ABSTRACT 771

Abstract

Background and aims: Pediatric Advanced Life Support (PALS) is designed to teach providers the skills needed during emergencies especially codes. Over a ten year period, survival of in-hospital cardiac arrest has improved but not the risk of brain damage. Resuscitation techniques are assessed during megacodes using low-fidelity mannequins and readiness is assumed adequate wirh certification. However due to infrequency of codes, skills decay may occur. Aims: This study was performed to assess the quality and timeliness of resucitation care and also to identify common skill deficiencies during simulated pediatric codes. Methods: An IRB waived descriptive study was performed on PALS certified participants which consisted of 21 physicians and 13 nurses. Each were presented with a variety of pulseless arrest code scenarios ranging from PEA to unstable SVT at the SimLab on a high fidelity manequin, Laerdal SimBaby. Majority of the physicans and half of the nurses had simulation experience. Essential resuscitation skills in providing a high quality CPR was collected and recorded by an independent observer. Results: Performance of both groups was similar in most parameters tested. The physicians performed significantly better than the nurses in airway management. However, both groups performed poorly on immediate provision of of high quality CPR. Other unsatisfactory skills identified were asynchronous ventilation, inadequate frequency of compressions and failure to rotate chest compressors. Although correct rhythm was recognized, decision to defibrillate or cardiovert was delayed. Conclusions: PALS certification does not guarantee satisfactory CPR. Simulation based medical education can help identify and strengthen resuscitation skills and should be incorporated with PALS certification.