1282 Heart Rate Assessment, Right on Time (Heart). Effects of Training Heart Rate Assessment in Neonatal Resuscitation: Performance, Confidence, Stress Level

Abstract

Background and aims: Stethoscopic heart rate estimation has previously been shown to be inaccurate in manikin models. We aimed to determine whether training could improve accuracy, and determine any association with perceived stress and confidence levels, in paediatric specialist registrars (SpRs). Methods: Prospective, simulation study involving an intervention group of 17 Paed SpRs and 22 controls (paediatric, anaesthesiology, obstetric SpRs and midwives without training intervention) assessing HR by stethoscope in a VitalSim© manikin. HR was randomly set at 40,50,70 and 80 BPM. Absolute HR was assessed in the first scenario, HR range ( 100) during bag and mask ventilation in second scenario and after three cycles of compressions and ventilation in third scenario. This was repeated 2 weeks after a training intervention. Results: There was a non-significant increase in accurate HR assessment in the first scenario in the intervention group relative to the control group (17.7%vs.9.1%, OR1.7,95%CI0.4-6.4), and non-significant shorter time to determine HR in the second scenario in the intervention group as compared to the control group (Beta-.03, P=0.094). Stress level was significantly lower after training in intervention and control group (P< 0.05). There was a trend towards higher level of confidence in intervention compared to the control group (Beta0.27, P=0.092). Lower stress and higher confidence level were associated with shorter time to determine HR (Beta0.59, P=0.045, Beta- 0.38, P=0.029, respectively). Conclusions: Training in neonatal resuscitation was not associated with significant improvement in performance, although there were trends toward higher accuracy and shorter time to determine HR. Confidence and stress level were associated with shorter time to determine HR.