Neonatal resuscitation video review - has the time for wider adoption come?

Neonatal resuscitation video review (NRVR) involves recording and reviewing resuscitations for education and quality assurance. Though NRVR has been shown to improve teamwork and skill retention, it is not widely used. We evaluated clinicians' experiences of NRVR to understand how NRVR impacts learning and can be improved. Neonatal Intensive Care Unit (NICU) clinicians with previous NRVR experience were recruited for individual semi-structured interviews. Using a social constructivist viewpoint, five researchers used thematic analysis to analyze participant responses. Twenty-two clinicians (11 nurses, 11 doctors) were interviewed. All participants expressed positive attitudes towards NRVR. Four themes were identified: (1) Learning from reality-exposure to real-life resuscitations was highly clinically relevant. (2) Immersive self-regulation-watching videos aided recall and reflection. (3) Complexities in learner psychological safety-all participants acknowledged viewing NRVR videos could be confronting. Some expressed fear of judgment from colleagues, though the educational benefit of NRVR superseded this. (4) Accessing and learning from diverse vantage points-NRVR promoted group discussion, which prompted participant learning from colleagues' viewpoints. Neonatal clinicians reported NRVR to be an effective and safe method for learning and refining skills required during neonatal resuscitation, such as situational awareness and communication. Neonatal resuscitation video review is not known to be widely used in neonatal resuscitation teaching, and published research in this area is limited. Our study examined clinician attitudes towards an established neonatal resuscitation video review program. We found strong support for teaching using neonatal resuscitation video review among neonatal doctors and nurses, with key benefits including increased situational awareness and increased clinical exposure to resuscitations, while maintaining psychological safety for participants. The results of this study add evidence to support the addition of video review to neonatal resuscitation training.

Debriefing is a critical component of effective simulation-based medical education. The optimal format in which to conduct debriefing is unknown. The use of video review has been promoted as a means of enhancing debriefing, and video-assisted debriefing is widely used in simulation training. Few empirical studies have evaluated the impact of video-assisted debriefing, and the results of those studies have been mixed. The objective of this study was to compare the effectiveness of video-assisted debriefing to oral debriefing alone at improving performance in neonatal resuscitation. Thirty residents, divided into 15 teams of 2 members each, participated in the study. Each team completed a series of 3 neonatal resuscitation simulations. Each simulation was followed by a facilitated debriefing. Teams were randomly assigned to receive either oral debriefing alone or video-assisted debriefing after each simulation. Objective measures of performance and times to complete critical tasks in resuscitation were evaluated by blinded video review on the first (pretest) and the third (posttest) simulations using a previously validated tool. Overall neonatal resuscitation performance scores improved in both groups [mean (SD), 83% (14%) for oral pretest vs. 91% (7%) for oral posttest (P = 0.005); 81% (16%) for video pretest vs. 93% (10%) for video posttest (P < 0.001)]. There was no difference in performance scores between the 2 groups on either the pretest or posttest [overall posttest scores, 91.3% for oral vs. 93.4% for video (P = 0.59)]. Times to complete the critical tasks of resuscitation also did not differ significantly between the 2 study groups. The educational effect of the video-assisted debriefing versus oral debriefing alone was small (d = 0.08). Using this study design, we failed to show a significant educational benefit of video-assisted debriefing. Although our results suggest that the use of video-assisted debriefing may not offer significant advantage over oral debriefing alone, exactly why this is the case remains obscure. Further research is needed to define the optimal role of video review during simulation debriefing in neonatal resuscitation.

BackgroundMonitoring of peripheral capillary oxygen saturation (SpO2) during neonatal resuscitation is standard of care in high-resource settings, but seldom performed in low-resource settings. We aimed to measure SpO2 and heart...

OBJECTIVES: To evaluate the current practice variabilities during resuscitation of preterm infants by the dedicated Resuscitation Stabilization Team (RST) using videos and respiratory function recordings of the delivery room management. DESIGN/METHODS: At our center, neonatal stabilization rooms are equipped with video recording and respiratory function monitor. We analyzed the first 10 minutes of delivery room stabilization of preterm infants at birth. The RST performance was evaluated and compared against the Canadian and regional Neonatal Resuscitation Guidelines. RESULTS: Thirty infants were video recorded over 8 months, with mean gestational age (GA) 26 (±2) weeks and birth weight 960 (±315)g. There was 100% compliance with using the plastic drape for infants less than 28 weeks GA. EKG leads and Pulse Oximetry were applied to all 30 patients. The median time[IQR] for application of the pulse oximetry was 47 seconds [35- 65] from the time of arrival at the table. Only 9/30 infants were suctioned prior to starting the respiratory support. There were inconsistencies in drying and stimulation within first minute for infants less than 28 weeks GA. There was a trend of initiating mask Continuous Positive Airway Pressure (CPAP) prior to completing initial assessment for adequacy of spontaneous breathing. 14 infants were apneic when placed on the table. The median [IQR] time to initiate positive pressure ventilation (PPV) in these apneic babies was 26 seconds [12-37.5]. 5/9 apneic babies didn’t have clinical assessment of heart rate as a part of initial assessment or to establish effectiveness of the ventilation. There were 10 events in 7 patients where PPV was interrupted by the PPV provider for purposes other than ventilation corrective steps. Early initiation of nasal CPAP i.e., less than 10 minutes was noted in 8 babies. CONCLUSION: The results of the RST performance are comparable to available literature. The results represent efficient neonatal stabilizations by a well-trained stabilization team. The variability of sequence in accomplishing each step of resuscitation could indicate resuscitator’s training and experience for individual skill set or judgement on rapidly changing clinical situation. There is a need of ongoing resuscitation training with special focus on situational awareness to prepare the NRP providers for timely strategized performance. Resuscitation videos can be a useful tool for educational and training of NRP providers.The results of the RST performance are comparable to available literature. The results represent efficient neonatal stabilizations by a well-trained stabilization team. The variability of sequence in accomplishing each step of resuscitation could indicate resuscitator’s training and experience for individual skill set or judgement on rapidly changing clinical situation. There is a need of ongoing resuscitation training with special focus on situational awareness to prepare the NRP providers for timely strategized performance. Resuscitation videos can be a useful tool for educational and training of NRP providers.The results of the RST performance are comparable to available literature. The results represent efficient neonatal stabilizations by a well-trained stabilization team. The variability of sequence in accomplishing each step of resuscitation could indicate resuscitator’s training and experience for individual skill set or judgement on rapidly changing clinical situation. There is a need of ongoing resuscitation training with special focus on situational awareness to prepare the NRP providers for timely strategized performance. Resuscitation videos can be a useful tool for educational and training of NRP providers.

Introduction: Previous research has described technical aspects of telemedicine and the clinical impact of provider-to-patient telemedicine; however, little is known about provider-to-provider telemedical interventions. Objective: The primary aim of this study was to compare two telemedicine delivery modes on the quality of a simulated neonatal resuscitation. Our secondary aim was to evaluate the providers’ task load. Methods: This was a prospective, single-center, randomized, simulation-based trial comparing a remote neonatal team leader (“teleleader”) versus a remote consultant (“teleconsultant”). Participants resuscitated a simulated, apneic, and bradycardic neonate. Performance was assessed by video review and task load was measured by the self-reported NASA task load index (NASA-TLX) tool. In the teleleader group, one remote neonatal specialist assumed the role of team leader in the resuscitation. In the teleconsultant group, the same remote specialist assumed the role of teleconsultant. Results: Twenty-two participants were included in the analyses. The teleleader group was associated with a higher overall checklist score compared to teleconsultants (median score 68%, interquartile range [IQR]: 66–69 vs. 58%, IQR: 42–62; p = 0.016). No significant difference was seen in overall subjective workload as measured by the NASA-TLX tool. However, mental demand and frustration were significantly greater with teleconsultants compared to teleleaders (mean mental demand: 14.1 vs. 17.0 out of 21; frustration: 7.9 vs. 14.7 out of 21). Conclusions: Simulated neonates randomized to teams with teleleaders received significantly better resuscitative care compared to those randomized to teams with teleconsultants. Mental demand and frustration were higher for providers in the teleconsultant compared to teleleader teams.

Birth asphyxia is one of the leading causes of neonatal deaths. A key for survival is performing immediate and continuous quality newborn resuscitation. A dataset of recorded signals during newborn resuscitation, including videos, has been collected in Haydom, Tanzania, and the aim is to analyze the treatment and its effect on the newborn outcome. An important step is to generate timelines of relevant resuscitation activities, including ventilation, stimulation, suction, etc., during the resuscitation episodes. We propose a two-step deep neural network system, ORAA-net, utilizing low-quality video recordings of resuscitation episodes to do activity recognition during newborn resuscitation. The first step is to detect and track relevant objects using Convolutional Neural Networks (CNN) and post-processing, and the second step is to analyze the proposed activity regions from step 1 to do activity recognition using 3D CNNs. The system recognized the activities newborn uncovered, stimulation, ventilation and suction with a mean precision of 77.67%, a mean recall of 77,64%, and a mean accuracy of 92.40%. Moreover, the accuracy of the estimated number of Health Care Providers (HCPs) present during the resuscitation episodes was 68.32%. The results indicate that the proposed CNN-based two-step ORAA-net could be used for object detection and activity recognition in noisy low-quality newborn resuscitation videos. A thorough analysis of the effect the different resuscitation activities have on the newborn outcome could potentially allow us to optimize treatment guidelines, training, debriefing, and local quality improvement in newborn resuscitation.

Out-of-hospital cardiac arrests are a leading global cause of mortality. The American Heart Association (AHA) promotes several important strategies associated with improved cardiac arrest (CA) outcomes, including decreasing pulse check time and maintaining a chest compression fraction (CCF)>0.80. Video review is a potential tool to improve skills and analyse deficiencies in various situations; however, its use in improving medical resuscitation remains poorly studied in the emergency department (ED). We implemented a quality improvement initiative, which utilised video review of CA resuscitations in an effort to improve compliance with such AHA quality metrics. A cardiopulmonary resuscitation video review team of emergency medicine residents were assembled to analyse CA resuscitations in our urban academic ED. Videos were reviewed by two residents, one of whom was a senior resident (Postgraduate Year 3 or 4), and analysed using Spearman's rank correlation coefficient for numerous quality improvement metrics, including pulse check time, CCF, time to intravenous access and time to patient attached to monitor. We collected data on 94 CA resuscitations between July 2017 and June 2020. Average pulse check time was 13.09 (SD±5.97)seconds, and 38% of pulse checks were <10seconds. After the implementation of the video review process, there was a significant decrease in average pulse check time (P=.01) and a significant increase in CCF (P=.01) throughout the study period. Our study suggests that the video review and feedback process was significantly associated with improvements in AHA quality metrics for resuscitation in CA amongst patients presented to the ED.

Neonatal resuscitation requires both technical and behavioral skills. Key behavioral skills in neonatal resuscitation have been identified by the Neonatal Resuscitation Program. Correlations and interactions between technical skills and behavioral skills in neonatal resuscitation were investigated. Behavioral skills were evaluated via blinded video review of 45 simulated neonatal resuscitations using a validated assessment tool. These were statistically correlated with previously obtained technical skill performance data. Technical skills and behavioral skills were strongly correlated (ρ=0.48; P=0.001). The strongest correlations were seen in distribution of workload (ρ=0.60; P=0.01), utilization of information (ρ=0.55; P=0.03) and utilization of resources (ρ=0.61; P=0.01). Teams with superior behavioral skills also demonstrated superior technical skills, and vice versa. Technical and behavioral skills were highly correlated during simulated neonatal resuscitations. Individual behavioral skill correlations are likely dependent on both intrinsic and extrinsic factors.

BACKGROUND: Low-frequency and high-risk situations, such as neonatal resuscitation, are the ideal targets for simulation-based learning. The aim of this paper is to present the structure of our internal neonatal resuscitation training program, using a realistic, simulated delivery room, and to present the participants' opinions about teamwork, emotional stress, and their subjective ability to face a resuscitation. METHODS: We administered a training course to 24 doctors and midwives. One of the simulation classrooms was modified to appear similar to a real delivery room. Four scenarios were conducted using a previously designed checklist of primary and secondary goals. Upon completion, all students participated in a debriefing session with the help of a video review. RESULTS: Students rated the achievement of their previously defined goals on a scale of 1 to 5. Grouping together the percentages of the highest ratings (Categories 4 and 5), 83.4% (20/24) of the students considered the course useful for acquiring clinical skills. For 87.5% (21/24) of the students, the scenarios simulated real clinical situations, the room properly simulated a real delivery room, and the course improved the students' ability to work in a team. For 66.6% (16/24) of the students, the course improved their stress in confronting neonatal resuscitation. Initially, only 33.3% (8/24) of the students considered themselves very capable or fully able to cope with a resuscitation. After the course, that percentage rose to 62.5% (15/24). CONCLUSIONS: The incorporation of simulation-based learning into neonatal resuscitation teaching programs, using realistic scenarios, is useful and offers the possibility of acquiring technical skills, but it also allows for the improvement of teamwork and the adoption of different roles and positive attitudes towards emotional stress.

Approximately 3% of births require neonatal resuscitation, which has a direct impact on the immediate survival of these infants. This report proposes an automatic video analysis method for neonatal resuscitation performance evaluation, which helps improve the quality of this procedure. More specifically, we design a deep learning based action model which incorporates motion and spatial information in order to classify neonatal resuscitation actions in videos. First, we use a Convolutional Neural Network to select regions containing infants and only keep those that are motion salient. Second, we extract deep spatial-temporal features to train a linear SVM classifier. Finally, we propose a pair-wise model to ensure consistent classification in consecutive frames. We evaluate the proposed method on a dataset consisting of 17 videos and compare the result against the state-of-the-art method for action classification in videos. To our best knowledge, this work is the first to attempt automatic evaluation of neonatal resuscitation videos and identifies several issues that require further work.

The quality of neonatal resuscitation after delivery needs to be improved to reach the Sustainable Development Goals 3.2 (reducing neonatal deaths to <12/1,000 live newborns) by the year 2030. Studies have emphasized the importance of correctly performing the basic steps of resuscitation including stimulation, heart rate assessment, ventilation, and thermal control. Recordings with video cameras have previously been shown to be one way to identify performance practices during neonatal resuscitation. A description of a low-cost delivery room set up for video recording of neonatal resuscitation. The technical setup includes rechargeable high-definition cameras with two-way audio, NeoBeat heart rate monitors, and the NeoTapAS data collection tools for iPad with direct data export of data for statistical analysis. The setup was field tested at Mulago National Referral Hospital, Kampala, Uganda, and Phu San Hanoi Hospital, Hanoi, Vietnam. The setup provided highly detailed resuscitation video footage including data on procedures and team performance, heart rate monitoring, and clinical assessment of the neonate. The data were analyzed with the free-of-charge NeoTapAS for iPad, which allowed fast and accurate registration of all resuscitative events. All events were automatically registered and exported to R statistical software for further analysis. Video analysis of neonatal resuscitation is an emerging quality assurance tool with the potential to improve neonatal resuscitation outcomes. Our methodology and technical setup are well adapted for low- and lower-middle-income countries settings where improving neonatal resuscitation outcomes is crucial. This delivery room video recording setup also included two-way audio communication that potentially could be implemented in day-to-day practice or used with remote teleconsultants.

Birth asphyxia is a major newborn mortality problem in low-resource countries. International guideline provides treatment recommendations; however, the importance and effect of the different treatments are not fully explored. The available data are collected in Tanzania, during newborn resuscitation, for analysis of the resuscitation activities and the response of the newborn. An important step in the analysis is to create activity timelines of the episodes, where activities include ventilation, suction, stimulation, etc. Methods: The available recordings are noisy real-world videos with large variations. We propose a two-step process in order to detect activities possibly overlapping in time. The first step is to detect and track the relevant objects, such as bag-mask resuscitator, heart rate sensors, etc., and the second step is to use this information to recognize the resuscitation activities. The topic of this paper is the first step, and the object detection and tracking are based on convolutional neural networks followed by post processing. The performance of the object detection during activities were 96.97% (ventilations), 100% (attaching/removing heart rate sensor), and 75% (suction) on a test set of 20 videos. The system also estimate the number of health care providers present with a performance of 71.16%. The proposed object detection and tracking system provides promising results in noisy newborn resuscitation videos. This is the first step in a thorough analysis of newborn resuscitation episodes, which could provide important insight about the importance and effect of different newborn resuscitation activities.

Introduction Utilization of trauma video review for quality and performance improvement initiatives has increased in recent years across numerous institutions. The value of video review for burn resuscitations remains unknown. The Joint Commission estimates over 80% of serious, preventable adverse medical events occur due to ineffective handoffs. We sought to study emergency medical service (EMS) handoff and measure initial resuscitation metrics using burn resuscitation video review (BVR). This initial review sought to determine the feasibility of using BVR to study the compliance of EMS providers and outside hospitals with Advanced Burn Life Support (ABLS) guidelines. Methods As part of an ongoing multi-center study of BVR at ABA verified burn centers, we reviewed 15 burn resuscitations from a single institution between May 2024 – August 2024. A team of five analysts reviewed the recorded resuscitations. EMS handoffs were evaluated in terms of content, interruptions, and overall efficacy to include the age, sex, weight, and past medical history of the patient, time of injury, possibility of inhalation injury, most recent vital signs, medical treatments prior to arrival, estimated total body surface area of the burn, hourly urine output, and hourly fluid titration. Data collection includes time to initiation of resuscitation and initial burn treatment. Results Video review of burn resuscitations and EMS handoff is feasible, and the audiovisual clarity is sufficient for data extraction. EMS handoff, measured from the time the EMS provider started speaking until report completion, including answered questions, had an average length of [0:01:28 minutes] with a range of [0:00:27 – 0:03:30 minutes]. Interruptions during handoff were seen in all encounters (15/15). Content of handoff varied with 100% including mechanism of injury, 60% including age, and 33.3% including time of injury. When looking at vital signs, most recent heart rate was communicated in 26% of handoffs and blood pressure in 40%, whereas temperature was not relayed in any case. Inconsistencies in initial burn resuscitations were also seen, with 46.6% of patients not receiving any intravenous fluids from EMS and 33.3% of receiving burn teams not specifying fluid resuscitation upon patient arrival. Conclusions Preliminary analysis of this ongoing project indicates BVR will allow for effective quality improvement efforts targeting EMS handoff and resuscitation by evaluating real-time adherence rates to current ABLS guidelines and the initial resuscitation of our burn patients. Applicability of Research to Practice BVR may identify key opportunities for improvement in EMS communication and ABLS guideline adherence. For the first time, we will be able to directly evaluate real-time practice rather than infer from documentation. Funding for the Study N/A

Bakcground: Cardiac arrest in the pediatric emergency department (PED) is an uncommon event requiring rapid assembly of ad hoc multidisciplinary care teams. Effective cardiopulmonary resuscitation (CPR) is influenced by teamwork, leadership, and communication. A designated CPR coach has been shown to improve CPR performance in simulated resuscitations. Objective: To describe dynamic components of pediatric CPR using video review and compare these factors between events with and without a designated CPR coach. Methods: Prospective observational study in a tertiary PED with a resuscitation video review program. Events where a child received chest compressions under videorecorded conditions were included. A CPR coach was designated at the team leader’s discretion. Data on CPR performance was collected from video review. Chest compressions (CC) were defined in CC segments (the duration of CC given by a single provider before switching to a different providers). Pauses in CC were measured in seconds and tasks performed during pauses (e.g. pulse check, rhythm check) were recorded. Unadjusted univariate analysis between events with and without a CPR coach was performed by c2 analyses for dichotomous variables and nonparametric analysis for continuous variables. Results: 88 events were analyzed (OHCA n=74, IHCA n=14; ROSC 23/88 (26%); survival to admission 21/88 (24%)). The median duration of CPR was 18 minutes (IQR 12 – 27 minutes). Median CC segment duration was 71 sec (IQR 42 – 104 sec). 84% of segments were less than 2 minutes; 39% were less than 1 minute. A median of 12 pauses in chest compressions occurred per event (range 2-30). Median pause duration was 4 sec (IQR 3 – 9 sec); 18% of pauses exceeded 10 seconds. The coordination of compressor change, pulse check, and rhythm check were done in 182/934 (18%) of CC pauses. Median chest compression fraction across all events was 87% (IQR 76% – 93%). A CPR coach was designated in 24/88 (27%) events. On univariate analysis comparing events with and without a CPR coach, there were no significant differences in CCF, average CC segment duration, or number of pauses &gt; 10 sec. Conclusions: Using video review, areas for improvement in team performance during pediatric CPR were identified. The presence of a designated CPR coach was not associated with significant differences in these parameters. Future studies should examine the impact of targeted CPR coach training on dynamic team function to improve CPR.

Development of a strategic process using checklists to facilitate team preparation and improve communication during neonatal resuscitation