Medical University Vienna, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Waehringerguertel 18-20, 1090 Vienna, Austria; STAR - SIMCharacters Training and Research, Lehargasse 1, 1090 Vienna, Austria; Neonatal Working Group, Austrian Resuscitation Council, Villefortgasse 22, 8010 Graz, Austria.
STAR - SIMCharacters Training and Research, Lehargasse 1, 1090 Vienna, Austria.
Resuscitation. 2022 Sep;178:109-115. doi: 10.1016/j.resuscitation.2022.06.006. Epub 2022 Jun 11.
To determine the effectiveness of a multidimensional neonatal simulation-based medical education training programme on direct and indirect patient outcome parameters.
This was a retrospective analytical study with a historical control group in a level II neonatal care unit (1,700 births per year). A multidimensional interdisciplinary training programme on neonatal resuscitation was implemented in 2015; pre-training (2012-2014) and post-training (2015-2019) eras were compared in terms of mortality (direct outcome) and the received intervention level immediately after birth (indirect outcome). Intervention levels were defined as follows: A) short-term non-invasive ventilation, B) prolonged non-invasive ventilation (>5 inflation breaths), C) chest compressions.
Of 13,950 neonates born during the study period, 826 full-term newborns received one of the three intervention levels for adaptation after birth. A total of 284 (34.4%) patients received short-term non-invasive ventilation (A), 477 (57.8%) had prolonged ventilation (B), and 65 (7.9%) chest compressions (C), respectively. Comparing the pre- and post-training eras, there was no significant reduction in mortality, and no significant changes were found in groups A or B. However, the risk for chest compressions (group C) decreased significantly from 0.91% in the pre-training era to 0.20% in the post-training era (p < 0.001).
Although there was no significant effect on neonatal mortality, regular interdisciplinary simulation training decreased the number of administered chest compressions immediately after birth. Further studies are needed to test indirect outcome-related parameters, such as frequency of chest compressions as a measure of effectiveness and impact of medical training.
确定基于多维新生儿模拟的医学教育培训计划对直接和间接患者结果参数的有效性。
这是一项在二级新生儿护理单元（每年 1700 例分娩）中进行的回顾性分析性研究，具有历史对照组。2015 年实施了一项多维跨学科新生儿复苏培训计划；比较了培训前（2012-2014 年）和培训后（2015-2019 年）时期的死亡率（直接结果）和出生后立即接受的干预水平（间接结果）。干预水平定义如下：A）短期非侵入性通气，B）延长非侵入性通气（>5 次呼吸），C）胸部按压。
在研究期间出生的 13950 名新生儿中，有 826 名足月新生儿在出生后接受了三种干预水平之一进行适应。共有 284 名（34.4%）患者接受了短期非侵入性通气（A），477 名（57.8%）患者接受了延长通气（B），65 名（7.9%）患者接受了胸部按压（C）。比较培训前和培训后时期，死亡率没有显著降低，A 组或 B 组也没有发现显著变化。然而，胸部按压（C 组）的风险从培训前时期的 0.91%显著降低至培训后时期的 0.20%（p<0.001）。
尽管对新生儿死亡率没有显著影响，但定期进行跨学科模拟培训可减少出生后立即进行的胸部按压次数。需要进一步的研究来测试间接结果相关的参数，例如作为有效性和医疗培训影响衡量标准的胸部按压频率。
