Bahr Nathan, Huynh Trang Kieu, Lambert William, Guise Jeanne-Marie
Department of Obstetrics and Gynecology, Oregon Health and Science University.
Department of Pediatrics, Oregon Health and Science University, United States.
Resusc Plus. 2022 May 18;10:100248. doi: 10.1016/j.resplu.2022.100248. eCollection 2022 Jun.
Neonatal cardiopulmonary arrests are rare but serious events. There is limited information on compliance to best-practice guidelines due to rarity, but deviations can have dire consequences. This research aimed to characterize compliance with and deviations from Neonatal Resuscitation Program (NRP) guidelines and their association with teamwork.
We observed Emergency Medical Service (EMS) teams responding to standardized neonatal resuscitation simulations following a precipitous home delivery. A Clinical expert evaluated teamwork during simulations using the Clinical Teamwork Scale (CTS™). A neonatologist evaluated technical performance in blinded video review according to NRP guidelines. We report the types, counts, and severity of observed deviations. Logistic regression tested the association of CTS™ factors with the occurrence of deviations.
Forty-five (45) teams of 265 EMS personnel from fire and transport agencies participated in the simulations. Eighty-seven percent (39/45) of teams were rated as having good teamwork according to CTS™. Nearly all teams (44 of 45) delayed or did not perform one or more of the initial steps of dry, warm, or stimulate; delayed bag-valve mask ventilation (BVM); or performed continuous compressions instead of the recommended 3:1 compression-to-ventilation ratio. Logistic regression revealed an 82% ( < 0.04) decrease in the odds of airway errors for each level of improvement in teams' decision-making.
Drying, warming, and stimulating, and ventilation tailored to the physiologic needs of infants continue to be top priorities in neonatal care for out-of-hospital settings. EMS teamwork is good and higher quality of decision-making appears to decrease the odds of ventilation errors.
新生儿心肺骤停虽罕见但后果严重。由于其罕见性，关于遵循最佳实践指南的信息有限，但偏差可能会带来可怕的后果。本研究旨在描述对新生儿复苏计划（NRP）指南的遵循情况和偏差，以及它们与团队协作的关联。
我们观察了紧急医疗服务（EMS）团队对家庭急产后标准化新生儿复苏模拟的反应。一名临床专家使用临床团队协作量表（CTS™）评估模拟过程中的团队协作。一名新生儿科医生在盲态视频回顾中根据NRP指南评估技术操作表现。我们报告观察到的偏差类型、数量和严重程度。逻辑回归检验CTS™因素与偏差发生之间的关联。
来自消防和运输机构的265名EMS人员组成的45个团队参与了模拟。根据CTS™，87%（39/45）的团队被评为团队协作良好。几乎所有团队（45个中的44个）延迟或未执行擦干、保暖或刺激等初始步骤中的一项或多项；延迟进行面罩气囊通气（BVM）；或进行持续按压而非推荐的3:1按压与通气比例。逻辑回归显示，团队决策每提高一个水平，气道错误发生几率降低82%（<0.04）。
在院外环境的新生儿护理中，擦干、保暖、刺激以及根据婴儿生理需求进行通气仍然是首要任务。EMS团队协作良好，更高质量的决策似乎会降低通气错误的几率。
