, Ron W Reeder3
1Department of Pediatrics, Duke Children's Hospital, Duke University, 2301 Erwin Road, Durham, NC 27710, USA.
Insights
Point-of-care cardiopulmonary resuscitation (CPR) training characteristics correlate with simulated and actual intensive care unit (ICU) CPR performance. Recent training, nurse involvement, and daytime sessions may enhance pediatric CPR outcomes.
Area of Science:
- Pediatric critical care medicine
- Medical simulation and training
- Cardiopulmonary resuscitation quality improvement
Background:
- In-hospital cardiac arrest in children presents unique challenges for resuscitation.
- Effective cardiopulmonary resuscitation (CPR) is crucial for survival and favorable neurologic outcomes.
- Point-of-care simulation offers a novel approach to enhance CPR skills in intensive care units (ICUs).
Purpose of the Study:
- To assess the relationship between point-of-care CPR simulation characteristics and both simulated and actual ICU CPR performance.
- To determine if simulation characteristics are associated with pediatric patient outcomes after in-hospital cardiac arrest.
- To identify specific simulation features that may optimize CPR quality and patient survival.
Main Methods:
- Secondary analysis of the prospective, multicentre ICU-RESUScitation Project (October 2016-March 2021).
- Inclusion of 18,912 point-of-care bedside CPR simulations with real-time feedback using a portable manikin.
- Collection of actual CPR performance data (hemodynamics, mechanics) and patient outcomes (survival with favorable neurologic status) for pediatric patients.
Main Results:
- Simulation characteristics such as site, participant discipline, and training timing were linked to CPR performance.
- No direct association was found between simulation characteristics and survival with favorable neurologic outcome.
- Sites with improved survival outcomes had more recent simulations, higher nurse participation, and achieved better compression depth and fraction goals.
Conclusions:
- Point-of-care CPR simulation characteristics are associated with both simulated and actual CPR performance in the ICU.
- Factors like recent simulation, increased nursing participation, and daytime training sessions may positively influence CPR quality.
- Optimizing simulation design and delivery holds potential for improving pediatric in-hospital cardiac arrest outcomes.
Aim:
To evaluate associations between characteristics of simulated point-of-care cardiopulmonary resuscitation (CPR) training with simulated and actual intensive care unit (ICU) CPR performance, and with outcomes of children after in-hospital cardiac arrest.
Methods:
This is a pre-specified secondary analysis of the ICU-RESUScitation Project; a prospective, multicentre cluster randomized interventional trial conducted in 18 ICUs from October 2016-March 2021. Point-of-care bedside simulations with real-time feedback to allow multidisciplinary ICU staff to practice CPR on a portable manikin were performed and quality metrics (rate, depth, release velocity, chest compression fraction) were recorded. Actual CPR performance was recorded for children 37 weeks post-conceptual age to 18 years who received chest compressions of any duration, and included intra-arrest haemodynamics and CPR mechanics. Outcomes included survival to hospital discharge with favourable neurologic status.
Results:
Overall, 18,912 point-of-care simulations were included. Simulation characteristics associated with both simulation and actual performance included site, participant discipline, and timing of simulation training. Simulation characteristics were not associated with survival with favourable neurologic outcome. However, participants in the top 3 sites for improvement in survival with favourable neurologic outcome were more likely to have participated in a simulation in the past month, on a weekday day, to be nurses, and to achieve targeted depth of compression and chest compression fraction goals during simulations than the bottom 3 sites.
Conclusions:
Point-of-care simulation characteristics were associated with both simulated and actual CPR performance. More recent simulation, increased nursing participation, and simulation training during daytime hours may improve CPR performance.
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