Management of Paediatric Cardiac Arrest Due to Shockable Rhythm-A Simulation-Based Study at Children's Hospitals in a German Federal State

Overview

Journal Children (Basel)

Specialty Health Services

Date 2024 Jul 27

PMID 39062225

Authors

Nadine Mand

Marieke Hoffmann

Anja Schwalb

Andreas Leonhardt

Martin Sassen

Tina Stibane

Rolf Felix Maier

Carolin Donath

Affiliations

Soon will be listed here.

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 ( = 0.012), and 80% defibrillated the patient ( = 0.028). The time to initiate CC decreased significantly (PRE 123 ± 11 s, POST 76 ± 85 s, = 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.

References

Soar J, Perkins G, Maconochie I, Bottiger B, Deakin C, Sandroni C . European Resuscitation Council Guidelines for Resuscitation: 2018 Update - Antiarrhythmic drugs for cardiac arrest. Resuscitation. 2018; 134:99-103. DOI: 10.1016/j.resuscitation.2018.11.018. View

Moler F, Meert K, Donaldson A, Nadkarni V, Brilli R, Dalton H . In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study. Crit Care Med. 2009; 37(7):2259-67. PMC: 2711020. DOI: 10.1097/CCM.0b013e3181a00a6a. View

Lee J, Yang W, Lee E, Huang J, Hsiao H, Lin M . Clinical Survey and Predictors of Outcomes of Pediatric Out-of-Hospital Cardiac Arrest Admitted to the Emergency Department. Sci Rep. 2019; 9(1):7032. PMC: 6505536. DOI: 10.1038/s41598-019-43020-0. View

Binkhorst M, Coopmans M, Draaisma J, Bot P, Hogeveen M . Retention of knowledge and skills in pediatric basic life support amongst pediatricians. Eur J Pediatr. 2018; 177(7):1089-1099. PMC: 5997099. DOI: 10.1007/s00431-018-3161-7. View

Sandeva M, Tufkova S, Ketev K, Paskaleva D . Evaluating the Effectiveness of Simulation Training in Obstetrics and Gynecology, Pediatrics and Emergency Medicine. Folia Med (Plovdiv). 2020; 61(4):605-611. DOI: 10.3897/folmed.61.e47961. View

Van de Voorde P, Turner N, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D . European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation. 2021; 161:327-387. DOI: 10.1016/j.resuscitation.2021.02.015. View

Meert K, Telford R, Holubkov R, Slomine B, Christensen J, Dean J . Pediatric Out-of-Hospital Cardiac Arrest Characteristics and Their Association With Survival and Neurobehavioral Outcome. Pediatr Crit Care Med. 2016; 17(12):e543-e550. PMC: 5138073. DOI: 10.1097/PCC.0000000000000969. View

Gilfoyle E, Koot D, Annear J, Bhanji F, Cheng A, Duff J . Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention. Pediatr Crit Care Med. 2017; 18(2):e62-e69. DOI: 10.1097/PCC.0000000000001025. View

Nadel F, LAVELLE J, Fein J, Giardino A, Decker J, Durbin D . Assessing pediatric senior residents' training in resuscitation: fund of knowledge, technical skills, and perception of confidence. Pediatr Emerg Care. 2000; 16(2):73-6. DOI: 10.1097/00006565-200004000-00001. View

10.

Shepard L, Reeder R, OHalloran A, Kienzle M, Dowling J, Graham K . Pediatric in-hospital cardiac arrest: Respiratory failure characteristics and association with outcomes. Resuscitation. 2023; 188:109856. PMC: 10402637. DOI: 10.1016/j.resuscitation.2023.109856. View

11.

Auerbach M, Brown L, Whitfill T, Baird J, Abulebda K, Bhatnagar A . Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation-based Study. Acad Emerg Med. 2018; 25(12):1396-1408. DOI: 10.1111/acem.13564. View

12.

Donoghue A, Abella B, Merchant R, Praestgaard A, Topjian A, Berg R . Cardiopulmonary resuscitation for in-hospital events in the emergency department: A comparison of adult and pediatric outcomes and care processes. Resuscitation. 2015; 92:94-100. PMC: 4788967. DOI: 10.1016/j.resuscitation.2015.04.027. View

13.

Maya-Enero S, Botet-Mussons F, Figueras-Aloy J, Izquierdo-Renau M, Thio M, Iriondo-Sanz M . Adherence to the neonatal resuscitation algorithm for preterm infants in a tertiary hospital in Spain. BMC Pediatr. 2018; 18(1):319. PMC: 6178255. DOI: 10.1186/s12887-018-1288-3. View

14.

Hunt E, Vera K, Diener-West M, Haggerty J, Nelson K, Shaffner D . Delays and errors in cardiopulmonary resuscitation and defibrillation by pediatric residents during simulated cardiopulmonary arrests. Resuscitation. 2009; 80(7):819-25. DOI: 10.1016/j.resuscitation.2009.03.020. View

15.

Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C . More Than 500 Kids Could Be Saved Each Year! Ten Consensus Actions to Improve Quality of Pediatric Resuscitation in DACH-Countries (Austria, Germany, and Switzerland). Front Pediatr. 2020; 8:549710. PMC: 7575775. DOI: 10.3389/fped.2020.549710. View

16.

Doymaz S, Rizvi M, Orsi M, Giambruno C . How Prepared Are Pediatric Residents for Pediatric Emergencies: Is Pediatric Advanced Life Support Certification Every 2 Years Adequate?. Glob Pediatr Health. 2019; 6:2333794X19876809. PMC: 6747847. DOI: 10.1177/2333794X19876809. View

17.

Mills D, Williams D, Dobson J . Simulation training as a mechanism for procedural and resuscitation education for pediatric residents: a systematic review. Hosp Pediatr. 2013; 3(2):167-76. DOI: 10.1542/hpeds.2012-0041. View

18.

Nadkarni V, Larkin G, Peberdy M, Carey S, Kaye W, Mancini M . First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006; 295(1):50-7. DOI: 10.1001/jama.295.1.50. View

19.

Phillips R, Scott B, Carter S, Taylor M, Peirce E, Davies P . Systematic review and meta-analysis of outcomes after cardiopulmonary arrest in childhood. PLoS One. 2015; 10(6):e0130327. PMC: 4479568. DOI: 10.1371/journal.pone.0130327. View

20.

Ross J, Trainor J, Eppich W, Adler M . Impact of simulation training on time to initiation of cardiopulmonary resuscitation for first-year pediatrics residents. J Grad Med Educ. 2014; 5(4):613-9. PMC: 3886460. DOI: 10.4300/JGME-D-12-00343.1. View