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Management of Paediatric Cardiac Arrest due to Shockable Rhythm-A Simulation-Based Study at Children's Hospitals in a
Nadine Mand1, Marieke Hoffmann2, Anja Schwalb3
1Neonatology and Paediatric Intensive Care, Department of Paediatrics, Philipps-University Marburg, 35043 Marburg, Germany.
Insights
Paediatric simulation-based training (SBT) significantly improved paediatric life support (PLS) quality in simulated cardiac arrests. All teams initiated chest compressions post-training, enhancing emergency care for children.
Area of Science:
- Pediatric Emergency Medicine
- Medical Simulation
- Cardiopulmonary Resuscitation
Background:
- Hessian Ministry initiative to enhance pediatric emergency care quality.
- Paediatric simulation-based training (SBT) offered to all children's hospitals in Hesse.
- Focus on improving paediatric life support (PLS) during simulated resuscitations.
Purpose of the Study:
- To investigate the quality of PLS before and after SBT.
- To assess the impact of SBT on interprofessional teams' resuscitation skills.
- To identify specific areas of improvement in pediatric cardiac arrest management.
Main Methods:
- Standardized, high-fidelity, two-day in-house SBT conducted in 11 children's hospitals.
- Interprofessional teams participated in pre- and post-training resuscitation scenarios.
- Quality of PLS assessed using a performance evaluation checklist.
Main Results:
- 179 nurses and physicians participated (47 PRE, 46 POST teams).
- Post-SBT, all teams initiated chest compressions (vs. 87% PRE, p=0.012) and 80% defibrillated (vs. 60% PRE, p=0.028).
- Time to chest compressions significantly decreased post-SBT (123s PRE vs. 76s POST, p=0.030).
Conclusions:
- Initial PLS quality in simulated pediatric cardiac arrests was poor.
- SBT led to significant improvements in critical resuscitation interventions.
- Mandatory SBT focusing on shockable rhythms is recommended to improve pediatric outcomes.
Abstract:
(1) Background: To improve the quality of emergency care for children, the Hessian Ministry for Social Affairs and Integration offered paediatric simulation-based training (SBT) for all children's hospitals in Hesse. We investigated the quality of paediatric life support (PLS) in simulated paediatric resuscitations before and after SBT. (2) Methods: In 2017, a standardised, high-fidelity, two-day in-house SBT was conducted in 11 children's hospitals. Before and after SBT, interprofessional teams participated in two study scenarios (PRE and POST) that followed the same clinical course of apnoea and cardiac arrest with a shockable rhythm. The quality of PLS was assessed using a performance evaluation checklist. (3) Results: 179 nurses and physicians participated, forming 47 PRE and 46 POST interprofessional teams. Ventilation was always initiated. Before SBT, chest compressions (CC) were initiated by 87%, and defibrillation by 60% of teams. After SBT, all teams initiated CC (p = 0.012), and 80% defibrillated the patient (p = 0.028). The time to initiate CC decreased significantly (PRE 123 ± 11 s, POST 76 ± 85 s, p = 0.030). (4) Conclusions: The quality of PLS in simulated paediatric cardiac arrests with shockable rhythm was poor in Hessian children's hospitals and improved significantly after SBT. To improve children's outcomes, SBT should be mandatory for paediatric staff and concentrate on the management of shockable rhythms.
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