Simulated Cardiopulmonary Resuscitation Research Articles

Pediatric Tracheostomy Education Program Structures, Barriers, and Support: A Nationwide Survey of Children's Hospitals.

Safe discharge for children with tracheostomies requires caregivers to be competent in tracheostomy management, including emergency interventions. Inpatient pediatric units are tasked with preparing families for discharge, yet variations exist in the standards of tracheostomy education across institutions. To address this gap, we aimed to describe the inpatient tracheostomy education programs in children's hospitals across the United States. This is a cross-sectional study conducted between May and July 2022. We distributed an online survey to a purposeful sample of representatives from participating children's hospitals. The 42-item survey evaluated various aspects of tracheostomy education, including teaching strategies, timing of education, operational support, and overall program structure. Descriptive statistics were generated, and researchers reviewed open-ended items to identify themes. Thirty-seven institutions participated, 26 of which were free-standing children's hospitals. All programs surveyed conducted bedside checkoffs, required a rooming-in period, and provided tracheostomy cardiopulmonary resuscitation and low-fidelity simulation for emergency teaching. Programs varied in the order of education and the type of support received. Many programs lacked a postdischarge follow-up structure and the majority evaluated program effectiveness with readmission rates. Lack of private-duty nursing was the primary barrier to discharge, followed by family availability and reluctance to participate in education. The program structure and support variations suggest that more investigation is needed in discharge education and postdischarge follow-up for children with tracheostomies. A national guideline for tracheostomy education and identification of standardized quality metrics for program evaluation would benefit current and emerging programs.

An observer tool to enhance learning of medical students during simulation training of cardiopulmonary resuscitation: a randomised controlled trial

BackgroundSimulation training in cardiopulmonary resuscitation (CPR) is effective but active practice time is limited given the large number of students and the learning effect size remains small. To improve learning during observation, the use of an observer tool (OT) has been advocated. The aim was to assess the value of OT to improve medical students' learning outcomes during CPR simulation training.MethodsThis prospective, randomized study took place during CPR training of medical students. The workshop targeted recognition of unconsciousness, absence of breathing, call for help, cardiac massage and defibrillation. Students practicing in dyads were randomized to use an OT (i.e., a checklist summarizing CPR skills and step-by-step actions) (OT +) or not (OT-) when observing others. At the end of the training, the global performance of the dyad was assessed by an evaluator using the OT checklist (primary outcome). The non-technical skills (NTS), chest compression quality, perceived improvement in knowledge and skills and knowledge score (MCQ) were also recorded.ResultsThe student dyads were included (OT + : n = 40 and OT-: n = 41). Immediately after training, the global performance was similar between the two groups: OT + : 24 [23—25] and OT-: 23 [21—24] (out of 25), p = 0.052. However, better learning of breathing assessment and cardiac massage performance, as well as a better knowledge score, were found in the OT + group. No significant difference was observed for NTS or perceived improvement in knowledge and skills. Satisfaction was higher in the OT- group.ConclusionsThe use of an OT during CPR simulation did not show any pedagogical benefit on the global performance of medical students. However, a potential benefit was found for several important secondary outcomes. Further studies are needed to confirm these positive results.

Evaluation of ventilation quality conducted by firefighters during simulated cardiopulmonary resuscitation

Evaluation of ventilation quality conducted by firefighters during simulated cardiopulmonary resuscitation

Effectiveness of a dispatcher-assisted CPR using an animated image: Simulation study

IntroductionConsidering the few studies evaluating bystander cardiopulmonary resuscitation (CPR) performance, we sought to analyze differences in bystander CPR performance with and without the use of our self-developed animated GIFs based on dispatcher-assisted CPR simulation. MethodsA total of 80 adults who had not received CPR training over the past two years participated in the study. Among them, 40 people were classified into the auditory group (receiving CPR instructions only over the phone), and the other 40 people were classified into the audiovisual group (receiving CPR instructions over the phone after receiving images on a smartphone). All participants were asked to perform adult and infant CPR for 2 min. CPR performance was recorded using two video cameras (front and side) and analyzed by two emergency physicians, whereas CPR quality was measured using Resusci Anne & Baby QCPR Mk II (Laerdal). ResultsIn the adult CPR study, the audiovisual group had higher performance scores for adequacy of “knee position,” “hand posture,” “elbow extension,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). No significant difference in CPR quality was observed between the two groups. In the infant CPR study, audiovisual group had higher performance scores in adequacy of “compression site,” “finger posture,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). Regarding CPR quality, the audiovisual group had higher scores for “adequate compression rate ratio” (p = 0.047). ConclusionAudiovisual guidance using animated GIFs more effectively improved CPR Standard Posture Completeness and Instruction Performance than did traditional auditory guidance.

Rapid cycle deliberate practice versus postsimulation debriefing in pediatric cardiopulmonary resuscitation training: a randomized controlled study.

Simulation plays an important role in cardiopulmonary resuscitation training. Comparing postsimulation debriefing with rapid cycle deliberate practice could help determine the best simulation strategy for pediatric cardiopulmonary resuscitation training among pediatric residents. This is a single-blind, prospective, randomized controlled study. First- and second year pediatric residents were enrolled and randomized into two groups (1:1 ratio): rapid cycle deliberate practice group (intervention) or postsimulation debriefing group (control). They participated in two rounds of simulated pediatric cardiopulmonary arrest to assess the simulated pediatric cardiopulmonary resuscitation performance gain (round 1) and retention after a 5-6 week washout period (round 2). Scenarios were video-recorded and analyzed by blinded evaluators. The main outcome was the time to initiation of chest compressions. Secondary outcomes included time to recognize a cardiopulmonary arrest, time to recognize a shockable rhythm, time to defibrillation, time to initiation of chest compressions after defibrillation, and chest compression fraction. Sixteen groups participated in the first round and fifteen groups in the second one. Time to intiation of chest compressions decreased from preintervention scenario to the round 1 testing scenario and increased from round 1 to round 2 testing scenario. However, no interaction effects nor group effects were observed (p=0.885 and p=0.329, respectively). There were no significant differences between the two groups regarding the secondary outcomes. Despite an overall improvement in simulated pediatric cardiopulmonary resuscitation performance, we did not observe significant differences between the two groups regarding the analyzed variables. The decline in simulated pediatric cardiopulmonary resuscitation performance after 5 weeks suggests the need for shorter time intervals between training sessions.

Designing of a High-Quality CPR Simulation Game Clinical Scenario for Nursing Students: A Qualitative Study

Cardiopulmonary resuscitation (CPR) is an important skill for nursing students. The process of learning high-quality CPR with a simulation-based learning method can be developed into a simulation game. In order to develop a CPR HQ simulation game, a clinical scenario that can be used as a guide in carrying out storyboards is needed. This research aims to formulate a simulation scenario that will serve as the basis for developing a high-quality CPR simulation game to increase nursing students' competency. This qualitative research uses a Participatory Action Research (PAR) approach by inviting 15 respondents from the prospective user population, namely Emergency Nursing Lecturers, Emergency Room Nurses, BLS Trainers, and nursing students, to carry out Focus Group Discussions. The study's results revealed clinical scenarios that were arranged based on 4 themes, including 1) suitability of the competency being tested, 2) minimum competency for 5 cycles of CPR, 3) settings in the pre-and intrahospital scope, and 4) choice of patient outcome. These components are crucial when designing simulation scenarios that support students’ cognitive processes to achieve High-Quality CPR in nursing students. Thus, the results of this research can then be used as a guide in developing the HQ-CPR game as a learning medium for nursing students.

Release velocity improvement with a new metronome-guided chest compression protocol: preliminary results of the RITMICO study

Abstract Introduction Annually, emergency medical services treat over 350’000 out-of-hospital cardiac arrests in the U.S. and over 25’000 in Europe. Outcomes vary widely, according also to the quality of the CardioPulmonary Resuscitation (CPR) provided. Recently, it was demonstrated how, on top of the compression phase, chest release phase is also important to obtain an adequate heart and brain perfusion. However, no studies describe how to ameliorate this parameter during resuscitation. Purpose We investigated if a modified metronome-guided procedure might improve chest compression release velocity during CPR simulation on standard manikin, compared to the standard procedure. Methods We developed a double-click metronome for CPR: the first click corresponds to chest compression and the second to the end of chest release. Volunteers with different levels of expertise in CPR and with a valid BLS-D certification have been included in the study. Each subject performed two CPR manikin simulations following a 4-min protocol with the standard and the modified metronome (Figure 1), in a random order. An Automated External Defibrillator (AED) equipped with pads allowed continuous measurement of CPR quality during simulations. Three CPR parameters have been measured: compression depth, rate and release velocity. CPR simulation was guided only by the external metronome, all audio prompts from the AED were silenced. The two procedures have been compared, in terms of CPR quality, using Wilcoxon signed-ranks test. Impact of subject-specific factors on the difference in CPR quality has been evaluated using stepwise regression. Results 151 volunteers were included in the study, 23 of them have been excluded due to incomplete data recording. Comparison between the two procedures (Figure 2) showed a significant increase of median chest compression depth (p&amp;lt;&amp;lt;0.001) and release velocity (p&amp;lt;0.05) with the modified metronome. Percentage of compressions within the optimal range was significantly higher for compression depth (p&amp;lt;0.05) and significantly lower for compression rate (p&amp;lt;0.01) with the modified metronome. Chest compression release velocity difference was not statistically significant (p=0.20). No significant impact of sex, age and level of expertise was observed. Conclusions The double-click metronome significantly increased CPR quality in terms of both compression depth and release velocity. The decrease of compressions within the optimal rate range in the modified procedure could be due to lack of familiarity with the new rhythm and needs further evaluation. Our study represents the first trial trying to improve chest compression release velocity. Demonstrating the efficacy of this procedure could pave the way to clinical trials in real resuscitations to confirm the potential impact on the outcome of out-of-hospital cardiac arrest.Study protocolComparison between the two procedures

Implications of pediatric extracorporeal cardiopulmonary resuscitation simulation for intensive care team confidence and coordination: A pilot study.

Extracorporeal cardiopulmonary resuscitation (ECPR) is associated with improved outcomes in select populations, however, crisis resource management (CRM) in this setting is logistically challenging. This study evaluates the impact of ECPR simulation on self-perceived confidence and collaboration of intensive care unit team members. This is a prospective observational study analyzing data obtained between July 2018-December 2019. This study focused on non-surgical members of critical care team consisting of pediatric intensivists, resident physicians, registered nurses, respiratory therapists. Participants were expected to perform cardiopulmonary resuscitation (CPR) during the ECPR event, participate in code-team responsibilities and provide ancillary support during cannulation. Pre- and post-simulation surveys employed the Likert scale (1 = not at all confident, 5 = highly confident) to assess self-perceived scores in specified clinical competencies. Twenty-nine providers participated in the simulation; 38% had prior ECPR experience. Compared to mean pre-study Likert scores (2.4, 2.4, 2.5), post-simulation scores increased (4.2, 4.4, 4.3) when self-evaluating: confidence in assessing patients needing ECPR, confidence in participating in ECPR workflow and confidence in performing high-quality CPR, respectively. Post-simulation values of >3 were reported by 100% of participants in all domains (p < .0001). All participants indicated the clinical scenario and procedural environment to be realistic and appropriately reflective of situational stress. Additionally, 100% of participants reported the simulation to improve perceived team communication and teamwork skills. This study demonstrated preliminary feasibility of pediatric ECPR simulation in enhancing independent provider confidence and team communication. This self-perceived improvement may establish a foundation for cohesive CRM, in preparation for a real life ECPR encounter.

Association of CPR simulation program characteristics with simulated and actual performance during paediatric in-hospital cardiac arrest

AimTo evaluate associations between characteristics of simulated point-of-care cardiopulmonary resuscitation (CPR) training with simulated and actual intensive care unit (ICU) CPR performance, and with outcomes of children after in-hospital cardiac arrest. MethodsThis is a pre-specified secondary analysis of the ICU-RESUScitation Project; a prospective, multicentre cluster randomized interventional trial conducted in 18 ICUs from October 2016–March 2021. Point-of-care bedside simulations with real-time feedback to allow multidisciplinary ICU staff to practice CPR on a portable manikin were performed and quality metrics (rate, depth, release velocity, chest compression fraction) were recorded. Actual CPR performance was recorded for children 37 weeks post-conceptual age to 18 years who received chest compressions of any duration, and included intra-arrest haemodynamics and CPR mechanics. Outcomes included survival to hospital discharge with favourable neurologic status. ResultsOverall, 18,912 point-of-care simulations were included. Simulation characteristics associated with both simulation and actual performance included site, participant discipline, and timing of simulation training. Simulation characteristics were not associated with survival with favourable neurologic outcome. However, participants in the top 3 sites for improvement in survival with favourable neurologic outcome were more likely to have participated in a simulation in the past month, on a weekday day, to be nurses, and to achieve targeted depth of compression and chest compression fraction goals during simulations than the bottom 3 sites. ConclusionsPoint-of-care simulation characteristics were associated with both simulated and actual CPR performance. More recent simulation, increased nursing participation, and simulation training during daytime hours may improve CPR performance.

Public Cardio Pulmonary Resuscitation Simulation Training on Self-Efficacy in Society

This study aims to determine the effect of lay cardiopulmonary resuscitation simulation method training on self-efficacy in the management of lay cardiopulmonary resuscitation in the community. The method used is a one-group pre-post test design with convenience sampling. The results showed that the significance value of self-efficacy before and after the intervention was 0.001 (p-value &lt;0.05). In conclusion, there is an effect of layman's CPR simulation training on community self-efficacy. This training can be an alternative for health workers to increase people's self-efficacy beliefs in CPR.&#x0D; &#x0D; Keywords: Self Efficacy, Cardiac Arrest, Community, Cardio Pulmonary Resuscitation

Assessment of over-the-head resuscitation method in an inflatable rescue boat sailing at full speed. A non-inferiority pilot study

IntroductionDrowning is a public health problem. Interrupting the drowning process as soon as possible and starting cardiopulmonary resuscitation (CPR) can improve survival rates. Inflatable rescue boats (IRBs) are widely used worldwide to rescue drowning victims. Performing CPR in special circumstances requires adjusting the position based on the environment and space available. The aim of this study was to assess the quality of over-the-head resuscitation performed by rescuers aboard an IRB in comparison to standard CPR. MethodsA quasi-experimental, quantitative, cross-sectional pilot study was conducted. Ten professional rescuers performed 1 min of simulated CPR on a QCPR Resuscy Anne manikin (Laerdal, Norway) sailing at 20 knots using two different techniques: 1) standard CPR (S-CPR) and 2) over-the-head CPR (OTH-CPR). Data were recorded through the APP QCPR Training (Laerdal, Norway). ResultsThe quality of CPR was similar between S-CPR (61%) and OTH-CPR (66%), with no statistically significant differences (p = 0.585). Both the percentage of compressions and the percentage of correct ventilations did not show significant differences (p > 0.05) between the techniques. ConclusionThe rescuers can perform CPR maneuvers with acceptable quality in the IRB. The OTH-CPR technique did not show inferiority compared to S-CPR, making it a viable alternative when boat space or rescue conditions do not allow the conventional technique to be performed.

Cardiopulmonary Resuscitation Capacity Building Training for High School Students in Martapura, Banjar Regency

The Banjar Regency area is prone to flooding and is one of the disaster areas that can cause casualties and stress that triggers an increase in cardiovascular disease sufferers. This condition requires community preparedness for emergencies. The purpose of this community service activity is to train partners skills in cardiopulmonary resuscitation skills to be able to help victims of cardiac or respiratory arrest. The first implementation of this community service activity is carrying out an initial test to recognize emergency signs in heart and lung attacks, then providing an introduction to the concept of heart and lung emergency through lecture methods, discussion, and sharing related to real events of cardiopulmonary arrest in the community, then the final stage is evaluation of student abilities. The target of this community service activity was 40 students who are members of the High School Youth Red Cross in Martapura City, Banjar Regency. The results of this community service activity students understand material related to cardiopulmonary resuscitation, and providing basic life support counseling has a significant effect on student knowledge. Through this activity, students are expected to be able to provide a pre-hospital cardiopulmonary resuscitation simulation, and students can disseminate information to those closest to them.

Transfer learning based deep network for signal restoration and rhythm analysis during cardiopulmonary resuscitation using only the ECG waveform

Minimizing the interruption of cardiopulmonary resuscitation (CPR) is an important technique to improve the survival of out-of-hospital cardiac arrest (OHCA) patients. Recent studies have adopted deep convolutional neural networks (CNNs) to analyze corrupted ECGs during CPR for shockable rhythm detection, however, none of them provided restored ECG signals using only the ECG waveform. In this study, a self-supervised UNet deep learning network is designed to restore the underlying ECG signals during chest compressions without additional reference signals. The UNet is pretrained using a large dataset created by combining 12-lead clean ECG signals with simulated CPR artifacts generated by a mathematical model. Transfer learning is applied to fine-tune the UNet parameters based on combined ECG signals from OHCA patients. Finally, an independent dataset extracted from OHCA patients is used to test the model. Compared with the artifact corrupted ECG signals, the overall signal-to-noise ratio (SNR) is improved from −5.3 (-11.2, 0.8) dB to 1.9 (0.7, 3.9) dB after the restoration, and the accuracy of the rhythm detection is improved from 65.8% to 90.8%. The proposed method not only effectively restores the underlying ECG signals but also provides accurate shock advice without interrupting CPR using only the ECG.

The Use of the Borg Rating of Perceived Exertion Scale in Cardiopulmonary Resuscitation.

A cardiopulmonary arrest is a critical event whose survival rate is related to the quality of resuscitation maneuvers combined with the use of technology. It is important to understand the perception of fatigue during this procedure, aiming to improve the effectiveness of compressions to increase the chances of survival. To apply the Borg rating of perceived exertion scale (Borg scale) to analyze the exertion perceived by nurses during cardiopulmonary resuscitation maneuvers using a feedback device. Experimental study with a randomized distribution of nurses in a teaching hospital. Perceived exertion during simulated cardiopulmonary resuscitation with/without a feedback device was assessed using the Borg scale. The statistical significance level of 5% was adopted. 69 nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference between critical and non-critical units. The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to lower exertion and heart rate reduction during resuscitation maneuvers. The low cost and ease of application favor its use during training and real-time resuscitation attempts to assess performance using a feedback device to reduce exertion and perception of fatigue. It allows reflection on the intervening factors and resources that can influence the quality of resuscitation attempts and the chances of survival.

Direct versus Video Laryngoscopy during Simulated Mechanical Chest Compressions: A Randomized Crossover Trial.

Sir, Mechanical compression devices are often utilized for cardiopulmonary resuscitation (mCPR) in the emergency department (ED). We conducted an investigation to evaluate the time to intubation, operator confidence, and success rates of endotracheal intubation with video laryngoscopy (VL) versus direct laryngoscopy (DL) during simulated mCPR. This was a prospective, randomized crossover trial. Thirty consenting emergency physicians were surveyed about experience/technique preferences, and then performed intubations on a moderately difficult airway and adult Manikin during simulated mCPR (LUCAS 3.0) at 100 compressions/min. Technique order was randomized. Intubation time defined as blade pick up until the tube cuff inflated. Participants rated success confidence on a 5-point scale (high = 5) and provided the Cormack/Lehane grade (difficult = 3 or 4). The scenario was repeated with the alternate technique. The categorical variables analyzed by the Chi-square and continuous variables by t-tests. Multivariate logistic regression was performed to control for confounding. There were 30 participants: 73% with 1–5 years of experience, 40% with >100 prior intubations, 73% utilized mac 4 direct blade, and 60% prefer VL during cardiopulmonary resuscitation (CPR). Participants had first pass intubation success for all but one of the attempts with both modalities (NS). Participants more often expressed “high confidence” that intubation was successful for direct 60% versus video 77% (P = 0.2), but they more often rated the airway “difficult” for direct (40% vs. 10%; P = 0.01). Within bivariate analysis, mean time difference to intubate was less for DL versus VL (−6.8 s; P = 0.02). There were no significant associations between time differences to intubate for the following variables: experience (P = 0.6), >100 prior intubations (P = 0.8), blade size (P = 0.3), preferred technique (P = 0.8), high confidence successful DL (P = 0.5), high confidence successful VL (P = 0.7), rating of difficult view DL (P = 0.8), and rating of difficult view VL (P = 0.9). In the multivariate logistic regression with time difference as the dependent variable, there were no statistically significant independent variables. Several prior investigators have reported the success rates of endotracheal intubation with and without chest compressions.[1–5] Han etal. described that VL was superior to DL in simulated CPR settings and that interruption of chest compressions was seemingly unnecessary.[1,3] However, within our literature search, we did not find earlier studies comparing VL versus DL mCPR. In contrast to the findings of Han etal., we observed a lower mean time difference to intubation for DL versus VL during simulated mCPR in our current study, although such differences are unlikely clinically meaningful. On the other hand, participants in our study group were more confident that intubation was successful when using VL. The limitations of our study include single center site, small sample size, participants had varying prior intubation experience, and the high-fidelity Manikin may not replicate all the aspects of difficult intubation in the setting of actual CPR in the ED. Future studies evaluating DL versus VL during mCPR should be conducted in the clinical setting. Research quality and ethics statement The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Design and Implementation of Cardiopulmonary Resuscitation Simulation Model

Cardiopulmonary resuscitation (CPR) is a life-saving procedure that can multiply a person's chances of survival after a cardiac arrest. The effectiveness of CPR procedures is heavily influenced by the individual skills of the rescuer providing assistance. Chest compressions delivered at an appropriate depth and rate, allowing full chest recoil and with minimal interruptions, are critical for improving cardiac arrest survival. The lack of quality CPR training models in developing countries has a significant impact on the quality of CPR training and skills acquired. Therefore, in this paper, we aim at improving CPR training by designing a high-fidelity CPR training manikin. The model includes a feedback mechanism for monitoring CPR performance status to allow for effective practice and rehearsal until required CPR skills are acquired. An in-depth study of existing training systems was conducted to ensure the proper design of the proposed system. The test results show that the designed manikin prototype analyses the quality of CPR performance and provides appropriate feedback to the trainee. The model can be used for training medical students and other practitioners to correctly perform CPR.

Time-to-Task in Interval Simulated Cardiopulmonary Resuscitation Training: A Method for Maintaining Resuscitation Skills

PurposeThe literature supports interval simulation training as a means of improving nurses’ cardiopulmonary resuscitation (CPR) skills. The aim of this project was to improve the time-to-task skills in single-rescuer basic life support (BLS) in an outpatient surgery center through interval simulation training. DesignQuality Improvement project. MethodsTwenty-nine nursing staff were included in this pretest/post-test within subjects interventional design quality improvement project. A 2-minute pretest cardiac arrest simulation was performed in the outpatient surgery center where time-to-task and quality of CPR data were collected. The pretest was followed by a lecture and CPR training. Three months later, the simulation was post-tested in an identical scenario with measures of time-to-task and quality of CPR. FindingsThe mean times for code bell activation and initiation of CPR decreased significantly following the interval simulation training (P < .05). A clinically significant decrease was seen in the mean time-to-task placement of a backboard on code team arrival. ConclusionsInterval simulation training is an effective means of maintaining CPR skills in the outpatient surgery center setting.

THE EFFECTIVENESS OF HANDS-ONLY OFFLINE APPLICATION

Cardiac arrest is an emergency that can occur inside or outside the hospital and has a high risk of death. However, the survival rate is higher if cardiopulmonary resuscitation (CPR) first aid is given immediately. The patient’s family can give first aid in the form of hands-only CPR if the cardiac arrest incident occurs at home. Nowadays, learning to use hands-only CPR offline application on a mobile phone is one way to increase knowledge and skills besides being easy to access, we can also take it with us wherever we go. This study aims to determine whether hands-only cardiac resuscitation offline applications can improve family skills. This study was quasi-experimental, using a control group with pre-test and post-test designs. The experimental group used independent learning through a hands-only CPR offline application, while the control group used a hands-only CPR simulation. The number of samples for each group was 17 people, with a total of 34 people for the two groups. Analysis was done using Wilcoxon and Mann-Whitney. P-value obtained was 0.000, so there is a significant difference in CPR skills before and after intervention in the offline application group and the simulation group. P-value obtained was 0.000, so there is a significant relationship between offline application and simulation in improving the skills of patients’ families in performing hands-only CPR. Learning through a CPR hand-only application improves the skills of the family of patients with heart disease to perform hands-only CPR. Meanwhile, learning with a simulation method has a higher rank in improving the skills of the family of patients with heart disease to perform hands-only CPR.&#x0D; &#x0D; &#x0D;

Interprofessional Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation Simulations Aimed at Decreasing Actual Cannulation Times: A Longitudinal Study.

Since 2013, the cardiac intensive care unit (CICU) at Children's National has conducted annual extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR) simulations that focus on team dynamics, room setup, and high-quality CPR. In 2019 and 2020, the simulations were expanded to include the surgical and extracorporeal membrane oxygenation (ECMO) teams in an effort to better understand and improve this process. During a 4-week period in 2019, 7 peripheral ECPR simulations were conducted, and through a 3-week period in 2020, 7 central ECPR simulations were conducted. Participants in each session included: 8 to 10 CICU nurses, 1 CICU attending, 1 to 2 ICU or cardiology fellows, 1 cardiovascular surgery fellow or attending, and 1 ECMO specialist. For each session, the scenario continued until the simulated patient was on full cardiopulmonary bypass. An ECMO trainer was used for peripheral simulations and a 3-dimensionally-printed heart was used for central cannulations. An ECMO checklist was used to objectively determine when the patient and room were fully prepared for surgical intervention, and simulated cannulation times were recorded for both groups. A retrospective chart review was conducted to compare actual cannulation times before and after the intervention period, and video was used to review the events and assist in dividing them into medical versus surgical phases. Control charts were used to trend the total ECPR times before and after the intervention period, and mean and P values were calculated for both ECPR times and for all other categorical data. Mean peripheral ECPR times decreased significantly from 71.7 to 45.1 minutes ( P = 0.036) after the intervention period, and this was reflected by a centerline shift. Although we could not describe a similar decrease in central ECPR times because there were only 6 postintervention events, the times for each of these events were shorter than the historical mean of 37.8 minutes. There was a trend in improved survival, which did not meet significance both among patients undergoing peripheral ECPR (15.4% ± 10% to 43.8% ± 12.4%, P = 0.10) and central ECPR (36.4% ± 8.4% to 50% ± 25%, P = 0.60). The percentage of time dedicated to the medical phases of the actual versus simulated procedures was very consistent among both peripheral (33.0% vs. 31.9%) and central (39.6% vs. 39.8%) cannulations. We observed a significant decrease in peripheral cannulation times at our institution after conducting interprofessional ECPR simulations taken to the establishment of full cardiopulmonary bypass. The use of an ECMO trainer and a 3-dimensionally-printed heart allowed for both the medical and surgical phases of the procedure to be studied in detail, providing opportunities to streamline and improve this complex process. Larger multisite studies will be needed in the future to assess the effect of efforts like these on patient survival.

Paediatric manikins and school nurses as Basic Life Support coordinators: A useful strategy for schools?

Objective: To evaluate cardiopulmonary resuscitation (CPR) skills performance and retention in schoolchildren aged 8 to 12 years following instruction by their teachers and with the guidance of a school nurse using paediatric manikins. Design: Descriptive simulation trial. Method: A school nurse provided support to six schoolteachers as they taught a modified 40-minute CPR course. Pupils were shown an out-of-hospital cardiac-arrest recognition video followed by a CPR simulation using paediatric manikins. 117 schoolchildren aged 8 to 12 years received the training. Both the schoolchildren and teachers completed a survey before and afterwards. Children completed an out-of-hospital cardiac-arrest recognition test and a 1-minute CPR test 1 week later. Results: After training, schoolchildren increased their self-efficacy as rescuers (8 ± 2 vs 10 ± 2; p &lt; 0.001). Irrespective of age differences, 74% of schoolchildren performed the entire out-of-hospital cardiac-arrest recognition sequence correctly. Children aged 11 to 12 years and 10 to 11 years performed higher quality CPR (49% and 47%, respectively) compared to 8 to 9 year olds (14%, p = 0.008 and p = 0.014). Children aged 11 to 12 years outperformed younger children aged 8 to 9 years with respect to compression depth (48 ± 6 mm vs 43 ± 5 mm, p = 0.008) Conclusion: Schoolchildren’s teachers, who were guided by a nurse using paediatric manikins, taught children aged 10 to 12 years to perform high-quality CPR. We suggest integrating paediatric manikins as part of children’s CPR training as feedback from successful CPR performance increases motivation and confidence to act as a rescuer as well as improves skills retention.