Nelson Kristen L, Shilkofski Nicole A, Haggerty Jamie A, Saliski Mary, Hunt Elizabeth A
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, The Johns Hopkins Medicine Simulation Center, Baltimore, MD, USA.
Simul Healthc. 2008 Fall;3(3):138-45. doi: 10.1097/SIH.0b013e31816b1b60.
Management of pediatric cardiopulmonary arrest (CPA) is challenging because of the low volume of experience of most pediatric health care providers. Use of cognitive aids may assist in making rapid decisions in these crises; however, there are no known published reports on whether these aids are actually used during arrest management and whether they impact quality of care.
Sixty pediatric residents participated in individual simulated CPA scenarios, which involved pulseless ventricular tachycardia and pulseless electrical activity. Our primary outcome measure was the proportion of pediatric residents who used cognitive aids during simulated CPAs. Secondary outcome measures were to quantify 1) type of aids used, 2) category of use, and 3) human errors made during resuscitation efforts.
Eighty-five percent of residents voluntarily used a cognitive aid to assist in managing simulated pediatric CPAs. The most commonly used aids were an American Heart Association Pediatric Advanced Life Support aid and an institutionally created aid. Forty-three of 51 (84.3%) and 23 of 46 (60.5%) residents used these aids for assistance with the pulseless ventricular tachycardia and pulseless electrical activity algorithm, respectively. Unfortunately, 13 of 51 (25.5%) residents chose the incorrect treatment algorithm, resulting in inappropriate management. CONCLUSION AND APPLICATION: Although the majority of residents chose to use cognitive aids for assistance, errors in management were common. Further study is required to determine whether these errors are associated with cognitive aid design flaws and whether improving their design through human factors research can help minimize errors in Basic and Advanced Life Support, ultimately improving patient outcomes.
由于大多数儿科医疗服务提供者的经验有限，小儿心肺骤停（CPA）的管理具有挑战性。使用认知辅助工具可能有助于在这些危机中快速做出决策；然而，目前尚无关于这些辅助工具在骤停管理期间是否实际被使用以及它们是否影响护理质量的公开报道。
60名儿科住院医师参与了个体模拟CPA场景，其中包括无脉性室性心动过速和无脉性电活动。我们的主要结局指标是在模拟CPA期间使用认知辅助工具的儿科住院医师比例。次要结局指标是量化1）使用的辅助工具类型，2）使用类别，以及3）复苏过程中出现的人为错误。
85%的住院医师自愿使用认知辅助工具来协助管理模拟小儿CPA。最常用的辅助工具是美国心脏协会儿科高级生命支持辅助工具和机构创建的辅助工具。51名住院医师中有43名（84.3%）和46名住院医师中有23名（60.5%）分别在无脉性室性心动过速和无脉性电活动算法中使用这些辅助工具来获得帮助。不幸的是，51名住院医师中有13名（25.5%）选择了错误的治疗算法，导致管理不当。结论与应用：尽管大多数住院医师选择使用认知辅助工具来获得帮助，但管理错误很常见。需要进一步研究以确定这些错误是否与认知辅助工具的设计缺陷有关，以及通过人因研究改进其设计是否有助于最大限度地减少基础和高级生命支持中的错误，最终改善患者结局。
