POCUS in pediatric arrest (Res-US pulse check): development and evaluation of a simulation-based curriculum

Area of Science:

• Pediatric Emergency Medicine
• Point-of-Care Ultrasound (POCUS)
• Cardiopulmonary Resuscitation (CPR)

Background:

• Manual pulse assessment in pediatric cardiac arrest is often inaccurate, despite guidelines recommending <10-second checks.
• Point-of-care ultrasound (POCUS) shows potential for improving pulsatility detection and identifying reversible causes of arrest.
• Limited pediatric-specific protocols exist for POCUS integration, with concerns about prolonging CPR interruptions.

Purpose of the Study:

• To develop and implement a structured protocol for integrating POCUS into pediatric cardiac arrest management.
• To evaluate the impact of this POCUS protocol on pulse detection accuracy, efficiency, and clinician confidence.
• To assess whether POCUS integration prolongs interruptions in cardiopulmonary resuscitation (CPR).

Main Methods:

• A simulation-based curriculum using rapid cycle deliberate practice and a flipped-classroom model.
• Online module for initial learning followed by in-person simulation sessions.
• Primary outcome: pulse detection accuracy. Secondary outcomes: interpretation time, decision time, CPR pause duration, confidence, and skill improvement.

Main Results:

• Pulse detection accuracy was 88.0% for presence and 89.3% for absence in the online module.
• During simulation, accuracy reached 100% for pulse presence and 94% for pulselessness.
• Clinician confidence significantly increased (Cohen's d=1.47), with no increase in CPR pause duration.

Conclusions:

• A structured POCUS pulse-check curriculum improves accuracy, efficiency, and confidence in pediatric resuscitation.
• POCUS integration can be achieved without prolonging critical CPR pauses.
• Multimodal training approaches may facilitate POCUS adoption in pediatric cardiac arrest management.