Nelson McMillan Kristen, Rosen Michael A, Shilkofski Nicole A, Bradshaw Jamie Haggerty, Saliski Mary, Hunt Elizabeth A
From the Johns Hopkins University School of Medicine (K.N.M., M.A.R., N.A.S., M.S., E.A.H.); Department of Anesthesiology and Critical Care Medicine (K.N.M., M.A.R., N.A.S., M.S., E.A.H.); Department of Pediatrics (K.N.M., N.A.S., E.A.H.); Johns Hopkins Medicine Simulation Center (K.N.M., N.A.S., E.A.H.), Baltimore, MD; Uniformed Services of the Health Sciences (J.H.B.), Bethesda, MD.
Simul Healthc. 2018 Feb;13(1):41-46. doi: 10.1097/SIH.0000000000000297.
Although American Heart Association guidelines exist for proper management of cardiopulmonary arrest (CPA), in-hospital cardiopulmonary resuscitation (CPR) may be of poor quality and is not performed in all indicated situations. Cognitive aids have been created to assist in rapid, accurate recall of guidelines for pediatric CPA management.
Pediatric residents participated in individual mock codes for two years. Using a high-fidelity simulator, each resident participated in a standardized scenario that required management of both pulseless ventricular tachycardia and pulseless electrical activity. The primary study objective was to calculate the proportion of residents (a) who were not performing CPR on a simulated "pulseless" patient when cognitive aid use was first initiated and (b) who subsequently initiated CPR after cognitive aid use.
One hundred thirty-two (83.5%) of 158 pediatric residents participated, and of 125 videos available for review, 107 residents (85.6%) used a cognitive aid. Mean (SD) time to cognitive aid use was 106 (100) seconds after the mannequin became pulseless. Most common immediate actions prompted by cognitive aid use were the following: defibrillation, 43 (40%) of 107; and adrenaline (epinephrine) administration, 28 (26%) of 107. Most alarmingly, 58 (54%) of 107 were not performing CPR on the pulseless patient when cognitive aid use was initiated and only two (3.4%) of 58 were subsequently prompted to initiate chest compressions.
Cognitive aids in use during this study did not prompt timely initiation of CPR, potentially contributing to delays and errors in CPA management. Failure of these aids to prompt CPR initiation represents a "missed opportunity" to enhance performance of this vital skill.
尽管美国心脏协会制定了心肺骤停（CPA）的正确管理指南，但院内心肺复苏（CPR）质量可能较差，且并非在所有指征情况下都能实施。已开发出认知辅助工具，以帮助快速、准确地回忆小儿CPA管理指南。
儿科住院医师参与了为期两年的个人模拟急救演练。使用高保真模拟器，每位住院医师参与一个标准化场景，该场景需要处理无脉性室性心动过速和无脉性电活动。主要研究目标是计算住院医师的比例：（a）在首次使用认知辅助工具时，对模拟“无脉”患者未进行心肺复苏的比例；（b）在使用认知辅助工具后随后开始进行心肺复苏的比例。
158名儿科住院医师中有132名（83.5%）参与，在可供审查的125个视频中，107名住院医师（85.6%）使用了认知辅助工具。在人体模型出现无脉状态后，使用认知辅助工具的平均（标准差）时间为106（100）秒。使用认知辅助工具后最常见的立即采取的行动如下：除颤，107例中有43例（40%）；给予肾上腺素，107例中有28例（26%）。最令人担忧的是，107例中有58例（54%）在开始使用认知辅助工具时对无脉患者未进行心肺复苏，而在这58例中只有2例（3.4%）随后被促使开始进行胸外按压。
本研究中使用的认知辅助工具未能促使及时开始进行心肺复苏，这可能导致CPA管理出现延误和错误。这些辅助工具未能促使开始进行心肺复苏代表了提高这项关键技能表现的“错失机会”。
