Donoghue Aaron, Heard Debra, Griffin Russell, Abbadessa Mary Kate, Gaines Shannon, Je Sangmo, Hanna Richard, Erbayri John, Myers Sage, Niles Dana, Nadkarni Vinay
Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Resusc Plus. 2021 Apr 10;6:100117. doi: 10.1016/j.resplu.2021.100117. eCollection 2021 Jun.
To determine the impact of high-frequency CPR training on performance during simulated and real pediatric CPR events in a pediatric emergency department (ED).
Prospective observational study. A high-frequency CPR training program (Resuscitation Quality Improvement (RQI)) was implemented among ED providers in a children's hospital. Data on CPR performance was collected longitundinally during quarterly retraining sessions; scores were analyzed between quarter 1 and quarter 4 by nonparametric methods. Data on CPR performance during actual patient events was collected by simultaneous combination of video review and compression monitor devices to allow measurement of CPR quality by individual providers; linear mixed effects models were used to analyze the association between RQI components and CPR quality.
159 providers completed four consecutive RQI sessions. Scores for all CPR tasks during retraining sessions significantly improved during the study period. 28 actual CPR events were captured during the study period; 49 observations of RQI trained providers performing CPR on children were analyzed. A significant association was found between the number of prior RQI sessions and the percent of compressions meeting guidelines for rate (β coefficient -0.08; standard error 0.04; p = 0.03).
Over a 15 month period, RQI resulted in improved performance during training sessions for all skills. A significant association was found between number of sessions and adherence to compression rate guidelines during real patient events. Fewer than 30% of providers performed CPR on a patient during the study period. Multicenter studies over longer time periods should be undertaken to overcome the limitation of these rare events.
确定高频心肺复苏培训对儿科急诊科模拟和实际儿科心肺复苏事件中的操作表现的影响。
前瞻性观察研究。在一家儿童医院的急诊科医护人员中实施了一项高频心肺复苏培训计划（复苏质量改进（RQI））。在季度再培训期间纵向收集心肺复苏操作表现的数据；采用非参数方法分析第1季度和第4季度之间的得分。通过视频回顾和按压监测设备同时结合的方式收集实际患者事件中心肺复苏操作表现的数据，以便对个体医护人员的心肺复苏质量进行测量；使用线性混合效应模型分析RQI各组成部分与心肺复苏质量之间的关联。
159名医护人员完成了连续四次RQI课程。在研究期间，再培训期间所有心肺复苏任务的得分均显著提高。在研究期间捕获了28起实际心肺复苏事件；分析了49次对接受RQI培训的医护人员对儿童进行心肺复苏的观察情况。发现之前RQI课程的次数与符合速率指南的按压百分比之间存在显著关联（β系数-0.08；标准误差0.04；p = 0.03）。
在15个月的时间里，RQI使所有技能在培训期间的操作表现得到改善。在实际患者事件中，发现课程次数与遵守按压速率指南之间存在显著关联。在研究期间，不到30%的医护人员对患者进行了心肺复苏。应开展更长时间的多中心研究，以克服这些罕见事件的局限性。
