Pediatric Advanced Life Support Training Research Articles

Strengthening safe children’s surgical care in Nigeria through paediatric advanced life support training

Strengthening safe children’s surgical care in Nigeria through paediatric advanced life support training

Implementing a Medical Emergency and Rapid Intervention Team

<h3>Background Information</h3> Failure to rescue accounts for approximately 60,000 deaths each year in Medicare patients under the age of 75. In a large outpatient oncology facility that encompasses an infusion center, multimodality procedure unit, radiation treatment center & multidisciplinary clinic, the need to implement a rapid rescue team was identified to mitigate the risk of failure to rescue. <h3>Objectives of Project</h3> The goal of this initiative was to implement a Medical Emergency and Rapid Intervention Team (MERIT) service to care for patients undergoing chemotherapy, blood transfusions, procedures, radiation and other oncology treatments. A standardized process was developed for MERIT activation by healthcare providers within the facility. In-Service all employees in the facility and empower them to activate MERIT for identified patients. <h3>Process of Implementation</h3> The current MERIT policy for inpatients was reviewed and collaboration was formed with institutional leaders to revise it for an ambulatory center. A needs assessment was conducted and knowledge deficits were identified. The skill mix of PACU nurses was reviewed to identify those with a high acuity background to be a core member of the MERIT team. An orientation and competency check-off was developed, which included requiring members to have Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS) and High Acuity Training. A post-implementation survey was conducted to assess needs and knowledge gaps. <h3>Statement of Successful Practice</h3> The assessment survey indicated 83% of staff were able to identify all the correct situations to call MERIT, 9% of staff were not sure what situations require MERIT and 25% of staff did not know the correct extension to request MERIT. Post implementation of MERIT service, the building team members indicated 84.4% of the staff were able to identify correct situations to call MERIT, and 98% of the staff knew the correct extension to request MERIT. Post education survey was done 2 weeks after go live and showed improvement in knowledge and comfort level in calling MERIT. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Providing a MERIT service in an outpatient facility could mitigate the risk of failure to rescue, and improve patient outcomes.

The Impact of a 9-Month Booster Training Using Rapid Cycle Deliberate Practice on Pediatric Resident PALS Skills.

The impact of booster training on pediatric resuscitation skills is not well understood. Rapid cycle deliberate practice (RCDP) to supplement pediatric advanced life support (PALS) training is beginning to be used to improve resuscitation skills. We tested the impact of booster RCDP training performed at 9 months after initial RCDP training on pediatric resuscitation skills of pediatric residents. This study evaluated the impact of a 9-month RCDP booster training on PALS skills compared with usual practice debriefing (plus/delta) after an initial RCDP training session for PALS-certified pediatric interns. All pediatric interns at a single institution were invited to a 45-minute RCDP training session after their initial PALS certification. The PALS performance score and times for key events were recorded for participants immediately before and after the RCDP training as well as 6, 9, and 12 months after the RCDP training. Learners were randomized to an RCDP intervention and usual practice (plus/delta) group. The intervention group received booster RCDP training after their 9-month assessment. Twenty eight of 30 residents participated in the initial training with 22 completing randomization at 9 months. There was no significant difference in 12-month PALS median performance scores after the booster training between the intervention and usual practice groups (83% vs. 94%, P = 0.31). There was significant improvement in PALS performance score from 51 ± 27% pre-initial RCDP assessment to 93 ± 5% post-initial RCDP training (P < 0.001). There were significant improvements in individual skills from pre- to post-initial RCDP testing, including time to verbalize pulseless, start compressions, and attach defibrillation pads (P < 0.001). Rapid cycle deliberate practice booster training versus plus/delta training at 9-month post-initial RCDP training did not alter 12-month performance. However, RCDP is effective at improving PALS performance skills, and this effect is maintained at 6, 9, and 12 months. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.

Prevalence of Pediatric Advanced Life Support Training Among Radiation Oncology Residency Programs

Prevalence of Pediatric Advanced Life Support Training Among Radiation Oncology Residency Programs

Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation-based Study.

Pediatric out-of-hospital cardiac arrest survival outcomes are dismal (<10%). Care that is provided in adherence to established guidelines has been associated with improved survival. Lower mortality rates have been reported in higher-volume hospitals, teaching hospitals, and trauma centers. The primary objective of this article was to explore the relationship of hospital characteristics, such as annual pediatric patient volume, to adherence to pediatric cardiac arrest guidelines during an insitu simulation. Secondary objectives included comparing adherence to other team, provider, and system factors. This prospective, multicenter, observational study evaluated interprofessional teams in their native emergency department (ED) resuscitation bays caring for a simulated 5-year-old child presenting in cardiac arrest. The primary outcome, adherence to the American Heart Association pediatric guidelines, was assessed using a 14-item tool including three component domains: basic life support (BLS), pulseless electrical activity (PEA), and ventricular fibrillation (VF). Provider, team, and hospital-level data were collected as independent data. EDs were evaluated in four pediatric volume groups (low<1,800/year; medium 1,800-4,999; medium-high 5,000-9,999; high>10,000). Cardiac arrest adherence and domains were evaluated by pediatric patient volume and other team and hospital-level characteristics, and path analyses were performed to evaluate the contribution of patient volume, systems readiness, and teamwork on BLS, PEA, and VF adherence. A total of 101 teams from a spectrum of 50 EDs participated including nine low pediatric volume (<1,800/year), 36 medium volume (1,800-4,999/year), 24 medium-high (5,000-9,999/year), and 32 high volume (≥10000/year). The median total adherence score was 57.1 (interquartile range= 50.0-78.6). This was not significantly different across the four volume groups. The highest level of adherence for BLS and PEA domains was noted in the medium-high-volume sites, while no difference was noted for the VF domain. The lowest level of BLS adherence was noted in the lowest-volume EDs. Improved adherence was not directly associated with higher pediatric readiness survey (PRS) score provider experience, simulation teamwork performance, or more providers with Pediatric Advanced Life Support (PALS) training. EDs in teaching hospitals with a trauma center designation that served only children demonstrated higher adherence compared to nonteaching hospitals (64.3 vs 57.1), nontrauma centers (64.3 vs. 57.1), and mixed pediatric and adult departments (67.9 vs. 57.1), respectively. The overall effect sizes for total cardiac adherence score are ED type γ=0.47 and pediatric volume (low and medium vs. medium-high and high) γ=0.41. A series of path analyses models was conducted that indicated that overall pediatric ED volume predicted significantly better guideline adherence, but the effect of volume on performance was only mediated by the PRS for the VF domain. This study demonstrated variable adherence to pediatric cardiac arrest guidelines across a spectrum of EDs. Overall adherence was not associated with ED pediatric volume. Medium-high-volume EDs demonstrated the highest levels of adherence for BLS and PEA. Lower-volume EDs were noted to have lower adherence to BLS guidelines. Improved adherence was not directly associated with higher PRS score provider experience, simulation teamwork performance, or more providers with PALS training. This study demonstrates that current approaches optimizing the care of children in cardiac arrest in the ED (provider training, teamwork training, environmental preparation) are insufficient.

The Effect of High Fidelity Simulators on Knowledge Retention and Skill Self Efficacy in Pediatric Advanced Life Support Courses in a Rural State

PurposeRural health care providers (HCPs) care for millions of Americans despite challenges. Pediatric Advanced Life Support (PALS) provides rural HCPs training in assessment and interventions for critically ill/injured pediatric patients (American Heart Association, 2015). The purpose of this study was to determine the effects of integration of high fidelity simulators into PALS courses in a rural setting. Design and MethodsParticipants were randomized by course to control or experimental PALS conditions where the control group received PALS with low fidelity static manikins (LFM) and the experimental group received PALS with high-fidelity simulators (HFS). Multiple level modeling (MLM) was used to examine participants time-to-task on pre-identified skills on PALS core case scenarios during testing on the last day of the course. MLM also was used to examine the differences in PALS knowledge and skills self-efficacy (SEI) between control and experimental groups at course end and six months later. ResultsThe experimental and control groups had similar scores on the PALS post course knowledge exam, however the skill performance of the experimental group on time-to-task in core case scenarios was significantly better when compared to the control group (p=0.05). A decrease in knowledge exam scores and SEI scores occurred in both groups over time, however the control group had significantly greater declines in PALS written exam (p=0.042) and SEI (p=0.003). Conclusions and Practice ImplicationsIntegration of HFS into PALS may increase HCPs' ability to recall valuable knowledge when seconds matter most. Further research in long-term recall of knowledge and retention of skills following PALS training is needed.

Rolling-refresher simulation improves performance and retention of paediatric intensive care unit nurse code cart management.

IntroductionPaediatric Intensive Care Unit Nurses (PICU RNs) manage the code cart during paediatric emergencies at the Children’s Hospital at Dartmouth-Hitchcock. These are low -frequency, high-stakes events.MethodsAn uncontrolled intervention study with 6-month follow-up. A collaboration of physician and nursing experts developed a rolling-refresher training programme consisting of five simulated scenarios, including 22 code cart skills, to establish nursing code cart competency. The cohort of PICU RNs underwent a competency assessment in training 1. To achieve competence, the participating RN received immediate feedback and instruction and repeated each task until mastery during training 1. The competencies were repeated 6 months later, designated training 2.ResultsThirty-two RNs participated in training 1. Sixteen RNs (50%) completed the second training. Our rolling-refresher training programme resulted in a 43% reduction in the odds of first attempt failures between training 1 and training 2 (p=0.01). Multivariate linear regression evaluating the difference in first attempt failure between training 1 and training 2 revealed that the following covariates were not significantly associated with this improvement: interval Paediatric Advanced Life Support training, interval use of the code cart or defibrillator (either real or simulated) and time between training sessions. Univariate analysis between the two trainings revealed a statistically significant reduction in first attempt failures for: preparing an epinephrine infusion (72% vs 41%, p=0.04) and providing bag-mask ventilation (28% vs 0%, p=0.02).ConclusionsOur rolling-refresher training programme demonstrated significant improvement in performance for low-frequency, high-risk skills required to manage a paediatric code cart with retention after initial training.

Assessment Tools for Use During Anesthesia-Centric Pediatric Advanced Life Support Training and Evaluation

BackgroundPediatric perioperative cardiac arrests are rare events that require rapid, skilled and coordinated efforts to optimize outcomes. We developed an assessment tool for assessing clinician performance during perioperative critical events termed Anesthesia-centric Pediatric Advanced Life Support (A-PALS). Here, we describe the development and evaluation of the A-PALS scoring instrument. MethodsA group of raters scored videos of a perioperative team managing simulated events representing a range of scenarios and competency. We assessed agreement with the reference standard grading, as well as interrater and intrarater reliability. ResultsOverall, raters agreed with the reference standard 86.2% of the time. Rater scores concerning scenarios that depicted highly competent performance correlated better with the reference standard than scores from scenarios that depicted low clinical competence (P < 0.0001). Agreement with the reference standard was significantly (P < 0.0001) associated with scenario type, item category, level of competency displayed in the scenario, correct versus incorrect actions and whether the action was performed versus not performed. Kappa values were significantly (P < 0.0001) higher for highly competent performances as compared to lesser competent performances (good: mean = 0.83 [standard deviation = 0.07] versus poor: mean = 0.61 [standard deviation = 0.14]). The intraclass correlation coefficient (interrater reliability) was 0.97 for the raters’ composite scores on correct actions and 0.98 for their composite scores on incorrect actions. ConclusionsThis study provides evidence for the validity of the A-PALS scoring instrument and demonstrates that the scoring instrument can provide reliable scores, although clinician performance affects reliability.

A Child's Last Hours'Multidisciplinary Training in End-of-Life Care in Children's Hospitals: Adolescent With Cystic Fibrosis

Abstract Introduction This resource is one of a three-module workshop using a case-based approach to teach interprofessional learners about end-of-life (EOL) care in dying hospitalized patients. Th...

Effect of scene simulation-based teaching on pediatric advanced life support training in medical students

Objective To assess the effect of scene simulation-based teaching on pediatric advanced life support(PALS) skills in medical students. Methods The students of two grades of Department of Pediatrics in Capital Medical University participated in the PALS training.All of them had the examination of theory and skills of critical illness management and cardiopulmonary resuscitation in children before and after the scene simulation-based teaching on PALS.The questionnaire was filled out and the data was analyzed after the training. Results Fifty-one students completed the training.The average score after the training was significantly higher than that before the training(86.51±7.16 vs.53.85±14.24, P<0.05). After the training, the error rate of ECG recognition, etiological identification and treatment of the disease, and the dosage as well as usage of medicine was significantly decreased(64.7% vs.15.7%, 71.0% vs.10.5%, 73.2% vs.25.9%). All of the students could use the defibrillator correctly and the students' satisfaction rate was more than 94%. Conclusion Scene simulation-based teaching on PALS skills can improve the theory and skills of critical illness management and cardiopulmonary resuscitation of children in medical students. Key words: Pediatric advanced life support; Scene simulation-based teaching

Education and simulation training of pediatric intensive care unit nurses to care for open heart surgery patients.

Providing appropriate education for nurses working in the pediatric intensive care unit (PICU) to develop and update the skill sets and knowledge required to care for infants and children with congenital heart disease (CHD) is a challenge. We provide care to children with a variety of congenital heart defects that require medical care and surgical corrections. In the extreme circumstance, we provide extracorporeal membrane oxygenation to those children who require extracardiac support postoperatively. Our program deals with a mean of about 150 cases annually that require surgical correction, in addition to the medically managed patients with CHD. The hospital-based simulation center opened in 2010. It provides high-fidelity simulation to enhance current medical and nursing education. Patient scenarios are created on the basis of real patient cases, maintaining the realistic details of the disease and injury processes essential to provide the pertinent learning points of each case. Shortly after the simulation center opened, the PICU educator inquired about the process to provide PICU nurses an opportunity to learn about pediatric open heart surgery patients at the simulation center. The inherent challenge within our PICU is that we have 32 nurses with various skills sets and experiences who must be able to provide care for all patients within our unit, including children with CHD. At that time, 7 PICU nurses were ready to learn how to provide nursing care to children who have undergone open heart surgery. This state of readiness is detailed later. A classroom format was used to present the material, which addressed identification of defects, along with medical and nursing management. This classroom training was followed by a 4-hour simulation session, wherein these nurses participated in 2 patient scenarios. Clinical objectives (Table 1) were reviewed and reinforced to define what needed to be learned and to ensure that learning occurred. Following this simulation training, each nurse was assigned to admit a pediatric open heart patient with an experienced nurse present to reinforce the prior learning.

Family presence during resuscitation (FPDR): A survey of emergency personnel in Victoria, Australia.

Family presence during resuscitation (FPDR) has been endorsed internationally by resuscitation councils since the year 2000; however, the extent to which FPDR is practiced in emergency settings requires further investigation. Emergency personnel (n=347) from 18 participating emergency departments across the state of Victoria, Australia completed a 10-page questionnaire, which was designed to develop an understanding of the current practice and implementation of FPDR and to ascertain the differences in practice between adult and paediatric resuscitations. Emergency personnel update their adult and paediatric advanced life support qualifications annually with 87% of nurses and 65% of doctors completing adult life support and 72% of nurses and 49% of doctors completing paediatric advanced life support training. The majority of nursing staff reported support for FPDR (83%) with over 70% indicating that it is apart of their current practice. There was strong agreement from both nurses (79%) and doctors (77%) that the family have the right to be present. A family support person was deemed as essential by nurses (92%) and doctors (89%) when allowing family to be present. A factor analysis was conducted on participant statements, revealing four codes; impact on professional practice and performance, personnel beliefs about FPDR, professional satisfaction and the importance of a support person and saying goodbye. A family support person was highlighted as essential to the successful implementation of FPDR, together with the development of a comprehensive training the education program for emergency personnel. FPDR continues to be a significant issue and further investigation into FPDR practice and implementation in the ED is warranted.

External validation of scoring instruments for evaluating pediatric resuscitation.

Although many methods have been proposed to assess clinical performance during resuscitation, robust and generalizable metrics are still lacking. Further research is necessary to develop validated clinical performance assessment tools and show an improvement in outcomes after training. We aimed to establish evidence for validity of a previously published scoring instrument--the Clinical Performance Tool (CPT)--designed to evaluate clinical performance during simulated pediatric resuscitations. This was a prospective experimental trial performed in the simulation laboratory of a pediatric tertiary care facility, with a pretest/posttest design that assessed residents before and after pediatric advanced life support (PALS) certification. Thirteen postgraduate year 1 (PGY1) and 11 PGY3 pediatric residents completed 5 simulated pediatric resuscitation scenarios each during 2 consecutive sessions; between the 2 sessions, they completed a full PALS certification course. All sessions were video recorded. Sessions were scored by raters using the CPT; total scores were expressed as a percentage of maximum points possible for each scenario. Validity evidence was established and interpreted according to Messick's framework. Evidence regarding relations to other variables was assessed by calculating differences in scores between pre-PALS and post-PALS certification and PGY1 and PGY3 using a repeated-measures analysis of variance test. Internal structure evidence was established by assessing interrater reliability using intraclass correlation coefficients (ICCs) for each scenario, a G-study, and a variance component analysis of individual measurement facets (scenarios, raters, and occasions) and associated interactions. Overall scores for the entire study cohort improved by 10% after PALS training. Scores improved by 9.9% (95% confidence interval [CI], 4.5-15.4) for the pulseless nonshockable arrest (ICC, 0.85; 95% CI, 0.74-0.92), 14.6% (95% CI, 6.7-22.4) for the pulseless shockable arrest (ICC, 0.98; 95% CI, 0.96-0.99), 4.1% (95% CI, -4.5 to 12.8) for the dysrhythmias (ICC, 0.92; 95% CI, 0.87-0.96), 18.4% (95% CI, 9.7-27.1) for the respiratory scenario (ICC, 0.97; 95% CI, 0.95-0.98), and 5.3% (95% CI, -1.4 to 2.0) for the shock scenarios (ICC, 0.94; 95% CI, 0.90-0.97). There were no differences between PGY1 and PGY3 scores before or after the PALS course. Reliability of the instrument was acceptable as demonstrated by a mean ICC of 0.95 (95% CI, 0.94-0.96). The G-study coefficient was 0.94. Most variance could be attributed to the subject (57%). Interactions between subject and scenario and subject and occasion were 9.9% and 1.4%, respectively, and variance attributable to rater was minimal (0%). Pediatric residents improved scores on CPT after completion of a PALS course. Clinical Performance Tool scores are sensitive to the increase in skills and knowledge resulting from such a course but not to learners' levels. Validity evidence from scores for the CPT confirms implementation in new contexts and partially supports internal structure. More evidence is required to further support internal structure and especially to support relations with other variables and consequence evidence. Additional modifications should be made to the CPT before considering its use for high-stakes certification such as PALS.

Medication preparation in pediatric emergencies: comparison of a web-based, standard-dose, bar code-enabled system and a traditional approach.

Increased acuity within the pediatric emergency department increases the risk of medication-related adverse events, despite the availability of validated dosing references. The eBroselow system is a standardized, web-based, bar code-enabled dosing system that eliminates the need for mathematic calculations. This study was designed to assess the accuracy of the eBroselow system and the time needed to prepare medications during pediatric simulated resuscitations compared with standard dosing references. This is a two-treatment, two-period crossover trial in which 13 nurses from the adult emergency department who had had pediatric advanced life support training within the previous 3 years, carried out medication dosing during pediatric code simulations. Nurses were randomized to the eBroselow system or to traditional dosing references during period one and transitioned to the opposite treatment group during period two. Use of the eBroselow system resulted in a 24.6% increase in the accuracy of prepared medications, with a complete elimination of clinically significant errors (those ≥20% deviation from the recommended dose). In addition, on average, medications were prepared 8 minutes faster with the eBroselow system versus standard dosing references. Use of the eBroselow system, a standardized, bar code-based, electronic medication dosing reference, increased the accuracy of medication doses prepared during pediatric code simulations by nearly 25%, with no errors being considered clinically significant.

ABSTRACT 997

Background and aims: Since 2006, the hospital was authorized to organize the medical foreign aid training program for developing countries. According to the characteristic of pediatrics, introducing the training of Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS) in the curriculum may enhance acquisition of these skills. Aims: We developed a survey to describe the perceptions and proficiency of pediatricians and pediatric nurse from developing counties regarding BLS and PALS training before and after training program. Methods: The study is to evaluate the perceptions of participants from developing countries of each program before and after the BLS and PALS training course, then to make a comprehensive analysis of their awareness and proficiency. Results: Before the training program, of 303 participants, 303 (100%) completed the survey; and 60%of participants had experience of BLS training and only 10%of participants had been trained PALS. However, among 10% trained participants, only 2% is qualified. After training course, the proficiency rate was up to 85%-95%? 99% of participants believe that BLS and PALS should be included in the medical foreign aid curriculum. Conclusions: The BLS and PALS training is welcomed by almost of participants from developing countries.The experience of such training may enhance the recognition of resuscitation as well as the practical abilities. It is very necessary to involve the BLS and PALS training in the curriculum for the trainees from developing counties.

Pediatric disaster triage education and skills assessment: A coalition approach

This study aims to 1) demonstrate one method of pediatric disaster preparedness education using a regional disaster coalition organized workshop and 2) evaluate factors reflecting the greatest shortfall in pediatric mass casualty incident (MCI) triage skills in a varied population of medical providers in King County, WA. Educational intervention and cross-sectional survey. Pediatric disaster preparedness conference created de novo and offered by the King County Healthcare Coalition, with didactic sessions and workshops including a scored mock pediatric MCI triage. Ninety-eight providers from throughout the King County, WA, region selected by their own institutions following invitation to participate, with 88 completing exit surveys. Didactic lectures regarding pediatric MCI triage followed by scored exercises. Mock triage scores were analyzed and compared according to participant characteristics and workplace environment. A half-day regional pediatric disaster preparedness educational conference convened in September 2011 by the King County Healthcare Coalition in partnership with regional pediatric experts was so effective and well-received that it has been rescheduled yearly (2012 and 2013) and has expanded to three Washington State venues sponsored by the Washington State Department of Health. Emergency department (ED) or intensive care unit (ICU) employment and regular exposure to pediatric patients best predicted higher mock pediatric MCI triage scores (ED/ICU 80 percent vs non-ED/ICU 73 percent, p = 0.026; regular pediatric exposure 80 percent vs less exposure 77 percent, p = 0.038, respectively). Pediatric Advanced Life Support training was not found to be associated with improved triage performance, and mock patients whose injuries were not immediately life threatening tended to be over-triaged (observed trend). A regional coalition can effectively organize member hospitals and provide education for focused populations using specialty experts such as pediatricians. Providers working in higher acuity environments and those with regular pediatric patient exposure perform better mock pediatric MCI triage than their counterparts after just-in-time training. Pediatric MCI patients with less than life-threatening injuries tended to be over-triaged.

Perceptions of Basic, Advanced, and Pediatric Life Support Training In a United States Medical School

BackgroundBasic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) are integral parts of emergency resuscitative care. Although this training is usually reserved for residents, introducing the training in the medical student curriculum may enhance acquisition and retention of these skills. ObjectivesWe developed a survey to characterize the perceptions and needs of graduating medical students regarding BLS, ACLS, and PALS training. MethodsThis was a study of graduating 4th-year medical students at a U.S. medical school. The students were surveyed prior to participating in an ACLS course in March of their final year. ResultsOf 152 students, 109 (71.7%) completed the survey; 48.6% of students entered medical school without any prior training and 47.7% started clinics without training; 83.4% of students reported witnessing an average of 3.0 in-hospital cardiac arrests during training (range of 0–20). Overall, students rated their preparedness 2.0 (SD 1.0) for adult resuscitations and 1.7 (SD 0.9) for pediatric resuscitations on a 1–5 Likert scale, with 1 being unprepared. A total of 36.8% of students avoided participating in resuscitations due to lack of training; 98.2%, 91.7%, and 64.2% of students believe that BLS, ACLS, and PALS, respectively, should be included in the medical student curriculum. ConclusionsAs per previous studies that have examined this topic, students feel unprepared to respond to cardiac arrests and resuscitations. They feel that training is needed in their curriculum and would possibly enhance perceived comfort levels and willingness to participate in resuscitations.

Pediatric Perioperative Life Support

Pediatric advanced life support training and guidelines are typically designed for first-responders and out-of-hospital resuscitation. Guidelines and scenarios that are more applicable to the perioperative environment would be beneficial for anesthesiologists. The goal of this article is to review resuscitation of pediatric patients during the perioperative period. We use a format that focuses on preresuscitation preparation, resuscitation techniques, and postresuscitation management in the perioperative period. In an effort to provide information of maximum benefit to anesthesiologists, we include common pediatric perioperative arrest scenarios with detailed description of their management. We also provide a section on postresuscitation management and review the techniques for maintaining the child's hemodynamic and metabolic stability. Finally, 3 appendices are included: an example of an intraoperative arrest record that provides feedback for interventions; a table of key medications for pediatric perioperative resuscitation; and a review of defibrillator use and simulation exercises to promote effective defibrillation.

G147(P) Evaluating the Impact of Introducing Advanced Paediatric Life Support Training in a Teaching Hospital in Zambia

AimsThe effective treatment of acutely sick children in resource-poor settings (including teaching hospitals in most developing countries) is limited by resources, but also by knowledge, skills and attitudes. Introducing rigorously-assessed,...

Real-time feedback can improve infant manikin cardiopulmonary resuscitation by up to 79%—A randomised controlled trial

SettingEuropean and Advanced Paediatric Life Support training courses. ParticipantsSixty-nine certified CPR providers. InterventionsCPR providers were randomly allocated to a ‘no-feedback’ or ‘feedback’ group, performing two-thumb and two-finger chest compressions on a “physiological”, instrumented resuscitation manikin. Baseline data was recorded without feedback, before chest compressions were repeated with one group receiving feedback. Main outcome measuresIndices were calculated that defined chest compression quality, based upon comparison of the chest wall displacement to the targets of four, internationally recommended parameters: chest compression depth, release force, chest compression rate and compression duty cycle. ResultsBaseline data were consistent with other studies, with <1% of chest compressions performed by providers simultaneously achieving the target of the four internationally recommended parameters. During the ‘experimental’ phase, 34 CPR providers benefitted from the provision of ‘real-time’ feedback which, on analysis, coincided with a statistical improvement in compression rate, depth and duty cycle quality across both compression techniques (all measures: p<0.001). Feedback enabled providers to simultaneously achieve the four targets in 75% (two-finger) and 80% (two-thumb) of chest compressions. ConclusionsReal-time feedback produced a dramatic increase in the quality of chest compression (i.e. from <1% to 75–80%). If these results transfer to a clinical scenario this technology could, for the first time, support providers in consistently performing accurate chest compressions during infant CPR and thus potentially improving clinical outcomes.