Pediatric Advanced Life Support Course Research Articles

Observational Study on the Effect of Duration from Pediatric Advanced Life Support (PALS) Certification on PALS Performance in Pediatric Interns in Simulated Cardiopulmonary Arrest.

Pediatric advanced life support (PALS) training is critical for pediatric residents. It is unclear how well PALS skills are developed during this course or maintained overtime. This study evaluated PALS skills of pediatric interns using a validated PALS performance score following their initial PALS certification. All pediatric interns were invited to a 45-minute rapid cycle deliberate practice (RCDP) training session following their initial PALS certification from July 2017 to June 2019. The PALS score and times for key events were recorded for participants prior to RCDP training. We then compared performance scores for those who took PALS ≥3 months, between 3 days to 3 months and 3 days after PALS. There were 72 participants, 30 (of 30) in 3 days, 18 in 3 days to 3 months, and 24 in ≥3 months groups (42 total of 52 residents, 81%). The average PALS performance score was 53 ± 20%. There was no significant difference between the groups (3 days, 53 ± 15%; 3 days-3 months, 51 ± 19%; ≥3 months, 54 ± 26%, p = 0.922). Chest compressions started later in the ≥3 months groups compared with the 3 days or ≤3 months groups ( p = 0.036). Time to defibrillation was longer in the 3 days group than the other groups ( p = 0.008). Defibrillation was asked for in 3 days group at 97%, 73% in 3 days to 3 months and 68% in ≥3 months groups. PALS performance skills were poor in pediatric interns after PALS certification and was unchanged regardless of when training occurred. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.

Pediatric Resuscitation Education in the Age of COVID-19

Despite improving medical care worldwide, vast healthcare disparities remain in low- and middle-income countries (LMIC). In Haiti, the under-5 mortality rate is more than double the rate of the Dominican Republic on the other side of the island. Through a partnership with St. Damien and Hospital Bernard Mevs in Port-Au-Prince, Haiti, and the Department of Emergency Medicine, University of Minnesota Medical School, healthcare providers have collaborated to improve pediatric emergency care and outcomes by teaching American Heart Association (AHA) courses in Haiti. Due to COVID-19, many global health initiatives, including through the University of Minnesota, have been postponed indefinitely. In efforts to continue working toward improved delivery of care, we sought to pilot a remote AHA Pediatric Advanced Life Support (PALS) course in Haiti. We delivered a complete AHA PALS course through videoconferencing, with participants engaging in hands-on procedures and simulations. We surveyed participants’ confidence in relevant skills and knowledge pre- and post-course. Results showed significantly improved ratings in 12 of the 18 surveyed items (p<0.05). Participant satisfaction in the video-based delivery of the course indicated that videoconferencing may be an effective method of course delivery. Videoconferencing shows promise as a successful tool to continue global health education.

P0682 / #1679: COMPARISON OF CRISIS RESOURCE MANAGEMENT SKILLS DURING CARDIOPULMONARY RESUSCITATION AMONG PEDIATRIC HEALTH CARE PROFESSIONALS: A SIMULATION BASED STUDY

Aims & Objectives: Cardiopulmonary resuscitation (CPR) is a team endeavor. Crisis Resource Management (CRM) is team training focusing on behavioral skills, resource utilization, communication, leadership and teamwork. CRM skills can decay over time after training. In this simulation study on CPR, we compared CRM skills of pediatric residents and nurses who have completed Pediatric Advanced Life Support Course (PALS) course less than 6-months versus more than 12-months ago. Methods:Design: Prospective observational study (January 2019- December 2019). Setting: Simulation scenario on high fidelity simulator. Participants: Pediatric residents and nursing staff. Outcome: CRM skills of leader and team members assessed using Mayo’s high-performance teamwork scale and Anesthesiologist Non-Technical skills (ANTS) tool. Results: Total 102 participants (residents-89 and nurses-13) divided into group-A (n=45) and group-B (n=57). Leaders in both groups had shown non-significant but below par CRM skills in terms of introducing team members (65.4% vs 82%), assigning roles (54.6% vs 59%) and summarizing the case (66.8% vs 68.2%). Group A participants felt problem as tem leader more often (82% vs 45.4%; p=0.04). Among team members, we found statistically significant difference in terms of leader recognition by team members (61% vs 62.5%, p= 0.01). There was no significant difference in terms of understanding roles (p= 0.22), clear message (p= 0.26), closing loop (p= 0.60), using checklist (p=0.80) and active participation (p= 0.80). Conclusions: In a simulated witnessed cardiac arrest, CRM skill were below par and were associated with poor team performance. This highlights the need for more emphasis on CRM skills in ALS course

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.

Teaching Versus Learning

Teaching Versus Learning

Simulation-Based Curricula for Enhanced Retention of Pediatric Resuscitation Skills: A Randomized Controlled Study.

Resuscitation skills decay as early as 4 months after course acquisition. Gaps in research remain regarding ideal educational modalities, timing, and frequency of curricula required to optimize skills retention. Our objective was to evaluate the impact on retention of resuscitation skills 8 months after the Pediatric Advanced Life Support (PALS) course when reinforced by an adjunct simulation-based curriculum 4 months after PALS certification. We hypothesized there would be improved retention in the intervention group. This is a partial, double-blind, randomized controlled study. First-year pediatric residents were randomized to an intervention or control group. The intervention group participated in a simulation-based curriculum grounded in principles of deliberate practice and debriefing. The control group received no intervention. T-tests were used to compare mean percent scores (M) from simulation-based assessments and multiple-choice tests immediately following the PALS course and after 8 months. Intervention group (n = 12) had overall improved retention of resuscitation skills at 8 months when compared with the control group (n = 12) (mean, 0.57 ± 0.05 vs 0.52 ± 0.06; P = 0.037). No significant difference existed between individual skills stations. The intervention group had greater retention of cognitive knowledge (mean, 0.78 ± 0.09 vs 0.68 ± 0.14; P = 0.049). Residents performed 61% of assessment items correctly immediately following the PALS course. Resuscitation skills acquisition from the PALS course and retention are suboptimal. These findings support the use of simulation-based curricula as course adjuncts to extend retention beyond 4 months.

Estimating the Weight of Children During Simulated Emergency Situations Using the Broselow Tape: Are We Underestimating the Risks of Errors?

The objective of this study was to evaluate whether residents can accurately estimate children's weight using the Broselow tape. We conducted a preplanned secondary analysis from an experimental trial. Participants were residents in pediatrics, family medicine, and emergency medicine rotating in the ED. Residents were randomly assigned to 2 sets of paired scenarios during 2 sessions. They were asked to estimate the weight of a manikin using the Broselow tape at the beginning of each scenario. The first scenario from the initial session and the last scenario from the second session were used for the current study. The primary analysis was the proportion of participants who accurately estimated manikin weight within a 10% margin of error. Forty residents were recruited. Thirty-two (80%) reported knowledge of the Broselow tape and 13 (32.5%) reported previous use. Weight estimation was accurate in 60% (24/40; 95% confidence interval [CI], 45%-74%) during the first scenarios. Error in weight estimation differed by greater than 25% in 28% (11/40). Error in estimation was not associated with previous knowledge (odds ratio, 6.2; 95% CI, 0.68-56) or previous use (odds ratio, 0.9; 95% CI, 0.23-3.5) of the Broselow tape. In the last scenario, 88% accurately estimated manikin weight (35/40; 95% CI, 73%-95%). Although most residents reported knowledge of the Broselow tape, 40% made erroneous weight estimations by at least 10% with the first use in this simulation study. With repeated use, they improved significantly over time. Teaching appropriate use of the Broselow tape should be part of residency-training curricula and pediatric advanced life support course.

LO38: Does spaced instructional design result in improved retention of pediatric resuscitation skills? A randomized education study

Introduction: Survival from cardiac arrest has been linked to the quality of resuscitation care. Unfortunately, healthcare providers frequently underperform in these critical scenarios, with a well-documented deterioration in skills weeks to months following advanced life support courses. Improving initial training and preventing decay in knowledge and skills are a priority in resuscitation education. The spacing effect has repeatedly been shown to have an impact on learning and retention. Despite its potential advantages, the spacing effect has seldom been applied to organized education training or complex motor skill learning where it has the potential to make a significant impact. The purpose of this study was to determine if a resuscitation course taught in a spaced format compared to the usual massed instruction results in improved retention of procedural skills. Methods: EMS providers (Paramedics and Emergency Medical Technicians (EMT)) were block randomized to receive a Pediatric Advanced Life Support (PALS) course in either a spaced format (four 210-minute weekly sessions) or a massed format (two sequential 7-hour days). Blinded observers used expert-developed 4-point global rating scales to assess video recordings of each learner performing various resuscitation skills before, after and 3-months following course completion. Primary outcomes were performance on infant bag-valve-mask ventilation (BVMV), intraosseous (IO) insertion, infant intubation, infant and adult chest compressions. Results: Forty-eight of 50 participants completed the study protocol (26 spaced and 22 massed). There was no significant difference between the two groups on testing before and immediately after the course. 3-months following course completion participants in the spaced cohort scored higher overall for BVMV (2.2 ± 0.13 versus 1.8 ± 0.14, p=0.012) without statistically significant difference in scores for IO insertion (3.0 ± 0.13 versus 2.7± 0.13, p= 0.052), intubation (2.7± 0.13 versus 2.5 ± 0.14, p=0.249), infant compressions (2.5± 0.28 versus 2.5± 0.31, p=0.831) and adult compressions (2.3± 0.24 versus 2.2± 0.26, p=0.728) Conclusion: Procedural skills taught in a spaced format result in at least as good learning as the traditional massed format; more complex skills taught in a spaced format may result in better long term retention when compared to traditional massed training as there was a clear difference in BVMV and trend toward a difference in IO insertion.

Assessing the Usefulness of a Mock Code Curriculum

BACKGROUND: Although health care providers are trained for pediatric cardiopulmonary resuscitation (CPR) using Pediatric Advanced Life Support (PALS) courses, there is a gap between training and performance. Pediatrics residents do not feel adequately prepared for these events outside of PALS, and multiple studies show that the skills developed during PALS progressively decline reaching pretest levels in 1-2 years. Studies done in Children’s hospitals show that this gap can be bridged by periodic mannequin simulation sessions. They also report an overall increase in readiness to codes …

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.

A Randomized Control Trial of Cardiopulmonary Feedback Devices and Their Impact on Infant Chest Compression Quality: A Simulation Study.

In effort to improve chest compression quality among health care providers, numerous feedback devices have been developed. Few studies, however, have focused on the use of cardiopulmonary resuscitation feedback devices for infants and children. This study evaluated the quality of chest compressions with standard team-leader coaching, a metronome (MetroTimer by ONYX Apps), and visual feedback (SkillGuide Cardiopulmonary Feedback Device) during simulated infant cardiopulmonary resuscitation. Seventy voluntary health care providers who had recently completed Pediatric Advanced Life Support or Basic Life Support courses were randomized to perform simulated infant cardiopulmonary resuscitation into 1 of 3 groups: team-leader coaching alone (control), coaching plus metronome, or coaching plus SkillGuide for 2 minutes continuously. Rate, depth, and frequency of complete recoil during cardiopulmonary resuscitation were recorded by the Laerdal SimPad device for each participant. American Heart Association-approved compression techniques were randomized to either 2-finger or encircling thumbs. The metronome was associated with more ideal compression rate than visual feedback or coaching alone (104/min vs 112/min and 113/min; P = 0.003, 0.019). Visual feedback was associated with more ideal depth than auditory (41 mm vs 38.9; P = 0.03). There were no significant differences in complete recoil between groups. Secondary outcomes of compression technique revealed a difference of 1 mm. Subgroup analysis of male versus female showed no difference in mean number of compressions (221.76 vs 219.79; P = 0.72), mean compression depth (40.47 vs 39.25; P = 0.09), or rate of complete release (70.27% vs 64.96%; P = 0.54). In the adult literature, feedback devices often show an increase in quality of chest compressions. Although more studies are needed, this study did not demonstrate a clinically significant improvement in chest compressions with the addition of a metronome or visual feedback device, no clinically significant difference in Pediatric Advanced Life Support-approved compression technique, and no difference between compression quality between genders.

Experience of Pediatric Advanced Life Support (PALS) provider courses in a tertiary care centre of Pakistan

Background: Pediatric Advanced Life Support (PALS) courses prepare candidates to respond to life-threatening emergencies in children. Objective: To describe the experiences of teaching the PALS course in a developing country. Methods: We described the experience of teaching PALS courses conducted according to guidelines of American Heart Association to physicians and nurses at Aga Khan University Hospital from January 2011 to December 2015. The outcome of the courses was recorded as passing of participants both in written test as well as skill stations. The passing score for test was 84%. We also recorded participant’s evaluation of the course. Data were entered in the excel sheet and descriptive statistics were applied. Results: During 5 years, 1044 candidates participated in 88 PALS courses. Majority were female (n=732, 70.1%). Physicians and nurses were 383 (36.6%) and 661(63.3%) respectively. Besides pediatricians, 373 participants (35.7%) were from emergency department and other clinical area. A passing grade was achieved by 936 (89.6%) of participants; the mean test score for whole sample was 88.37%. Four PALS instructor courses were also conducted and 33 new instructors were added to instructor pool. Evaluation of the course by students revealed that 98% of student felt able to respond in emergency situations while 93% felt confident in the use of taught skills. Conclusion: We found that conducting PALS courses is a positive educational experience to participants which will help in saving the lives of acutely ill children by practical implications.

Pediatric advanced life support (PALS) and simulation

Pediatric Advanced Life Support (PALS) course is a very popular course directed towards Pediatricians aimed towards improving the outcomes of sick children. However, despite the popularity of the course, translation of this knowledge to the bedside has been far from satisfactory due to variety of reasons. Few strategies have been employed to make the course more effective. Modular training by delivering PALS components in a staggered fashion over a defined time period, self-directed interactive web based learning, use of high fidelity simulators to deliver realistic scenarios, conducting the course in the provider’s workplace using his resources and team and using reflective practice based debriefing technique to enhance learning from real life events have shown some promise.

Board #158 - Research Abstract CAB Versus ABC

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.

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.

Board #119 - Research Abstract Quantifying Clinical Performance During Simulated Pediatric Cardiac Arrest (Submission #9887)

Hypothesis Methods to quantitatively measure performance during resuscitative care are lacking in published literature. Members of our investigative team have previously published psychometric analyses of task-based scoring instruments used in educational research in pediatric resuscitation. These published investigations used instruments that were designed for specific cases in pediatric resuscitation, rather than for a more generalizable application. We hypothesize that a novel scoring instrument will reliably assess clinical performance during simulated cardiac arrest. Methods This study was conducted at 11 pediatric centers in Canada and the US. Teams of pediatric healthcare providers performed a simulated arrest scenario (asystole for 6 minutes, VF for 6 minutes). A task-based scoring instrument was designed using a 0, 1, or 2 point scoring system to rate performance; items were chosen according to the pulseless arrest algorithm of the American Heart Association Pediatric Advanced Life Support course and include CPR performance parameters (chest compression rate, depth, release, pauses), defibrillation (dose, timing), and epinephrine administration (dose, timing). Multiple raters reviewed and scored a set of simulations. Overall interrater reliability was measured; a fully-crossed generalizability study with team and rater as facets was performed to determine the variance in scores ascribable to each facet; a decision study was done to determine the effect of additional raters and scenarios on the G coefficient. Results Three raters scored four videos. Overall scores ranged from 53/90 (59%) to 73/90 (81%) possible points. Intraclass correlation coefficient was 0.77 (F 3,8 = 4.46, p = 0.04). Variance components were 21% for rater, 57% for scenario. G coefficient was 0.80; by D study this increased to 0.91 and 0.93 with 8 and 10 raters, respectively. Conclusion A novel scoring instrument for quantifying performance during pediatric cardiac arrest showed modest reliability and generalizability. Future studies should examine the effect of a larger number of raters and/or scenarios on generalizability, as well as the utility of the instrument in assessing real clinical performance. Disclosures Adam Cheng receives grant support from the Heart and Stroke Foundation of Canada, and the Canadian Institute for Health Research. Nancy Tofil spoke at a Laerdal Conference, presenting her own original material. She did not receive honoraria, but was reimbursed travel expenses.

Abstract 268: Quantitative Performance Assessment of Simulated Pediatric Cardiopulmonary Resuscitation

Background: Methods to quantitatively measure performance during resuscitative care are lacking in published literature. Members of our group have previously published psychometric analyses of task-based scoring instruments used in educational research in pediatric resuscitation. These published investigations used instruments that were designed for specific cases in pediatric resuscitation, rather than for a more generalizable application. We hypothesize that a novel scoring instrument will reliably assess clinical performance during simulated cardiac arrest. Methods: This study was conducted at 11 pediatric centers in Canada and the US. Teams of pediatric providers performed a simulated cardiac arrest scenario (asystole for 6 minutes, VF for 6 minutes). A task-based scoring instrument was designed by investigator consensus using a 0, 1, or 2 point scoring system to rate performance during cardiac arrest. The items were chosen according to the essential steps in the pulseless arrest algorithm of the AHA Pediatric Advanced Life Support course and include CPR performance parameters (chest compression rate, depth, release, pauses), defibrillation (dose in J/kg, timing), and epinephrine (dose, timing). Multiple raters reviewed and scored a set of simulations. Overall interrater reliability was measured; a fully-crossed generalizability study with team and rater as facets was performed to determine the variance in scores ascribable to each facet; a decision study was done to determine the effect of additional raters and scenarios on the G coefficient. Results: Three raters scored four videos. Overall scores ranged from 53/90 (59%) to 73/90 (81%) possible points. Intraclass correlation coefficient was 0.77 (F 3,8 = 4.46, p = 0.04). Variance components were 21% for rater, 57% for scenario. G coefficient was 0.80; by D study this increased to 0.91 and 0.93 with 8 and 10 raters, respectively. Conclusions: A novel scoring instrument for quantifying performance during pediatric cardiac arrest showed modest reliability and generalizability. Future studies should examine the effect of a larger number of raters and/or scenarios on generalizability, as well as the utility of the instrument in assessing real clinical performance.

ABSTRACT 957

Background and aims: WFPICCS launched in 2007 the Sepsis Initiative, until 2009 in Guatemala and Mexico provinces with higher infant mortality, there is not available a pediatric advanced life support courses to the populations with Very Low Human Development index. Aims: Widespread the training in pediatric advanced life support in public hospitals and rural places with the highest mortality. Methods: Volunteer Instructors from Guatemala and Mexico, with the academic support of Red Iberoamericana del Estudio de la Parada Cardiorrespiratoria de la Infancia (RIBEPCI), from June 2009 to December 2013 developed 30 basic life support, 5 immediate life support and 28 pediatric advanced life support courses. Those with high educational standards course with affordable low cost for the health workers and freshmen residents. (US $ 100.00 each participant). Results: 1,186 health care workers were trained in pediatric life support, following the European Resuscitation Council Guidelines. The majority of this group are freshmen pediatrics residents and community hospital physicians. More than 95% of them after they took the course were evaluated and passed the rapid cardiopulmonary assessment, developed the life threatening approach and management manuevers, and all of them describes themselves enough confident for treating, as individual and as a part of a team the clinical scenarios. Conclusions: The assurement of pediatric advanced life support, early recognition and treatment as a part of Sepsis Initiative. With affordable low cost, educational high quality and widespread distribution in places with high mortality could improve the Surviving Sepsis Campaing endorsment.

Board 424 - Research Abstract Validation of a Tool for the Assessment of Trainees During Simulated Pediatric Resuscitation (Submission #967)

Introduction/Background Dealing with a patient in an emergency situation, such as cardiac arrest, is among the most challenging scenarios that a physician may face in their career. To better prepare trainees for such events, a growing number of residency programs are incorporating high-fidelity simulation into their training.1 As part such a curriculum, it is crucial to have a tool that can objectively assess performance of trainees during simulated resuscitations. Many tools have been proposed to measure clinical skills, but recently Grant2 developed a tool that assesses not only clinical performance but also leadership skills during simulated pediatric resuscitations. We aimed to validate Grant’s tool and assess inter-rater reliability of the instrument when used by providers not involved in the tool’s development. Methods This study took place in the simulation lab of a tertiary care pediatric center. In the setting of a previous study,3 a total of 13 first-year and 11 third-year residents were videotaped during simulated pediatric resuscitation scenarios. Each resident led five scenarios before and after their Pediatric Advanced Life Support (PALS) course. The pre and post-PALS scenarios were paired, such that each resident acted as team leader in a pulseless non-shockable arrest, pulseless shockable arrest, dysrhythmia, respiratory and shock scenario. Five subspecialists in the fields of pediatric emergency medicine and intensive care from North America and Europe were trained to evaluate the residents’ performance using Grant’s assessment tool. All raters were blinded to the pre and post-PALS phases of the scenarios. Inter-rater reliability was assessed by having two expert raters independently evaluate the residents performance. In the absence of a gold standard scoring tool, we used construct validity to validate the tool. Knowing that the PALS course has been shown to increase immediate short-term knowledge of healthcare professionals,4 it was determined that, for the tool to be valid, participants should improve their score after participating in the PALS course. Pre and post-PALS scores were compared using a paired sample Student T-test. Inter-rater reliability was measured for the five scenarios using intra-class correlation coefficient (ICC). Results Following the PALS course, the residents scores improved by 11% (95%CI 6.1-16) for the pulseless non-shockable arrest, 17% (95%CI 11-24) for the pulseless shockable arrest, 6% (95%CI 0.1-12) for the dysrhythmias, 12% (95%CI 4.3-21) for the respiratory scenario, 14% (95%CI 7.3-21) for the shock scenarios. Inter-rater reliability was excellent as demonstrated by an overall intra-class correlation coefficient of 0.91 (95%CI 0.88-0.93). Conclusion Grant’s scoring instrument demonstrated construct validity and excellent reliability as a measure of clinical performance for simulated pediatric resuscitations. Moreover, we were able to show that it is a generalizable tool, as it was valid for all of our five simulated scenarios. Further research should be done to assess whether this tool is reliable when used to assess trainees in real-time rather than video-based assessments.

G143(P) Is There a Case to Emphasise the Use of Luscombe Formula Instead of the Advanced Paediatric Life Support Course Formula For the Paediatric Weight Calculation?

AimTo validate Luscombe’s formula (LF) for paediatric weight calculation comparing with the measured weight and the calculated weight by the Advanced Paediatric Life Support (APLS) formula and applying it to...