Utilizing Low-Dose High-Frequency Simulation Training to Improve Neonatal Mask Ventilation in the Delivery Room

Effective mask ventilation is essential during neonatal resuscitation. Our academic children's hospital houses both a labor and delivery unit with 4,500 annual deliveries and a Level IV neonatal intensive care unit (NICU). More than 100 healthcare professionals provide mask ventilation in the delivery room with varying skill performance as shown through review of recorded resuscitations. The authors evaluated low-dose high-frequency simulation training (LDHFST) for mask ventilation and its impact on clinical mask ventilation quality.

LDHFST for mask ventilation was implemented at the beginning of each clinical shift using a commercially available neonatal manikin. Recordings of mask ventilation delivered to actual patients during neonatal resuscitations were scored for technical performance before and after the intervention. Correct performance was defined as ventilation rate 40-60 breaths per minute, inspiratory time (I_t) 0.3-1.0 seconds, C-shape hold with three fingers under the bony angle of jaw (not on the chin), and the head in sniffing position.

Over 22 months, 2,239 episodes of LDHFST for mask ventilation were conducted. The authors compared mask ventilation performance delivered to 84 neonates pre-LDHFST to 81 neonates post-LDHFST. The proportion of time during which correct mask ventilation was delivered increased significantly from median 5% (interquartile range [IQR] 5.25%) preintervention to 57.5% (IQR 21.25%) postintervention (Welch's two-sample t-test, t = 8.5, df = 12.1, p < 0.001).

LDHFST for mask ventilation improves the duration of correct technique used during actual patient care. This training model is readily replicable across other healthcare settings to optimize clinically relevant skill acquisition.