Board #158 - Research Abstract CAB Versus ABC

Abstract

Hypothesis In 2010, the American Heart Association (AHA) published guidelines recommending a new algorithm, Circulation-Airway-Breathing (CAB), as a more suitable alternative to the traditional Airway-Breathing-Circulation (ABC) protocol for patients presenting in cardiac arrest. CAB is now included in the curriculum of the Pediatric Advanced Life Support (PALS) course. The aim of this modification was to facilitate rapid recognition of cardiac arrest and timely initiation of chest compressions and other major components of resuscitation. One recent study by Lubrano et al., showed that the CAB sequence allows for earlier recognition of respiratory and cardiac arrest by basic life support providers. No study has examined the impact of CAB versus ABC on time to epinephrine administration and time to defibrillation. We aim to compare performances of pediatric residents during simulated resuscitation scenarios after being taught the CAB versus the ABC sequence during a PALS course. Methods A single center study was conducted in the simulation lab of a tertiary care pediatric hospital using a pre/post experimental design. All first and third year pediatric residents were invited to participate in simulation sessions shortly after taking a PALS course taught according to 2010 AHA guidelines emphasizing the circulation-airway-breathing (CAB) sequence. A total of twenty-three residents acted as team leaders in two videotaped, simulated resuscitation scenarios: Pulseless non-shockable arrest and pulseless shockable arrest. Their performance was compared to those of 24 residents who participated in a previous study and were trained according to the 2005 AHA guidelines emphasizing the airway-breathing-circulation (ABC) sequence. Two raters evaluated the residents’ performance on five critical tasks: time to pulse check, cardiopulmonary resuscitation (CPR), bag-valve-mask ventilation, epinephrine request and defibrillation. Results Residents who were taught the CAB sequence performed significantly better on time to pulse check (median delays of 10 versus 31 seconds (p value <0.01)) and CPR (median 20 versus 46 seconds (p value <0.01)). Time to ventilation was significantly delayed for the CAB group (33 versus 19 seconds; p-value <0.01). No significant difference was noted in the two groups for time to epinephrine request (p value 0.11) and defibrillation (p value 0.64). Conclusion CAB training was associated with shorter time to pulse check and CPR initiation but at the cost of delayed ventilation. Moreover, epinephrine request and defibrillation were not performed more rapidly in either group.