Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS) and Department of Anaesthesiology, Oslo University Hospital and University of Oslo, Oslo, Norway.
Department of Paediatric and Adolescent Medicine and Institute of Clinical Medicine, University of Oslo and Akershus University Hospital, Lørenskog, Norway.
Resuscitation. 2018 Nov;132:140-146. doi: 10.1016/j.resuscitation.2018.07.013. Epub 2018 Jul 18.
Providers caring for newly born infants require skills and knowledge to initiate prompt and effective positive pressure ventilation (PPV) if the newborn does not breathe spontaneously after birth. We hypothesized implementation of high frequency/short duration deliberate practice training and post event video-based debriefings would improve process of care and decreases time to effective spontaneous respiration.
Pre- and post-interventional quality study performed at two Norwegian university hospitals. All newborns receiving PPV were prospectively video-recorded, and initial performance data guided the development of educational interventions. A priori primary outcome was changed from process of care using the Neonatal Resuscitation Performance Evaluation (NRPE) score to time to effective spontaneous respiration as the NRPE score could only be obtained from one site due to lack of staff resources.
Over 12 months, 297 PPV-Refreshers and 52 performance debriefings were completed with 227 unique providers attending a PPV-Refresher and 93 unique providers completed a debriefing. We compared 102 PPV-events pre- to 160 PPV-events post-bundle implementation. The time to effective spontaneous respiration decreased from median (95% confidence interval) 196 (140-237) to 144 (120-163) s, p = 0.010. The NRPE-score increased significantly from median 77% (75-81) pre- to 89% (86-92) post-implementation, p < 0.001. There were no significant differences in time to heart rate >100 beats/min or number of newborns transferred to intensive care.
High frequency/short duration deliberate practice PPV psychomotor training combined with performance-focused team debriefings using video recordings of actual resuscitations may improve time to effective spontaneous breathing and adherence to guidelines during real neonatal resuscitations.
如果新生儿出生后不能自主呼吸，照顾新生儿的医护人员需要掌握技能和知识，以便及时有效地进行正压通气（PPV）。我们假设实施高频/短时间的刻意练习培训和事件后基于视频的讨论，将改善护理过程并缩短有效自主呼吸的时间。
在挪威的两家大学医院进行了干预前后的质量研究。所有接受 PPV 的新生儿均进行前瞻性视频记录，初始表现数据指导教育干预的开展。首要的原始结果从使用新生儿复苏绩效评估（NRPE）评分的护理过程改为有效自主呼吸的时间，因为由于缺乏人员资源，只能从一个地点获得 NRPE 评分。
在 12 个月内，完成了 297 次 PPV 刷新课程和 52 次表现讨论，227 名独特的提供者参加了 PPV 刷新课程，93 名独特的提供者完成了讨论。我们比较了实施捆绑包前后的 102 次 PPV 事件和 160 次 PPV 事件。有效自主呼吸的时间从中位数（95%置信区间）196（140-237）减少到 144（120-163）秒，p=0.010。NRPE 评分从实施前的中位数 77%（75-81）显著增加到实施后的 89%（86-92），p<0.001。心率>100 次/分的时间或需要转入重症监护的新生儿数量没有显著差异。
高频/短时间的刻意练习 PPV 运动技能训练，结合使用实际复苏录像的以表现为重点的团队讨论，可能会改善真实新生儿复苏中有效自主呼吸的时间和对指南的遵循。
