Department of Pediatrics, Duke Children's Hospital, Duke University, 2301 Erwin Road, Durham, NC 27710, USA.
Department of Anaesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th Street and Civic Centre Blvd, Philadelphia, PA 19104, USA.
Resuscitation. 2023 Oct;191:109939. doi: 10.1016/j.resuscitation.2023.109939. Epub 2023 Aug 23.
To evaluate associations between characteristics of simulated point-of-care cardiopulmonary resuscitation (CPR) training with simulated and actual intensive care unit (ICU) CPR performance, and with outcomes of children after in-hospital cardiac arrest.
This is a pre-specified secondary analysis of the ICU-RESUScitation Project; a prospective, multicentre cluster randomized interventional trial conducted in 18 ICUs from October 2016-March 2021. Point-of-care bedside simulations with real-time feedback to allow multidisciplinary ICU staff to practice CPR on a portable manikin were performed and quality metrics (rate, depth, release velocity, chest compression fraction) were recorded. Actual CPR performance was recorded for children 37 weeks post-conceptual age to 18 years who received chest compressions of any duration, and included intra-arrest haemodynamics and CPR mechanics. Outcomes included survival to hospital discharge with favourable neurologic status.
Overall, 18,912 point-of-care simulations were included. Simulation characteristics associated with both simulation and actual performance included site, participant discipline, and timing of simulation training. Simulation characteristics were not associated with survival with favourable neurologic outcome. However, participants in the top 3 sites for improvement in survival with favourable neurologic outcome were more likely to have participated in a simulation in the past month, on a weekday day, to be nurses, and to achieve targeted depth of compression and chest compression fraction goals during simulations than the bottom 3 sites.
Point-of-care simulation characteristics were associated with both simulated and actual CPR performance. More recent simulation, increased nursing participation, and simulation training during daytime hours may improve CPR performance.
评估模拟床边心肺复苏术（CPR）培训的特点与模拟和实际重症监护室（ICU）CPR 表现，以及与院内心搏骤停后儿童结局之间的关联。
这是 ICU-RESUScitation 项目的一项预先指定的二次分析；这是一项前瞻性、多中心集群随机干预试验，于 2016 年 10 月至 2021 年 3 月在 18 个 ICU 进行。进行床边即时反馈模拟，使多学科 ICU 工作人员能够在便携式模型上练习 CPR，并记录质量指标（频率、深度、释放速度、胸外按压分数）。对接受任何时长胸外按压的 37 周龄至 18 岁儿童进行实际 CPR 表现记录，包括心搏骤停期间的血流动力学和 CPR 力学。结局包括存活至出院且神经功能良好。
共有 18912 次床边模拟纳入研究。与模拟和实际表现均相关的模拟特征包括地点、参与者学科和模拟培训时间。模拟特征与神经功能良好的生存结局无关。然而，在神经功能良好的生存结局改善排名前 3 的地点的参与者，更有可能在过去一个月内参加过模拟培训，在工作日进行模拟，是护士，并且在模拟中达到目标的按压深度和胸外按压分数目标，而排名后 3 的地点则没有。
床边模拟特征与模拟和实际 CPR 表现均相关。最近的模拟、增加护士参与度和日间时段的模拟培训可能会改善 CPR 表现。
