Department of Pediatrics CHEO, Ottawa, Ontario, Canada.
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Med Educ Online. 2022 Dec;27(1):2106811. doi: 10.1080/10872981.2022.2106811.
In-hospital pediatric cardiopulmonary arrest is rare. With more than 50% of patients not surviving to discharge following cardiopulmonary arrest, it is important that health-care providers (HCPs) respond appropriately to deteriorating patients. Our study evaluated the performance of basic life support skills using non-acute HCPs during pediatric inpatient resuscitation events. We conducted a retrospective chart review of all code blue team (CBT) activations in non-acute care areas of a tertiary care children's hospital from 2008 to 2017. The main outcomes were frequency of life support algorithmic assessments and interventions (critical actions) performed by non-acute HCPs prior to the arrival of CBT. CBT activation and outcome data were summarized descriptively. Logistic regression was used to assess for an association of outcomes with the presence of established leadership. A total of 60 CBT activations were retrieved, 48 of which had data available on isolated non-acute HCP performance. Most children (93%) survived to discharge. Critical action performance review revealed that an airway, breathing and pulse assessment was documented to have occurred in 33%, 69% and 29% of cases, respectively. A full primary assessment was documented in 6% of cases. The presence of established leadership was associated with the performance of a partial ABC assessment. Our results suggest that resuscitation performance of pediatric inpatient non-acute HCPs often does not adhere to standard life support guidelines. These results highlight the need to reconsider the current approaches used for non-acute HCP resuscitation training.
院内儿科心搏骤停较为罕见。心搏骤停后,超过 50%的患者无法存活至出院,因此医护人员(HCP)应妥善应对病情恶化的患者。我们的研究评估了非急症 HCP 在儿科住院患者复苏事件中使用基础生命支持技能的表现。我们对 2008 年至 2017 年期间一家三级儿童医院非急症护理区域的所有 CBT 激活进行了回顾性图表审查。主要结局是在 CBT 到达之前,非急症 HCP 进行生命支持算法评估和干预(关键操作)的频率。CBT 激活和结局数据以描述性方式总结。使用逻辑回归评估既定领导的存在与结局之间的关联。共检索到 60 次 CBT 激活,其中 48 次有关于孤立的非急症 HCP 表现的数据。大多数儿童(93%)存活至出院。关键操作表现回顾显示,气道、呼吸和脉搏评估分别记录在 33%、69%和 29%的病例中。6%的病例记录了完整的初步评估。既定领导的存在与部分 ABC 评估的执行相关。我们的结果表明,儿科住院非急症 HCP 的复苏表现通常不符合标准生命支持指南。这些结果强调需要重新考虑当前用于非急症 HCP 复苏培训的方法。