Abstract
IntroductionAmerican Heart Association guidelines recommend the use of feedback devices for CPR provider resuscitation training. There is paucity of published literature regarding the utility of these devices especially in neonates and infants. We sought to evaluate if simulation-based education and debriefing using a CPR feedback device would improve CPR performance on an infant manikin in a cohort of NICU nurses as evaluated by CPR feedback device.MethodsWe conducted a prospective, observational simulation study to assess the quality of chest compressions by NICU nurses before and after debriefing using CPR quality data captured by an accelerometer-based device. Chest compression (CC) depth, rate, recoil, CC fraction and nursing confidence level related to performing a high-quality CPR were compared before and after debriefing using paired t-test and Wilcoxon rank sum test.ResultsA total of 62 NICU nurses participated in the study and all of them were Neonatal Resuscitation Program (NRP) certified. There was a significant improvement in CC depth and CC fraction [mean + SD values = 0.79 in + 0.17 (pre-debrief), 0.86 in + 0.21 (post-debrief) (p = 0.034) and 56.8% + 17.7 (pre-debrief), 70.8% + 18.4 (post-debrief) (0.0014), respectively]. There was no difference in CC rate (p = 0.36) and recoil (p = 0.25) between pre and post structured debriefing. The confidence level of nurses in all CPR dynamics (appropriate CC rate, CC depth, team communication, minimizing interruption in CC and coordinating CC with ventilation) was significantly higher after simulation and structured debriefing. All the nurses used 3:1 compression: ventilation ratio of NRP despite the patient being a 4 month old premature baby in the NICU.ConclusionsSimulation training and debriefing of NICU nurses using CPR feedback device improved their chest compression quality on an infant mannequin and their confidence level for performing high-quality CPR. NICU providers tend to use NRP protocol of 3:1 compression: ventilation ratio during CPR in the NICU irrespective of age of the infant.
Highlights
American Heart Association guidelines recommend the use of feedback devices for cardiopulmonary resuscitation (CPR) provider resuscitation training
As one of the objectives of the study was to assess if the neonatal intensive care units (NICUs) nurses would use the Neonatal Resuscitation Program (NRP) vs. the Pediatric Advanced Life Support (PALS) guidelines for cardiac arrest in an infant managed in the NICU, we chose a scenario of respiratory arrest progressing into a cardiac arrest in a 4-month-old, ex 34-week premature baby in the NICU
There was a significant improvement in chest compression (CC) depth (p = 0.034) and CC fraction (CCF) (0.0014) after structured debriefing
Summary
American Heart Association guidelines recommend the use of feedback devices for CPR provider resuscitation training. The incidence of in-hospital cardiac arrest in infants and children is estimated to be more than 15,000 per year in the United States [1]. This major public health burden has been increasing in adults as well as in children [1]. The rate of survival in pediatric in-hospital cardiac arrest is better than out-of-hospital cardiac arrest (OHCA) (41.1% vs 11.4%) [2], there is a significant room for improvement, especially for long-term neurologic outcome. High-quality CPR has been shown to improve patient outcomes [6], but CPR quality frequently does not meet standards as recommended by current guidelines, even when performed by well-trained hospital staff [7]
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