Noje Corina, Duval-Arnould Jordan, Costabile Philomena M, Henderson Eric, Perretta Julianne, Sorcher Jill L, Shilkofski Nicole, Hunt Elizabeth A
From the Department of Anesthesiology and Critical Care Medicine (C.N., J.D.-A., J.P., E.A.H.), Johns Hopkins University School of Medicine; Pediatric Transport (C.N., P.M.C., E.H.), The Johns Hopkins Hospital; Health Informatics (J.D.-A., E.A.H.), Johns Hopkins University School of Medicine; Johns Hopkins Medicine Simulation Center (J.D.-A., J.P., E.A.H.); Department of Nursing (P.M.C.), The Johns Hopkins Hospital; LifeStar Response of Maryland (E.H.); Johns Hopkins University School of Medicine (J.L.S.); Department of Pediatrics (N.S., E.A.H.), Johns Hopkins University School of Medicine; and Health Policy and Management (E.A.H.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Simul Healthc. 2023 Apr 1;18(2):117-125. doi: 10.1097/SIH.0000000000000645. Epub 2022 Feb 21.
Little is known about cardiopulmonary resuscitation (CPR) quality during pediatric interhospital transport; hence, our aim was to investigate its feasibility.
After implementing an institutional education curriculum on pediatric resuscitation during ambulance transport, we conducted a 4-year prospective observational study involving simulation events. Simulated scenarios were (1) interhospital transport of a child retrieved in cardiac arrest (Sim1) and (2) unanticipated cardiac arrest of a child during transport (Sim2). Cardiopulmonary resuscitation data were collected via Zoll RSeries defibrillators. Performance was evaluated using age-appropriate American Heart Association (AHA) Guidelines. Video recordings were reviewed for qualitative thematic analysis.
Twenty-six simulations were included: 16 Sim1 [mannequins: Laerdal SimMan 3G (n = 13); Gaumard 5-year-old HAL (n = 3)] and 10 Sim2 [Gaumard 1-year-old HAL (n = 8); Laerdal SimBaby (n = 2)]. Median (IQR) CPR duration was 18 minutes 23 seconds (14-22 minutes), chest compression rate was 112 per minute (106-118), and fraction (CCF) was 1 (0.9-1). Five hundred eight 60-second resuscitation epochs were evaluated (Sim1: 356; Sim2: 152); 73% were AHA compliant for rate and 87.8% for CCF. Twenty-four minutes (4.7%) had pauses more than 10 seconds. One hundred fifty seven Sim1 epochs (44.1%) met criteria for excellent CPR (AHA-compliant for rate, depth, and CCF). Rates of excellent CPR were higher for learner groups with increased simulation and transport experience (59.1% vs. 35.3%, P < 0.001). Thematic analysis identified performance-enhancing strategies, stemming from anticipating challenges, planning solutions, and ensuring team's shared mental model.
High-quality CPR may be achievable during pediatric interhospital transport. Certain transport-specific strategies may enhance resuscitation quality. Learners' performance improved with simulation and transport experience, highlighting ongoing education's role.
关于儿科院际转运期间的心肺复苏（CPR）质量，目前所知甚少；因此，我们的目的是研究其可行性。
在实施了关于救护车转运期间儿科复苏的机构教育课程后，我们开展了一项为期4年的前瞻性观察性研究，涉及模拟事件。模拟场景为：（1）院际转运一名心脏骤停后被救治的儿童（Sim1）和（2）转运期间一名儿童意外发生心脏骤停（Sim2）。通过卓尔R系列除颤器收集心肺复苏数据。使用符合年龄的美国心脏协会（AHA）指南评估操作表现。对视频记录进行定性主题分析。
共纳入26次模拟：16次Sim1[人体模型：Laerdal SimMan 3G（n = 13）；Gaumard 5岁HAL（n = 3）]和10次Sim2[Gaumard 1岁HAL（n = 8）；Laerdal SimBaby（n = 2）]。心肺复苏持续时间的中位数（IQR）为18分23秒（14 - 22分钟），胸外按压频率为每分钟112次（106 - 118次），按压分数（CCF）为1（0.9 - 1）。评估了508个60秒的复苏时段（Sim1：356个；Sim2：152个）；73%的时段按压频率符合AHA标准，87.8%的时段CCF符合标准。24分钟（4.7%）存在超过10秒的中断。157个Sim1时段（44.1%）符合高质量心肺复苏标准（按压频率、深度和CCF均符合AHA标准）。模拟和转运经验增加的学习者组高质量心肺复苏的比例更高（59.1%对35.3%，P < 0.001）。主题分析确定了性能提升策略，这些策略源于对挑战的预判、解决方案的规划以及确保团队的共享心智模式。
儿科院际转运期间可能实现高质量心肺复苏。某些特定于转运的策略可能提高复苏质量。学习者的表现随着模拟和转运经验的增加而改善，突出了持续教育的作用。
