Abstract
BackgroundThe Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is widely recommended and taught in many resuscitation courses. This study assessed the adherence to the ABCDE algorithm and whether this was affected by the instruction method used to teach this approach.MethodsRandomized controlled trial in which simulation was used as investigational method. Between June 2017 and January 2018, neonatal healthcare providers routinely participated in simulated neonatal advanced life support (NALS) scenarios, using a high-fidelity manikin. They were randomly assigned to a video-based instruction (intervention group) or a conventional lecture (control group) as the method of instruction. One blinded researcher evaluated the adherence to the ABCDE approach on video with an assessment tool specifically designed and tested for this study. The primary outcomes were: 1) the overall adherence and 2) the between-group difference in individual adherence to the ABCDE approach, both expressed as a percentage score. Secondary outcomes were: 1) the scores of each profession category (nurses, neonatal ward clinicians, fellows/neonatologists) and 2) the scores for the separate domains (A, B, C, D, and E) of the algorithm.ResultsSeventy-two participants were assessed. Overall mean (SD) percentage score (i.e. overall adherence) was 31.5% (19.0). The video-based instruction group (28 participants) adhered better to the ABCDE approach than the lecture group (44 participants), with mean (SD) scores of 38.8% (18.7) and 27.8% (18.2), respectively (p = 0.026). The difference in adherence between both groups could mainly be attributed to differences in the adherence to domain B (p = 0.023) and C (p = 0.007). Neonatal ward clinicians (39.9% (18.2)) showed better adherence than nurses (25.0% (15.2)), independent of the study group (p = 0.010).ConclusionsOverall adherence to the ABCDE algorithm was rather low. Video-based instruction resulted in better adherence to the ABCDE approach during NALS training than lecturing.Trial registrationISRCTN registry, trial ID ISRCTN95998973, retrospectively registered on October 13th, 2020.
Highlights
The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is widely recommended and taught in many resuscitation courses
This study shows that the adherence to the ABCDE approach by neonatal healthcare professionals during
CL conventional lecture, VBI video-based instruction aAnalyses are based on the number of percentage scores bAnalyzed using a non-parametric test (Mann-Whitney U) and displayed in median (IQR) due to the non-normal distribution of the percentage scores within the domains simulated neonatal advanced life support (NALS) scenarios improved when the ABCDE approach was taught with video-based instruction (VBI) instead of a conventional lecture (CL)
Summary
The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is widely recommended and taught in many resuscitation courses. The systematic ABCDE approach, acronym for Airway, Breathing, Circulation, Disability, and Exposure, is a widely accepted, expert-based algorithm for the management of (possibly) critically ill or injured patients of all age categories [1, 2]. For example: the algorithm’s feasibility and scientific base may be enhanced, consensus on algorithm application may be augmented within teams, and various mnemonics, checklists, prompts, feedback devices, and other adjuncts may be used [6]. Another straightforward strategy is to develop effective training programs, through which healthcare professionals can acquire and retain the knowledge and skills required to apply the algorithm adequately
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