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Mommers L, Wulterkens D, Winkel S, van den Bogaard B, Eppich WJ, van Mook WNKA. Getting ON-TRAC, a team-centred design study of a reflexivity aid to support resuscitation teams' information sharing. Adv Simul (Lond) 2025; 10:17. [PMID: 40156074 PMCID: PMC11951662 DOI: 10.1186/s41077-025-00340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/28/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND Effective information sharing is crucial for emergency care teams to maintain an accurate shared mental model. This study describes the design, simulation-based testing and implementation of a team reflexivity aid to facilitate in-action information sharing during resuscitations. METHODS A five-phase team-centred iterative design process was employed. Phase 1 involved a literature review to identify in-action cognitive aids. Phase 2 focused on conceptual design, followed by simulation-based testing and modifications in phase 3. Implementation through simulation-based user training occurred in phase 4 at a large non-university teaching hospital. Phase 5 evaluated the aid among resuscitation team members in the emergency department after one year. RESULTS The phase 1 literature review identified 58 cognitive aids, with only 10 designed as 'team aid'. Studies using team information screens found increase team and task performance in simulation-based environments, with no evaluations in authentic workplaces. Phase 2 resulted in a three-section team reflexivity aid, iteratively modified in three rounds of simulation-based testing (N = 30 groups) phase 3 resulted in a team reflexivity aid containing five sections: resuscitation times and intervals, patient history, interventions on a longitudinal timeline, differential diagnosis and a quick review section. Phase 4 consisted of reflexivity aid user training with simulation-based education (N = 60 sessions) and the creation of a digital entry form to store data in the patient's electronic medical record. Evaluation after one year in phase 5, (N = 84) showed perceived improvements in communication (3.82 ± 0.77), documentation (4.25 ± 0.66), cognitive load (3.94 ± 0.68), and team performance (3.80 ± 0.76) on a 5-point Likert scale. Thematic analysis of user feedback identified improvements in both teamwork and taskwork. Teamwork enhancements included better situation awareness, communication and team participation. Taskwork improvements were seen in drug administration and clinical reasoning. CONCLUSIONS This study demonstrated the successful development and implementation of a Team Reflexivity Aid for Cardiac arrests using simulation methodology. This task-focused team tool improved perceived team situation awareness, communication, and overall performance. The research highlights the interplay between task- and teamwork in healthcare settings, underscoring the potential for taskwork-oriented tools to benefit team dynamics. These findings warrant further investigation into team-supportive interventions and their impact on resuscitation outcomes.
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Affiliation(s)
- Lars Mommers
- Department of Simulation in Healthcare, MUMC, Maastricht, the Netherlands.
- Department of Anaesthesiology and Pain Medicine, MUMC, Maastricht, the Netherlands.
| | | | - Steven Winkel
- Department of Intensive Care Medicine, OLVG, Amsterdam, The Netherlands
| | | | - Walter J Eppich
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Walther N K A van Mook
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Academy for Postgraduate Medical Training, MUMC, Maastricht, The Netherlands
- Department of Intensive Care Medicine, MUMC, Maastricht, The Netherlands
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Stirparo G, Gaetti G, Ristagno G, Babini G, Di Marco S, Scapigliati A, Galazzi A, Cucino A. Ten years of Basic Life Support provider course: results and challenges from the Italian Resuscitation Council's experience. Resusc Plus 2025; 22:100903. [PMID: 40123986 PMCID: PMC11930182 DOI: 10.1016/j.resplu.2025.100903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 02/03/2025] [Accepted: 02/07/2025] [Indexed: 03/25/2025] Open
Abstract
Introduction Widespread basic life support (BLS) training plays a central role in improving cardiac arrest (CA) survival. This study presents an extensive analysis of numbers, candidates' characteristics, and outcomes over 10 years of BLS provider courses organized by the Italian Resuscitation Council (IRC) in Italy. Method This is a retrospective analysis of data recorded in the national IRC BLS training database from January 2014 to December 2023. Candidates' demographic and professional factors were analyzed with regional differences and course outcomes. Results Over the study period, a total 906,686 candidates attended the course, 646,743 (71.3%) of whom were healthcare professionals (HP) and 259,943 (28.8%) non-healthcare professionals (NHP). The percentage of candidates passing the final exam was 99.5% for HP and 99.8% for NHP. The rate per 1000 HP per year of physicians and nurses attending the BLS course varied considerably across the Italian regions, ranging from 4.2 in central Italy to 669.7 in some northern areas. The rate per 1000 inhabitants of NHP per year attending the BLS course was also different among regions, varying from 0.1 in the southern and central regions up to 1.7 in the northern and northeastern ones. Conclusion The pass rate of the BLS provider course is overall very high, indicating that it provides an easy and accessible set of skills for both HP and NHP candidates. Regional disparities (e.g. the rates of trained individuals and distribution between HP and NHP) and the low attendance of retraining courses represent important challenges that need to be addressed. Analysing training registers is a valuable tool for better planning future training projects.
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Affiliation(s)
- Giuseppe Stirparo
- Agenzia Regionale Emergenza Urgenza, Milan, Italy
- Italian Resuscitation Council Scientific Committee, Bologna, Italy
- Italian Society of Medicine and Scientific Communication, Parma, Italy
| | - Giovanni Gaetti
- Italian Society of Medicine and Scientific Communication, Parma, Italy
| | - Giuseppe Ristagno
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Fondazione IRC, Bologna, Italy
| | - Giovanni Babini
- Italian Resuscitation Council Scientific Committee, Bologna, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Di Marco
- Dipartimento Emergenza Accettazione Azienda Sociosanitaria Ligura 5, La Spezia, Italy
- Italian Resuscitation Council Steering Committee, Bologna, Italy
| | - Andrea Scapigliati
- Italian Resuscitation Council Steering Committee, Bologna, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Galazzi
- Italian Resuscitation Council Scientific Committee, Bologna, Italy
- Libera Università Mediterranea, Casamassima (Bari), Italy
| | - Alberto Cucino
- Italian Resuscitation Council Steering Committee, Bologna, Italy
- Department of Anaesthesia and Intensive Care Medicine, S.Chiara Hospital, APSS Trento, Italy
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Lauridsen KG, Bürgstein E, Nabecker S, Lin Y, Donoghue A, Duff JP, Cheng A. Cardiopulmonary resuscitation coaching for resuscitation teams: A systematic review. Resusc Plus 2025; 21:100868. [PMID: 39897064 PMCID: PMC11787430 DOI: 10.1016/j.resplu.2025.100868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 01/02/2025] [Accepted: 01/02/2025] [Indexed: 02/04/2025] Open
Abstract
Aim Cardiopulmonary resuscitation (CPR) quality is often substandard to guidelines for resuscitation teams. We aimed to investigate if the use of a CPR coach as part of the resuscitation team can improve teamwork, quality of care, and patient outcomes during simulated and clinical cardiac arrest resuscitation. Methods We searched PubMed, Embase, and Cochrane from inception until October 9, 2024 for randomized trials and observational studies. We assessed risk of bias using Cochrane tools and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. PROSPERO CRD42024603212. Results We screened 505 records and included 7 studies. Overall, 6 were randomized studies involving pediatric resuscitation of which 4 studies were secondary analyses of one simulation-based trial, and one was an observational study on adult out-of-hospital cardiac arrest. Reported outcomes were: CPR performance in a simulated setting (n = 3), workload in a simulated setting (n = 2), adherence to guidelines in a simulated setting (n = 1), team communication in a simulated setting (n = 1), and clinical CPR performance (n = 1). All studies suggested improved CPR quality and guideline adherence when using a CPR coach compared to not using a coach. Risk of bias varied from low to critical and the certainty of evidence across outcomes was low or very low. Conclusions We identified low- to very-low certainty of evidence supporting the use of a CPR coach as part of the resuscitation team in order to improve CPR quality and guideline adherence. However, further research is needed, in particular for clinical performance and patient outcomes.
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Affiliation(s)
- Kasper G. Lauridsen
- Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, United States
| | - Emma Bürgstein
- Department of Clinical Medicine, Aarhus University, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
| | - Sabine Nabecker
- Department of Anesthesiology and Pain Management, Mount Sinai Hospital, Canada
| | - Yiqun Lin
- KidSIM-ASPIRE Simulation Research Program, University of Calgary, Canada
| | - Aaron Donoghue
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, United States
- Department of Anesthesia and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, USA
| | | | - Adam Cheng
- KidSIM-ASPIRE Simulation Research Program, University of Calgary, Canada
- Departments of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Canada
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McDermott KL, Rajzer-Wakeham KL, Andres JM, Yan K, Liegl MA, Schindler CA. Impact of a Quality Cardiopulmonary Resuscitation Coach on Pediatric Intensive Care Unit Resuscitation Teams. Am J Crit Care 2025; 34:21-29. [PMID: 39740973 DOI: 10.4037/ajcc2025828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Abstract
BACKGROUND The quality cardiopulmonary resuscitation (CPR) coach role was developed for hospital-based resuscitation teams. This supplementary team member (CPR coach) provides real-time, verbal feedback on chest compression quality to compressors during a cardiac arrest. OBJECTIVES To evaluate the impact of a quality CPR coach training intervention on resuscitation teams, including presence of coaches on teams and physiologic metrics of quality CPR delivery in real compression events. METHODS The quality CPR coach curriculum and role implementation were designed and evaluated using a logic model framework. Medical records of patients who had in-unit cardiopulmonary arrests were reviewed retrospectively. Data included physiologic metrics of quality CPR delivery. Analysis included descriptive statistics and comparison of arrest data before and after the intervention. RESULTS A total of 79 cardiopulmonary arrests were analyzed: 40 before and 39 after the intervention. Presence of a quality CPR coach on resuscitation teams was more frequent after training, increasing from 35% before the intervention to 72% after (P = .002). No significant difference was found in the frequency of application of Zoll defibrillator pads. Metrics of quality CPR delivery and adherence with American Heart Association recommendations were either unchanged or improved after the intervention. CONCLUSIONS The quality CPR coach training intervention significantly increased coach presence on code teams, which was associated with clinically significant improvements in some metrics of quality CPR delivery in real cardiopulmonary arrests.
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Affiliation(s)
- Katie L McDermott
- Katie L. McDermott is a critical care pediatric nurse practitioner, Children's Wisconsin, Milwaukee/Medical College of Wisconsin, Milwaukee, and part-time nursing faculty, Marquette University, Milwaukee, Wisconsin
| | - Kari L Rajzer-Wakeham
- Kari L. Rajzer-Wakeham is a critical care pediatric nurse practitioner, Children's Wisconsin, Milwaukee/Medical College of Wisconsin, Milwaukee
| | - Jennifer M Andres
- Jennifer M. Andres is quality and outcomes manager, Children's Wisconsin, Milwaukee
| | - Ke Yan
- Ke Yan is a biostatistican and associate professor in the Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee
| | - Melodee A Liegl
- Melodee A. Liegl is a biostatistician and program manager, Quantitative Health Sciences, , Medical College of Wisconsin, Milwaukee
| | - Christine A Schindler
- Christine A. Schindler is a critical care pediatric nurse practitioner, critical care advanced practice provider program director, Children's Wisconsin/Medical College of Wisconsin, and a clinical professor, Marquette University, Milwaukee, Wisconsin
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Drennan IR, Lee M, Héroux JP, Lee A, Riches J, Peppler J, Poitras A, Cheskes S. The impact of real-time feedback on ventilation quality during out-of-hospital cardiac arrest: A before-and-after study. Resuscitation 2024; 204:110381. [PMID: 39299509 DOI: 10.1016/j.resuscitation.2024.110381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/25/2024] [Accepted: 08/27/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Ventilations are a critical component of cardiopulmonary resuscitation (CPR). There is conflicting evidence, however, on the most appropriate method of ventilation during cardiac arrest management. Recent evidence has suggested that regardless of the optimal ventilation strategy, ventilations are often not delivered compliant with guideline recommendations. Recent technological advancements have allowed for accurate measurement and real-time feedback of ventilation rate and volume during resuscitation. Simulation studies have found significant improvements in ventilations with the use of real-time feedback during simulated cardiac arrest. The use of feedback has not been studied in clinical practice. The objective of this study was to determine whether the use of real-time feedback improves compliance with pre-defined targets for ventilation rate and volume during out-of-hospital cardiac resuscitation. METHODS This was a before-and-after study with four paramedic services in Ontario, Canada. We enrolled adult, out-of-hospital cardiac arrest (OHCA) patients where the ZOLL Accuvent® device was utilized to measure ventilation rate and volume. In the before phase (without feedback), the Accuvent® was used to measure ventilations, however, providers were blinded to the real-time feedback. In the after phase (with feedback), the feedback dashboard was activated and providers used the real-time feedback to guide their ventilations. All other aspects of resuscitation remained consistent throughout the study. The main objective of the study was to compare the proportion of each case that was compliant with pre-defined ventilation targets with real-time feedback and without real-time feedback. We also examined the use of advanced airways on ventilation quality and examined for associations between ventilation parameters and return of circulation. RESULTS We enrolled 412 patients in the study (191 in the before phase without feedback and 221 in the after phase with feedback). Overall, we found significant improvements in both ventilation rate and volume in the after phase (with real-time feedback) compared to the before phase (without real-time feedback). We did not find any differences in ventilation compliance with or without advanced airways, or intra-arrest or post-cardiac arrest. CONCLUSION The use of real-time feedback was associated with an increased proportion of ventilations that were compliant with pre-defined targets during cardiac resuscitation. Further work is required to improve the use of real-time ventilation feedback, and to determine the impact of ventilations on patient outcomes.
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Affiliation(s)
- Ian R Drennan
- Department of Emergency Services, Sunnybrook Health Science Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Science Centre, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Ornge Air Ambulance and Critical Care Transport, Toronto, ON, Canada; FIRST60, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada.
| | - Meji Lee
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jean-Philippe Héroux
- United Counties of Prescott and Russell Emergency Services, Plantagenet, ON, Canada
| | - Andrew Lee
- County of Peterborough Paramedic Services, Peterborough, ON, Canada
| | - John Riches
- Region of Waterloo Paramedic Services, Cambridge, ON, Canada
| | | | | | - Sheldon Cheskes
- Department of Emergency Services, Sunnybrook Health Science Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Science Centre, Toronto, ON, Canada; Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; FIRST60, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada; Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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LaPrad AS, Joseph B, Chokshi S, Aldrich K, Kessler D, Oppenheimer BW. A smartwatch-based CPR feedback device improves chest compression quality among health care professionals and lay rescuers. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:122-131. [PMID: 38989046 PMCID: PMC11232421 DOI: 10.1016/j.cvdhj.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Background Cardiopulmonary resuscitation (CPR) quality significantly impacts patient outcomes during cardiac arrests. With advancements in health care technology, smartwatch-based CPR feedback devices have emerged as potential tools to enhance CPR delivery. Objective This study evaluated a novel smartwatch-based CPR feedback device in enhancing chest compression quality among health care professionals and lay rescuers. Methods A single-center, open-label, randomized crossover study was conducted with 30 subjects categorized into 3 groups based on rescuer category. The Relay Response BLS smartwatch application was compared to a defibrillator-based feedback device (Zoll OneStep CPR Pads). Following an introduction to the technology, subjects performed chest compressions in 3 modules: baseline unaided, aided by the smartwatch-based feedback device, and aided by the defibrillator-based feedback device. Outcome measures included effectiveness, learnability, and usability. Results Across all groups, the smartwatch-based device significantly improved mean compression depth effectiveness (68.4% vs 29.7%; P < .05) and mean rate effectiveness (87.5% vs 30.1%; P < .05), compared to unaided compressions. Compression variability was significantly reduced with the smartwatch-based device (coefficient of variation: 14.9% vs 26.6%), indicating more consistent performance. Fifteen of 20 professional rescuers reached effective compressions using the smartwatch-based device in an average 2.6 seconds. A usability questionnaire revealed strong preference for the smartwatch-based device over the defibrillator-based device. Conclusion The smartwatch-based device enhances the quality of CPR delivery by keeping compressions within recommended ranges and reducing performance variability. Its user-friendliness and rapid learnability suggest potential for widespread adoption in both professional and lay rescuer scenarios, contributing positively to CPR training and real-life emergency responses.
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Affiliation(s)
| | | | | | - Kelly Aldrich
- Vanderbilt University School of Nursing, Nashville, TN
| | - David Kessler
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Huang LW, Chan YW, Tsan YT, Zhang QX, Chan WC, Yang HH. Implementation of a Smart Teaching and Assessment System for High-Quality Cardiopulmonary Resuscitation. Diagnostics (Basel) 2024; 14:995. [PMID: 38786293 PMCID: PMC11120156 DOI: 10.3390/diagnostics14100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
The purpose of this study is to develop a smart training and assessment system called SmartCPR, for teaching and training cardiopulmonary resuscitation (CPR), based on human posture estimation techniques. In this system, trainees can automatically recognize and evaluate whether chest compressions during CPR meet the standard of high-quality CPR by simply using a device such as a smart phone. Through the system, trainees are able to obtain real-time feedback on the quality of compressions so that they can adjust the cycle, depth, frequency, and posture of compressions to meet the standard of high-quality CPR. In addition, the SmartCPR system is convenient for CPR trainers. Trainers can instantly and accurately assess whether the trainee's compressions meet the standard of high-quality CPR, which reduces the risk of manual assessment errors and also reduces the trainer's teaching pressures. Therefore, the SmartCPR system developed in this study can be an important tool for CPR teaching and training for physicians, which can provide training and guidance for high-quality CPR maneuvers and enable trainees to become more proficient in CPR and self-training.
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Affiliation(s)
- Li-Wen Huang
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-W.H.); (Y.-T.T.); (W.-C.C.)
| | - Yu-Wei Chan
- Department of Computer Science and Information Management, Providence University, Taichung 40301, Taiwan;
| | - Yu-Tse Tsan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-W.H.); (Y.-T.T.); (W.-C.C.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Qi-Xiang Zhang
- Department of Computer Science and Information Engineering, Providence University, Taichung 40301, Taiwan
| | - Wei-Chang Chan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-W.H.); (Y.-T.T.); (W.-C.C.)
| | - Han-Hsuan Yang
- Everlink Occupational Medicine Clinic, Taichung 40760, Taiwan;
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Brogaard L, Hinshaw K, Kierkegaard O, Manser T, Uldbjerg N, Hvidman L. Developing the TeamOBS-vacuum-assisted delivery checklist to assess clinical performance in a vacuum-assisted delivery: a Delphi study with initial validation. Front Med (Lausanne) 2024; 11:1330443. [PMID: 38371513 PMCID: PMC10869485 DOI: 10.3389/fmed.2024.1330443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction In Northern Europe, vacuum-assisted delivery (VAD) accounts for 6-15% of all deliveries; VAD is considered safe when conducted by adequately trained personnel. However, failed vacuum extraction can be harmful to both the mother and child. Therefore, the clinical performance in VAD must be assessed to guide learning, determine a performance benchmark, and evaluate the quality to achieve an overall high performance. We were unable to identify a pre-existing tool for evaluating the clinical performance in real-life vacuum-assisted births. Objective We aimed to develop and validate a checklist for assessing the clinical performance in VAD. Methods We conducted a Delphi process, described as an interactive process where experts answer questions until answers converge toward a "joint opinion" (consensus). We invited international experts as Delphi panelists and reached a consensus after four Delphi rounds, described as follows: (1) the panelists were asked to add, remove, or suggest corrections to the preliminary list of items essential for evaluating clinical performance in VAD; (2) the panelists applied weights of clinical importance on a Likert scale of 1-5 for each item; (3) each panelist revised their original scores after reviewing a summary of the other panelists' scores and arguments; and (4) the TeamOBS-VAD was tested using videos of real-life VADs, and the Delphi panel made final adjustments and approved the checklist. Results Twelve Delphi panelists from the UK (n = 3), Norway (n = 2), Sweden (n = 3), Denmark (n = 3), and Iceland (n = 1) were included. After four Delphi rounds, the Delphi panel reached a consensus on the checklist items and scores. The TeamOBS-VAD checklist was tested using 60 videos of real-life vacuum extractions. The inter-rater agreement had an intraclass correlation coefficient (ICC) of 0.73; 95% confidence interval (95% CI) of [0.58, 0.83], and that for the average of two raters was ICC 0.84 95% CI [0.73, 0.91]. The TeamOBS-VAD score was not associated with difficulties in delivery, such as the number of contractions during vacuum extraction delivery, cephalic level, rotation, and position. Failed vacuum extraction occurred in 6% of the video deliveries, but none were associated with the teams with low clinical performance scores. Conclusion The TeamOBS-VAD checklist provides a valid and reliable evaluation of the clinical performance of vaginal-assisted vacuum extraction.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kim Hinshaw
- Department of Obstetrics and Gynecology, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Ole Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Tanja Manser
- Fachhochschule Nordwestschweiz (FHNW) School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Walton R, Riha J, Swor T, Kopper J, Yuan L, Mochel J, T Hoen M, Blong A. Comparison of Traditional Didactic Versus Additional Hands-On Simulation Training in the Performance of Basic Life Support in Veterinary Students-A Prospective, Blinded, Randomized Study. JOURNAL OF VETERINARY MEDICAL EDUCATION 2024; 51:38-43. [PMID: 37104287 DOI: 10.3138/jvme-2022-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Cardiopulmonary resuscitation (CPR) is a critical skill for veterinarians, but the most effective training methods and techniques are still unknown. In human medicine, simulation training enhances both knowledge and performance of basic life support CPR. This study evaluated the comparative effectiveness of didactic versus a combination of didactic and simulation training on performance and understanding of basic life support techniques in second-year veterinary medical students.
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St-Onge-St-Hilaire A, Cheng A, Davidson J, Wan B, Lin Y. Completeness and accuracy of digital charting vs paper charting in simulated pediatric cardiac arrest: a randomized controlled trial. CAN J EMERG MED 2024; 26:94-102. [PMID: 38097910 DOI: 10.1007/s43678-023-00624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/14/2023] [Indexed: 02/15/2024]
Abstract
OBJECTIVES To determine if data collected through digital charting are more complete and more accurate compared to traditional paper-based charting during simulated pediatric cardiac arrest. METHODS We performed a single-center simulation-based randomized controlled trial. Participants were randomized to a novel handheld digital charting device (intervention group) or to the standard resuscitation paper chart (control group). Participants documented two 15-min simulated pediatric cardiac arrest scenarios. We compared the charting completeness between the two groups. Completeness score (primary outcome) was established by calculating a completeness score for each group based on a list of pre-determined critical tasks. Charting accuracy (secondary outcome) was compared between the two groups, defined as the time interval between the real-time task performance and charted time. RESULTS Charting data from 34 simulated cardiac arrest events were included in the analysis (n = 18 intervention; n = 16 control). The paper charting group had a higher completeness score (median (IQR) paper vs digital: 72.0% (66.4-76.9%) vs 65.0% (58.5-66.4%), p = 0.015). For accuracy, the digital charting group was superior to the paper charting group for all pre-established critical tasks. CONCLUSION Compared to paper-based charting, digital charting group captured more critical tasks during pediatric simulated resuscitation and was more accurate in the time intervals between real-time tasks performance and charted time. For tasks charted, paper-based charting was significantly more complete and more detailed during simulated pediatric cardiac arrest.
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Affiliation(s)
| | - Adam Cheng
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Jennifer Davidson
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Brandi Wan
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Yiqun Lin
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.
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Pongtriang P, Soontorn T, Sumleepun J, Chuson N. Emergency Scenario-Based Training Curriculum Development: Enhancement of Caregivers for the Elderly' Emergency Assistance Competency in a Rural Thai Community. SAGE Open Nurs 2024; 10:23779608241255635. [PMID: 38770423 PMCID: PMC11104023 DOI: 10.1177/23779608241255635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/31/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
Background Caregivers for the elderly are a critical component of the health care system, especially in rural communities. They play a crucial role, assisting older people in confronting emergency illnesses. Objective The study describes the process of developing an emergency scenario-based training curriculum (ESBTC) for caregivers of the elderly, focusing on geriatric life-threatening surveillance and emergency assistance (GLTSEA) in rural communities. Methods The descriptive qualitative research utilized for developing the ESBTC followed Karn's six steps of curriculum development: (1) needs assessment, (2) targeted needs assessment, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback. The research sample comprised community representatives engaged in providing care during emergency illnesses, emergency experts, and health care providers. A group discussion and focus group were conducted along with semi-structured interviews. The data were analyzed by content analysis following Creswell's six steps. Results The results revealed problems and needs related to the care and management of emergency illnesses in rural communities. Five main themes emerged, including insufficient knowledge, difficulties in communication, mindfulness and self-confidence, Unable to assess the initial symptoms, and a need for skills development. In the development step, the curriculum focused on skill development and continued follow-up to ensure necessary skills, such as providing basic life support, using automated external defibrillators, through training scenarios. In the evaluation step, the participants indicated that their emergency assistance skills had improved. The six main themes that emerged regarding the training continuity, courses, and competencies needed to support the emergency system for caregivers were benefits and value, competence enhancements, upstreaming confidence, sustainable development, challenges in curriculum development, and effective strategies. Conclusions The ESBTC combines community-based and realistic scenarios, involving the participation of community stakeholders. It is crucial to gather community feedback and needs assessments to formulate potential strategies as part of the curriculum.
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Affiliation(s)
- Praditporn Pongtriang
- Department of Adult and Elderly Nursing, Faculty of Nursing, Suratthani Rajabhat University, Surat Thani, Thailand
| | - Thassanee Soontorn
- Department of Adult and Elderly Nursing, Faculty of Nursing, Suratthani Rajabhat University, Surat Thani, Thailand
| | - Jaruwat Sumleepun
- Department of Emergency and Accident, Suratthani Hospital, Surat Thani, Thailand
| | - Noawarat Chuson
- Department of Emergency and Accident, Vibhavadi Hospital, Surat Thani, Thailand
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Stefanidis D, Cook D, Kalantar-Motamedi SM, Muret-Wagstaff S, Calhoun AW, Lauridsen KG, Paige JT, Lockey A, Donoghue A, Hall AK, Patocka C, Palaganas J, Gross IT, Kessler D, Vermylen J, Lin Y, Aebersold M, Chang TP, Duff J, Kolbe M, Rutherford-Hemming T, Decker S, Collings A, Toseef Ansari M. Society for Simulation in Healthcare Guidelines for Simulation Training. Simul Healthc 2024; 19:S4-S22. [PMID: 38240614 DOI: 10.1097/sih.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. METHODS Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. OBJECTIVE These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare. RESULTS Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided. CONCLUSIONS The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.
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Affiliation(s)
- Dimitrios Stefanidis
- From the Department of Surgery (D.S., S.-M.K.-M.), Indiana University School of Medicine, Indianapolis, IN; Department of Internal Medicine (D.C.), Mayo Clinic, Rochester, MN; Department of Surgery (S.M.-W.), Emory University, Atlanta, GA; Department of Pediatrics (A.W.C.), University of Louisville School of Medicine and Norton Children's Medical Group, Louisville, KY; Department of Medicine (K.G.L.), Randers Regional Hospital, Randers, Denmark; Research Center for Emergency Medicine (K.G.L.), Aarhus University, Aarhus, Denmark; Department of Surgery (J.T.P.), LSU Health New Orleans School of Medicine, New Orleans, LA; Emergency Department (A.L.), Calderdale and Huddersfield NHS Trust, Halifax; School of Human and Health Sciences (A.L.), University of Huddersfield, Huddersfield, UK; Critical Care Medicine and Pediatrics (A.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Emergency Medicine (A.K.H.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine (C.P.), Cumming School of Medicine University of Calgary, Calgary, AB, Canada; Department of Health Professions Education (J.P.), School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA; Department of Pediatrics (I.T.G.), Section of Emergency Medicine, Yale University, New Haven, CT; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY,; Department of Medicine and Medical Education (J.V.), Feinberg School of Medicine, Northwestern University, Chicago, IL; KidSIM Simulation Research Program (Y.L.), Alberta Children's Hospital, Calgary, Canada; University of Michigan School of Nursing (M.A.), Ann Arbor, MI; Las Madrinas Simulation Center, Children's Hospital (T.C.), University South California, Los Angeles, CA; Department of Pediatrics (J.D.), University of Alberta, Edmonton, Alberta, Canada; Simulation Center (M.K.), University Hospital Zurich, ETH Zurich, Switzerland; Department of Nursing (T.R.-H.), University of North Carolina, Chapel Hill, NC; Department of Nursing (S.D.), Texas Tech University Health Sciences Center, Lubbock, TX; Department of Surgery (A.C.), University of Louisville, Louisville, KY; and Independent Methodologist (M.T.A.), Ottawa, Ontario, Canada
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Patocka C, Pandya A, Brennan E, Lacroix L, Anderson I, Ganshorn H, Hall AK. The Impact of Just-in-Time Simulation Training for Healthcare Professionals on Learning and Performance Outcomes: A Systematic Review. Simul Healthc 2024; 19:S32-S40. [PMID: 38240616 DOI: 10.1097/sih.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT Although just-in-time training (JIT) is increasingly used in simulation-based health professions education, its impact on learning, performance, and patient outcomes remains uncertain. The aim of this study was to determine whether JIT simulation training leads to improved learning and performance outcomes. We included randomized or nonrandomized interventional studies assessing the impact of JIT simulation training (training conducted in temporal or spatial proximity to performance) on learning outcomes among health professionals (trainees or practitioners). Of 4077 citations screened, 28 studies were eligible for inclusion. Just-in-time training simulation training has been evaluated for a variety of medical, resuscitation, and surgical procedures. Most JIT simulation training occurred immediately before procedures and lasted between 5 and 30 minutes. Despite the very low certainty of evidence, this systematic review suggests JIT simulation training can improve learning and performance outcomes, in particular time to complete skills. There remains limited data on better patient outcomes and collateral educational effects.
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Affiliation(s)
- Catherine Patocka
- From the Department of Emergency Medicine (C.P., A.P.), University of Calgary Cumming School of Medicine, Calgary, Canada; Department of Emergency Medicine (E.B.), Queen's University, Kingston, Canada ; Department of Emergency Medicine (L.L., A.K.H.), University of Ottawa, Ottawa, Canada; Department of Pediatric Emergency Medicine (I.A.), Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH; Royal College of Physicians and Surgeons of Canada (A.K.H.), Ottawa, Canada ; Libraries and Cultural Resources (H.G.), University of Calgary, Calgary, Canada
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14
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Lauridsen KG, Riis DN, Yeung J. Rapid response teams: Looking at the elephant through a different key hole. Resuscitation 2023; 193:110011. [PMID: 37884219 DOI: 10.1016/j.resuscitation.2023.110011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University, Denmark; Department of Medicine, Randers Regional Hospital, Denmark; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, United States.
| | - Dung N Riis
- Research Center for Emergency Medicine, Aarhus University, Denmark; Department of Medicine, Randers Regional Hospital, Denmark
| | - Joyce Yeung
- University of Warwick, Warwick Medical School, United Kingdom; Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
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Abstract
Pediatric cardiac arrest in the emergency department is rare. We emphasize the importance of preparedness for pediatric cardiac arrest and offer strategies for the optimal recognition and care of patients in cardiac arrest and peri-arrest. This article focuses on both prevention of arrest and the key elements of pediatric resuscitation that have been shown to improve outcomes for children in cardiac arrest. Finally, we review changes to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care that were published in 2020.
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Affiliation(s)
- Steven Garbin
- Emergency Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Joshua Easter
- Emergency Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
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Lin Y, Savage T, Gravel G, Davidson J, Tofil N, Duff J, Cheng A. Who is the real team leader? Comparing leadership performance of the team leader and CPR Coach during simulated cardiac arrest. Resusc Plus 2023; 14:100400. [PMID: 37265710 PMCID: PMC10230253 DOI: 10.1016/j.resplu.2023.100400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Purpose To describe the leadership performance of team leaders and CPR Coaches, and to determine if there is a correlation between leadership scores and CPR performance during management of simulated pediatric cardiac arrest events. Methods This is a secondary analysis of data from a prior randomized controlled trial. We observed the performance of both team leaders and CPR coaches during the management of an 18-minute simulated cardiac arrest scenario which was run for 20 resuscitation teams comprised of CPR-certified professionals from four pediatric tertiary care centers. CPR Coaches were responsible for providing real-time verbal feedback of CPR performance to compressors. Two raters were trained to use the Behavioral Assessment Tool (BAT) to assess leadership performance of the team leader and CPR Coach. BAT scores of team leaders and CPR coaches were compared and linked with objective CPR performance. Results There was no significant difference between the BAT scores of team leaders and CPR coaches (median score 27/40 vs 28.8/40, p = 0.16). Higher BAT scores of team leaders were significantly associated with higher percentage of excellent CPR (r = 0.52, p = 0.02), while higher BAT scores of CPR coaches were significantly associated with higher chest compression fraction (r = 0.48, p = 0.03). Conclusions Both team leaders and CPR coaches have similarly high leadership performance during the management of simulated cardiac arrest. Leadership behaviors were associated with quality of CPR performance.Clinical Trial Registration: Registration ID: NCT02539238; https://www.clinicaltrials.gov.
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Affiliation(s)
- Yiqun Lin
- Jennifer Davidson RN, KidSIM-ASPIRE Simulation Research Program, Alberta Children’s Hospital, University of Calgary, Canada
| | - Tyson Savage
- Department of Emergency Medicine, University of Calgary, Canada
| | - Genevieve Gravel
- Department of Emergency Medicine, Laval University, Quebec City, Canada
| | - Jennifer Davidson
- Jennifer Davidson RN, KidSIM-ASPIRE Simulation Research Program, Alberta Children’s Hospital, University of Calgary, Canada
| | - Nancy Tofil
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jonathan Duff
- Department of Pediatrics, Faculty of Medicine and Dentristry, University of Alberta, Edmonton, Canada
| | - Adam Cheng
- Department of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, KidSIM-ASPIRE Simulation Research Program, Alberta Children’s Hospital, Canada
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Kleinman K, Hairston T, Smith B, Billings E, Tackett S, Chopra E, Risko N, Swedien D, Schreurs BA, Dean JL, Scott B, Canares T, Jeffers JM. Pediatric Chest Compression Improvement Via Augmented Reality Cardiopulmonary Resuscitation Feedback in Community General Emergency Departments: A Mixed-Methods Simulation-Based Pilot Study. J Emerg Med 2023; 64:696-708. [PMID: 37438023 PMCID: PMC10360435 DOI: 10.1016/j.jemermed.2023.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/19/2023] [Accepted: 03/11/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Yearly, more than 20,000 children experience a cardiac arrest. High-quality pediatric cardiopulmonary resuscitation (CPR) is generally challenging for community hospital teams, where pediatric cardiac arrest is infrequent. Current feedback systems are insufficient. Therefore, we developed an augmented reality (AR) CPR feedback system for use in many settings. OBJECTIVE We aimed to evaluate whether AR-CPR improves chest compression (CC) performance in non-pediatric-specialized community emergency departments (EDs). METHODS We performed an unblinded, randomized, crossover simulation-based study. A convenience sample of community ED nonpediatric nurses and technicians were included. Each participant performed three 2-min cycles of CC during a simulated pediatric cardiac arrest. Participants were randomized to use AR-CPR in one of three CC cycles. Afterward, participants participated in a qualitative interview to inquire about their experience with AR-CPR. RESULTS Of 36 participants, 18 were randomized to AR-CPR in cycle 2 (group A) and 18 were randomized to AR-CPR in cycle 3 (group B). When using AR-CPR, 87-90% (SD 12-13%) of all CCs were in goal range, analyzed as 1-min intervals, compared with 18-21% (SD 30-33%) without feedback (p < 0.001). Analysis of qualitative themes revealed that AR-CPR may be usable without a device orientation, be effective at cognitive offloading, and reduce anxiety around and enhance confidence in the CC delivered. CONCLUSIONS The novel CPR feedback system, AR-CPR, significantly changed the CC performance in community hospital non-pediatric-specialized general EDs from 18-21% to 87-90% of CC epochs at goal. This study offers preliminary evidence suggesting AR-CPR improves CC quality in community hospital settings.
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Affiliation(s)
- Keith Kleinman
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland.
| | - Tai Hairston
- The Harriet Lane Pediatric Residency Program, The Johns Hopkins University, Baltimore, Maryland
| | - Brittany Smith
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Emma Billings
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Eisha Chopra
- Department of Emergency Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Nicholas Risko
- Department of Emergency Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Daniel Swedien
- Department of Emergency Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Blake A Schreurs
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, Laurel, Maryland
| | - James L Dean
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, Laurel, Maryland
| | - Brandon Scott
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, Laurel, Maryland
| | - Therese Canares
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Justin M Jeffers
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
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Cheng A, Davidson J, Wan B, St-Onge-St-Hilaire A, Lin Y. Data-informed debriefing for cardiopulmonary arrest: A randomized controlled trial. Resusc Plus 2023; 14:100401. [PMID: 37260809 PMCID: PMC10227448 DOI: 10.1016/j.resplu.2023.100401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023] Open
Abstract
Aim To determine if data-informed debriefing, compared to a traditional debriefing, improves the process of care provided by healthcare teams during a simulated pediatric cardiac arrest. Methods We conducted a prospective, randomized trial. Participants were randomized to a traditional debriefing or a data-informed debriefing supported by a debriefing tool. Participant teams managed a 10-minute cardiac arrest simulation case, followed by a debriefing (i.e. traditional or data-informed), and then a second cardiac arrest case. The primary outcome was the percentage of overall excellent CPR. The secondary outcomes were compliance with AHA guidelines for depth and rate, chest compression (CC) fraction, peri-shock pause duration, and time to critical interventions. Results A total of 21 teams (84 participants) were enrolled, with data from 20 teams (80 participants) analyzed. The data-informed debriefing group was significantly better in percentage of overall excellent CPR (control vs intervention: 53.8% vs 78.7%; MD 24.9%, 95%CI: 5.4 to 44.4%, p = 0.02), guideline-compliant depth (control vs. intervention: 60.4% vs 85.8%, MD 25.4%, 95%CI: 5.5 to 45.3%, p = 0.02), CC fraction (control vs intervention: 88.6% vs 92.6, MD 4.0%, 95%CI: 0.5 to 7.4%, p = 0.03), and peri-shock pause duration (control vs intervention: 5.8 s vs 3.7 s, MD -2.1 s, 95%CI: -3.5 to -0.8 s, p = 0.004) compared to the control group. There was no significant difference in time to critical interventions between groups. Conclusion When compared with traditional debriefing, data-informed debriefing improves CPR quality and reduces pauses in CPR during simulated cardiac arrest, with no improvement in time to critical interventions.
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Affiliation(s)
- Adam Cheng
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, KidSIM-ASPIRE Research Program, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada
| | - Jennifer Davidson
- KidSIM Simulation Program, Alberta Children’s Hospital, University of Calgary, Canada
| | - Brandi Wan
- KidSIM Simulation Program, Alberta Children’s Hospital, University of Calgary, Canada
| | | | - Yiqun Lin
- KidSIM Simulation Program, Alberta Children’s Hospital, University of Calgary, Canada
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Kshetrapal A, McBride ME, Mannarino C. Taking the Pulse of the Current State of Simulation. Crit Care Clin 2023; 39:373-384. [PMID: 36898780 DOI: 10.1016/j.ccc.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Simulation in health-care professions has grown in the last few decades. We provide an overview of the history of simulation in other fields, the trajectory of simulation in health professions education, and research in medical education, including the learning theories and tools to assess and evaluate simulation programs. We also propose future directions for simulation and research in health professions education.
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Affiliation(s)
- Anisha Kshetrapal
- Department of Pediatrics, Division of Emergency Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA.
| | - Mary E McBride
- Depatment of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA
| | - Candace Mannarino
- Depatment of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA
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Effect of real-time feedback device compared to use or non-use of a checklist performance aid on post-training performance and retention of infant cardiopulmonary resuscitation: A randomized simulation-based trial. Australas Emerg Care 2023; 26:36-44. [PMID: 35915032 DOI: 10.1016/j.auec.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/02/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This study aims to determine the best method for achieving optimal performance of pediatric cardiopulmonary resuscitation (CPR) during simulation-based training, whether with or without a performance aid. METHODS In this randomized controlled study, 46 participants performed simulated CPR in pairs on a Resusci Baby QCPR™ mannequin, repeated after four weeks. All participants performed the first simulation without performance aids. For the second simulation, they were randomly assigned to one of three groups with stratification based on status: throughout CPR, Group A (n = 16) was the control group and did not use a performance aid; Group B (n = 16) used the CPR checklist; Group C (n = 14) used real-time visualization of their CPR activity on a feedback device. Overall performance was assessed using the QCPR™. RESULTS All groups demonstrated improved performance on the second simulation (p < 0.01). Use of the feedback device resulted in better CPR performance than use of the CPR checklist (p = 0.02) or no performance aid (p = 0.04). Additionally, participants thought that the QCPR™ could effectively improve their technical competences. CONCLUSIONS Performance aid based on continuous feedback is helpful in the learning process. The use of the QCPR™, a real-time feedback device, improved the quality of resuscitation during infant CPR simulation-based training.
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Saidu A, Lee K, Ismail I, Arulogun O, Lim PY. Effectiveness of video self-instruction training on cardiopulmonary resuscitation retention of knowledge and skills among nurses in north-western Nigeria. Front Public Health 2023; 11:1124270. [PMID: 37026136 PMCID: PMC10070802 DOI: 10.3389/fpubh.2023.1124270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/20/2023] [Indexed: 04/08/2023] Open
Abstract
Background Adaptable cardiopulmonary resuscitation/basic life support (CPR/BLS) training are required to reduce cardiac arrest mortality globally, especially among nurses. Thus, this study aims to compared CPR knowledge and skills retention level between instructor-led (control group) and video self-instruction training (intervention group) among nurses in northwestern Nigeria. Methods A two-arm randomized controlled trial study using double blinding method was conducted with 150 nurses from two referral hospitals. Stratified simple random method was used to choose eligible nurses. For video self-instruction training (intervention group), participants learnt the CPR training via computer in a simulation lab for 7 days, in their own available time whereas for instructor-led training (control group), a 1-day program was conducted by AHA certified instructors. A generalized estimated equation model was used for statistical analysis. Results Generalized Estimated Equation showed that there were no significant differences between the intervention group (p = 0.055) and control group (p = 0.121) for both CPR knowledge and skills levels respectively, whereas higher probability of having good knowledge and skills in a post-test, one month and three-month follow-up compared to baseline respectively, adjusted with covariates (p < 0.05). Participants had a lower probability of having good skills at 6-month follow-up compared to baseline, adjusted with covariates (p = 0.003). Conclusion This study showed no significant differences between the two training methods, hence video self-instruction training is suggested can train more nurses in a less cost-effective manner to maximize resource utilization and quality nursing care. It is suggested to be used to improve knowledge and skills among nurses to ensure cardiac arrest patients receive excellent resuscitation care.
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Affiliation(s)
- Ahmed Saidu
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Federal University Birnin-Kebbi, Birnin Kebbi, Kebbi, Nigeria
| | - Khuan Lee
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Iskasymar Ismail
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- RESQ Stroke Emergency Unit, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Malaysia
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- *Correspondence: Poh Ying Lim
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Mallory LA, Doughty CB, Davis KI, Cheng A, Calhoun AW, Auerbach MA, Duff JP, Kessler DO. A Decade Later-Progress and Next Steps for Pediatric Simulation Research. Simul Healthc 2022; 17:366-376. [PMID: 34570084 DOI: 10.1097/sih.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT A decade ago, at the time of formation of the International Network for Pediatric Simulation-based Innovation, Research, and Education, the group embarked on a consensus building exercise. The goal was to forecast the facilitators and barriers to growth and maturity of science in the field of pediatric simulation-based research. This exercise produced 6 domains critical to progress in the field: (1) prioritization, (2) research methodology and outcomes, (3) academic collaboration, (4) integration/implementation/sustainability, (5) technology, and (6) resources/support/advocacy. This article reflects on and summarizes a decade of progress in the field of pediatric simulation research and suggests next steps in each domain as we look forward, including lessons learned by our collaborative grass roots network that can be used to accelerate research efforts in other domains within healthcare simulation science.
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Affiliation(s)
- Leah A Mallory
- From the Tufts University School of Medicine (L.A.M.), Boston, MA; Department of Medical Education (L.A.M.), The Hannaford Center for Simulation, Innovation and Education; Section of Hospital Medicine (L.A.M.), Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Section of Emergency Medicine (C.B.D.), Department of Pediatrics, Baylor College of Medicine; Simulation Center (C.B.D.), Texas Children's Hospital, Pediatric Emergency Medicine, Baylor College of Medicine; Section of Critical Care Medicine (K.I.D.), Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Departments of Pediatrics and Emergency Medicine (A.C.), University of Calgary, Calgary, Canada; Division of Pediatric Critical Care (A.W.C.), University of Louisville School of Medicine and Norton Children's Hospital, Louisville, KY; Section of Emergency Medicine (M.A.A.), Yale University School of Medicine, New Haven, CT; Division of Critical Care (J.P.D.), University of Alberta, Alberta, Canada; and Columbia University Vagelos College of Physicians and Surgeons (D.O.K.), New York, NY
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Corazza F, Stritoni V, Martinolli F, Daverio M, Binotti M, Genoni G, Ingrassia PL, De Luca M, Palmas G, Maccora I, Frigo AC, Da Dalt L, Bressan S. Adherence to guideline recommendations in the management of pediatric cardiac arrest: a multicentre observational simulation-based study. Eur J Emerg Med 2022; 29:271-278. [PMID: 35404331 PMCID: PMC10878464 DOI: 10.1097/mej.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND IMPORTANCE Pediatric cardiac arrest is a rare emergency with associated high mortality. Its management is challenging and deviations from guidelines can affect clinical outcomes. OBJECTIVES To evaluate the adherence to guideline recommendations in the management of a pediatric cardiac arrest scenario by teams of pediatric residents. Secondarily, the association between the use of the Pediatric Advanced Life Support-2015 (PALS-2015) pocket card, and the teams' adherence to international guidelines, were explored. DESIGN, SETTINGS AND PARTICIPANTS Multicentre observational simulation-based study at three Italian University Hospitals in 2018, including PALS-2015 certified pediatric residents in their 3rd-5th year of residency program, divided in teams of three. INTERVENTION OR EXPOSURE Each team conducted a standard nonshockable pediatric cardiac arrest scenario and independently decided whether to use the PALS-2015 pocket card. OUTCOME MEASURE AND ANALYSIS The primary outcome was the overall number and frequency of individual deviations from the PALS-2015 guidelines, measured by the novel c-DEV15plus score (range 0-15). Secondarily, the performance on the validated Clinical Performance Tool for asystole scenarios, the time to perform resuscitation tasks and cardiopulmonary resuscitation (CPR) quality metrics were compared between the teams that used and did not use the PALS-2015 pocket card. MAIN RESULTS Twenty-seven teams (81 residents) were included. Overall, the median number of deviations per scenario was 7 out of 15 [interquartile range (IQR), 6-8]. The most frequent deviations were delays in positioning of a CPR board (92.6%), calling for adrenaline (92.6%), calling for help (88.9%) and incorrect/delayed administration of adrenaline (88.9%). The median Clinical Performance Tool score was 9 out of 13 (IQR, 7-10). The comparison between teams that used ( n = 13) and did not use ( n = 14) the PALS-2015 pocket card showed only significantly higher Clinical Performance Tool scores in the former group [9 (IQR 9-10) vs. 7 (IQR 6-8); P = 0.002]. CONCLUSIONS Deviations from guidelines, although measured by means of a nonvalidated tool, were frequent in the management of a pediatric cardiac arrest scenario by pediatric residents. The use of the PALS-2015 pocket card was associated with better Clinical Performance Tool scores but was not associated with less deviations or shorter times to resuscitation tasks.
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Affiliation(s)
- Francesco Corazza
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Valentina Stritoni
- Department of Woman’s and Child’s Health, Paediatric Intensive Care Unit, University of Padua, Padua
| | - Francesco Martinolli
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Marco Daverio
- Department of Woman’s and Child’s Health, Paediatric Intensive Care Unit, University of Padua, Padua
| | - Marco Binotti
- Neonatal and Paediatric Intensive Care Unit, Maggiore della Carità University Hospital, University of Piemonte Orientale, Novara, Italy
| | - Giulia Genoni
- Neonatal and Paediatric Intensive Care Unit, Maggiore della Carità University Hospital, University of Piemonte Orientale, Novara, Italy
| | - Pier Luigi Ingrassia
- Centro di Simulazione (CeSi), Centro Professionale Sociosanitario di Lugano, Lugano, Switzerland
| | - Marco De Luca
- Paediatric Simulation Centre, Meyer Children’s University Hospital
| | - Giordano Palmas
- Department of Health Sciences, University of Florence and Meyer Children’s University Hospital, Florence
| | - Ilaria Maccora
- Department of Health Sciences, University of Florence and Meyer Children’s University Hospital, Florence
| | - Anna Chiara Frigo
- Department of Cardiac, Biostatistics, Epidemiology and Public Health Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Silvia Bressan
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
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Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C, Eich C, Eifinger F, Huth R, Heimberg E, Landsleitner B, Olivieri M, Sasse M, Weisner T, Wagner M, Warnke G, Ziegler B, Boettiger BW, Nadkarni V, Hoffmann F. Mehr als 500 Kinder pro Jahr könnten gerettet werden! Zehn Thesen zur Verbesserung der Qualität pädiatrischer Reanimationen im deutschsprachigen Raum. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jeffers JM, Schreurs BA, Dean JL, Scott B, Canares T, Tackett S, Smith B, Billings E, Billioux V, Sampathkumar HD, Kleinman K. Paediatric chest compression performance improves via novel augmented-reality cardiopulmonary resuscitation feedback system: A mixed-methods pilot study in a simulation-based setting. Resusc Plus 2022; 11:100273. [PMID: 35844631 PMCID: PMC9283661 DOI: 10.1016/j.resplu.2022.100273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 12/21/2022] Open
Abstract
Aim More than 20,000 children experience a cardiac arrest event each year in the United States. Most children do not survive. High-quality cardiopulmonary resuscitation (CPR) has been associated with improved outcomes yet adherence to guidelines is poor. We developed and tested an augmented reality head mounted display chest compression (CC) feedback system (AR-CPR) designed to provide real-time CC feedback and guidance. Methods We conducted an unblinded randomized crossover simulation-based study to determine whether AR-CPR changes a user's CC performance. A convenience sample of healthcare providers who perform CC on children were included. Subjects performed three two-minute cycles of CC during a simulated 18-minute paediatric cardiac arrest. Subjects were randomized to utilize AR-CPR in the second or third CC cycle. After, subjects participated in a qualitative portion to inquire about their experience with AR-CPR and offer criticisms and suggestions for future development. Results There were 34 subjects recruited. Sixteen subjects were randomly assigned to have AR-CPR in cycle two (Group A) and 18 subjects were randomized to have AR-CPR in cycle three (Group B). There were no differences between groups CC performance in cycle one (baseline). In cycle two, subjects in Group A had 73% (SD 18%) perfect CC epochs compared to 17% (SD 26%) in Group B (p < 0.001). Overall, subjects enjoyed using AR-CPR and felt it improved their CC performance. Conclusion This novel AR-CPR feedback system showed significant CC performance change closer to CC guidelines. Numerous hardware, software, and user interface improvements were made during this pilot study.
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Affiliation(s)
- Justin M. Jeffers
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States,Corresponding author at: Bloomberg Children’s Center, 1800 Orleans St, Suite G-1509, United States.
| | - Blake A. Schreurs
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, 11100 Johns Hopkins Rd, Laurel, MD 20723, United States
| | - James L. Dean
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, 11100 Johns Hopkins Rd, Laurel, MD 20723, United States
| | - Brandon Scott
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, 11100 Johns Hopkins Rd, Laurel, MD 20723, United States
| | - Therese Canares
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, United States
| | - Brittany Smith
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
| | - Emma Billings
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
| | - Veena Billioux
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
| | - Harshini D. Sampathkumar
- Department of International Health, Johns Hopkins University School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Keith Kleinman
- Department of Paediatrics, The Johns Hopkins University, Bloomberg Children’s Center, 1800 Orleans St., Baltimore, MD 21287, United States
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Dhillon GS, Lasa JJ. Invited Commentary: An Ounce of Prevention Is Worth a Pound of Cure: Advancing the Search for Modifiable Factors Associated With Cardiac Arrest. World J Pediatr Congenit Heart Surg 2022; 13:482-484. [PMID: 35757946 DOI: 10.1177/21501351221102069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gurpreet S Dhillon
- Division of Cardiology, Department of Pediatrics, 24349Lucile Packard Children's Hospital at Stanford Medical Center, Stanford, CA, USA
| | - Javier J Lasa
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.,Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Lin L, Ni S, Liu Y, Xue J, Ma B, Xiong D, Zhao Y, Jin X. Effect of peer videorecording feedback CPR training on students' practical CPR skills: a randomized controlled manikin study. BMC MEDICAL EDUCATION 2022; 22:484. [PMID: 35733183 PMCID: PMC9215097 DOI: 10.1186/s12909-022-03563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of this study was to compare one-month acquisition and half-a-year quality retention of cardiopulmonary resuscitation (CPR) skills after initial training of medical students between peer videorecording feedback training (PVF) and traditional peer verbal feedback training (TVF). METHODS Participants were randomly assigned to the PVF group (n = 62) and the TVF group (n = 65). All participants received a 45-min CPR training program performed by an American Heart Association basic life support-certified instructor, and then they began two hours of practice in groups. During interactive peer learning, students cooperated in couples of a doer and a helper to realize maximization of each other's learning. In the PVF group, training performance feedback came from peers based on practice videorecording. In the TVF group, feedback came from peers verbally without videorecording. CPR quality was tested at 1 and 6 months after training. RESULTS After 1 month of initial training, the PVF group had a better presentation of CPR skills acquisition than the TVF group. Compared to the TVF group, the PVF group had significantly higher total scores, compression depth, appropriate compression depth, and complete chest recoil (p < 0.05). Moreover, compression interruption was a significantly positive change in the PVF group compared to the TVF group (p < 0.05). However, after 6 months, proportions of appropriate compression depth in the PVF group were better than those in the TVF group (p < 0.05). The differences in total scores, compression depth, appropriate compression depth, complete chest recoil and compression interruption were non-significant (all p > 0.05). CONCLUSIONS Compared to TVF, PVF is more effective in enhancing CPR skill acquisition at 1 month. After half a year, CPR skill quality was obviously reduced in both groups, and no difference in CPR quality was found between the two groups.
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Affiliation(s)
- Lian Lin
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Hubei, 430071, Wuhan, China
| | - Shaozhou Ni
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Hubei, 430071, Wuhan, China
- Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Yaqi Liu
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Hubei, 430071, Wuhan, China
- The Second Clinical College of Wuhan University, Wuhan, 430071, Hubei, China
| | - Jingyi Xue
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Hubei, 430071, Wuhan, China
| | - Binyu Ma
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Hubei, 430071, Wuhan, China
| | - Dan Xiong
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Hubei, 430071, Wuhan, China
- Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Yan Zhao
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Hubei, 430071, Wuhan, China.
- Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
| | - Xiaoqing Jin
- Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Hubei, 430071, Wuhan, China.
- Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
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Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study. Pediatr Res 2022; 91:1762-1768. [PMID: 34290385 PMCID: PMC9270220 DOI: 10.1038/s41390-021-01653-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate the effect of feedback devices on visual attention and the quality of pediatric resuscitation. METHODS This was a randomized cross-over simulation study at the Medical University of Vienna. Participants were students and neonatal providers performing four resuscitation scenarios with the support of feedback devices randomized. The primary outcome was the quality of resuscitation. Secondary outcomes were total dwell time (=total duration of visit time) on areas of interest and the workload of participants. RESULTS Forty participants were analyzed. Overall, chest compression (P < 0.001) and ventilation quality were significantly better (P = 0.002) when using a feedback device. Dwell time on the feedback device was 40.1% in the ventilation feedback condition and 48.7% in the chest compression feedback condition. In both conditions, participants significantly reduced attention from the infant's chest and mask (72.9 vs. 32.6% and 21.9 vs. 12.7%). Participants' subjective workload increased by 3.5% (P = 0.018) and 8% (P < 0.001) when provided with feedback during a 3-min chest compression and ventilation scenario, respectively. CONCLUSIONS The quality of pediatric resuscitation significantly improved when using real-time feedback. However, attention shifted from the manikin and other equipment to the feedback device and subjective workload increased, respectively. IMPACT Cardiopulmonary resuscitation with feedback devices results in a higher quality of resuscitation and has the potential to lead to a better outcome for patients. Feedback devices consume attention from resuscitation providers. Feedback devices were associated with a shift of visual attention to the feedback devices and an increased workload of participants. Increased workload for providers and benefits for resuscitation quality need to be balanced for the best effect.
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Lauridsen KG, Løfgren B, Brogaard L, Paltved C, Hvidman L, Krogh K. Cardiopulmonary Resuscitation Training for Healthcare Professionals: A Scoping Review. Simul Healthc 2022; 17:170-182. [PMID: 34652328 DOI: 10.1097/sih.0000000000000608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT The optimal strategy for training cardiopulmonary resuscitation (CPR) for healthcare professionals remains to be determined. This scoping review aimed to describe the emerging evidence for CPR training for healthcare professionals.We screened 7605 abstracts and included 110 studies in this scoping review on CPR training for healthcare professionals. We assessed the included articles for evidence for the following topics: training duration, retraining intervals, e-learning, virtual reality/augmented reality/gamified learning, instructor-learner ratio, equipment and manikins, other aspects of contextual learning content, feedback devices, and feedback/debriefing. We found emerging evidence supporting the use of low-dose, high-frequency training with e-learning to achieve knowledge, feedback devices to perform high-quality chest compressions, and in situ team simulations with debriefings to improve the performance of provider teams.
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Affiliation(s)
- Kasper Glerup Lauridsen
- From the Department of Medicine (K.G.L., B.L.), Randers Regional Hospital, Randers; Research Center for Emergency Medicine (K.G.L., B.L., K.K.), Aarhus University Hospital, Aarhus, Denmark; Center for Simulation, Innovation, and Advanced Education (K.G.L.), Children's Hospital of Philadelphia, Philadelphia; Department of Clinical Medicine (B.L.), Aarhus University; Department of Obstetrics and Gynaecology (L.B., L.H.), Aarhus University Hospital; Corporate HR Midtsim (C.P.) Central Denmark Region; and Department of Anesthesiology, Aarhus University Hospital (K.K.), Aarhus University Hospital, Aarhus, Denmark
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Intensive Care Unit Nurses' Perceptions and Experience Using the American Heart Association Resuscitation Quality Improvement Program. CLIN NURSE SPEC 2022. [DOI: 10.1097/nur.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khattab M, Frisell K, MacKinnon R, Chang T, Raymond T, Lofton L, Tofil N, Forrester K, Gohel C, Aitken D, Scalzo A, Moore-Clingenpeel M, Auerbach M. Healthcare Provider Characteristics and Cardiopulmonary Resuscitation Quality During Infant Resuscitation: A Simulation Study. Simul Healthc 2022; 17:88-95. [PMID: 34468421 DOI: 10.1097/sih.0000000000000599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Healthcare providers' anthropometric characteristics can adversely affect adult cardiopulmonary resuscitation (CPR) performance quality. However, their effects on infant CPR are unknown. We aimed to determine any relationships between healthcare provider characteristics (anthropomorphic, demographics, training, occupational data) and simulated infant CPR performance at multiple international sites. Our secondary aim was to examine provider's CPR performance degradation. METHODS Providers from 4 international hospitals performed 2 minutes of single-rescuer simulated infant CPR using 2015 American Heart Association Basic Life Support criteria with guidance from a real-time visual performance feedback device. Providers' characteristics were collected, and the simulator collected compression and ventilation data. Multivariate analyses examined the entire 2 minutes and performance degradation. RESULTS Data from 127 participants were analyzed. Although median values for all compression variables (depth, rate, lean) and ventilation volume were within guideline target ranges, when looking at individuals, only 52% chest compressions and 20% ventilations adhered to the American Heart Association guidelines. Age was found to be independently associated with ventilation volume (direct-relationship), and height was associated with chest compression lean (shorter participant-deeper lean). No significant differences were noted based on sex or body mass index. Neonatal intensive care unit participants were noted to perform shallower chest compressions (P < 0.001). Overall, there was minimal evidence of performance degradation over 2 minutes. CONCLUSIONS Isolated provider characteristics were noted among a diverse cohort of healthcare providers that may affect the CPR quality on a simulated infant. Understanding the relationships between provider characteristics and CPR quality could inform future infant CPR guidelines customized for the provider and not just the patient.
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Affiliation(s)
- Mona Khattab
- From the Division of Neonatology (M.K.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Department of Anesthesiology (K.F.), Mälarsjukhuset Hospital; Department of Anesthesiology (K.F.), Mälarsjukhuset/Karolinska Institutet, Eskilstuna, Sweden; Faculty of Biology, Medicine and Health (R.M.), The University of Manchester; Faculty of Health, Psychology, and Social Care (R.M.), Manchester Metropolitan University; Department of Paediatric Anaesthesia (R.M.), Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Emergency Medicine (T.C.), Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA; Division of Cardiac Critical Care (T.R.), Department of Pediatrics, Medical City Children's Hospital, Dallas, TX; NHS Harefield Trust (L.L.), Health Education England (HEE), London, UK; Division of Critical Care (N.T.), Children's Hospital Alabama, University of Alabama, Tuscaloosa, AL; Division of Emergency Medicine (K.F., A.S.), Department of Pediatrics, SSM Health Cardinal Glennon Children's Hospital, St Louis University School of Medicine, St Louis, MO; Golden Valley Health Centers (C.G.), Modesto, CA; Department of Pediatrics and Emergency Medicine (C.G., M.A.), Yale University School of Medicine, New Haven, CT; Department of Research and Innovation (D.A.), Manchester University NHS Foundation Trust, Manchester, UK; Abigail Wexner Research Institute (M.M.-C.); and Division of Critical Care Medicine and Biostatistics Resource (M.M.-C.), Nationwide Children's Hospital, Columbus, OH
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Zheng J, Du L, Deng X, Zhang L, Wang J, Chen G. Efficacy of virtual reality techniques in cardiopulmonary resuscitation training: protocol for a meta-analysis of randomised controlled trials and trial sequential analysis. BMJ Open 2022; 12:e058827. [PMID: 35149577 PMCID: PMC8845316 DOI: 10.1136/bmjopen-2021-058827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Cardiopulmonary resuscitation (CPR) is the most critical procedure in the rescue of patients with sudden cardiac death (SCD). The success rate of CPR remains far below expectations, which made CPR education identified as the top priority for SCD. CPR training using the virtual reality (VR) technique is a feasible training method, with a wider population and lower cost, but its efficacy remains controversial. Thus, we will perform a protocol for a systematic review and meta-analysis to identify the efficacy of the VR technique on CPR quality. METHODS AND ANALYSIS We will search PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase, China National Knowledge Infrastructure, Chinese BioMedical Literature, Wanfang and VIP databases from inception to November 2021, to identify randomised controlled trials and the first period in randomised cross-over trials assessing the efficacy of VR techniques versus non-VR techniques for adult participants accepting adult CPR training. No language restrictions will be considered. Data synthesis will be performed using RevMan V.5.4 and Stata/MP V.16.0. Outcome measures will be present as relative risk with 95% CIs for dichotomous data and mean difference with 95% CIs for continuous data. The primary outcome will be the CPR quality defined as chest compression rate and depth. Secondary outcomes will be the overall performance of CPR. Heterogeneity will be assessed by the χ2 test and I2 statistic. Data will be synthesised by either fixed-effects or random-effects models according to the I2 value. Trial sequential analysis and modified Jadad Scale will be used to control the risks of random errors and evaluate the evidence quality. Egger's regression test and funnel plots will be used to assess the publication bias. ETHICS AND DISSEMINATION Ethical approval was not required for this systematic review protocol. The findings will be disseminated through peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42021281059.
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Affiliation(s)
- Jianqiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Du
- Department of Anesthesiology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaoqian Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jia Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Yao S, Tang Y, Yi C, Xiao Y. Research Hotspots and Trend Exploration on the Clinical Translational Outcome of Simulation-Based Medical Education: A 10-Year Scientific Bibliometric Analysis From 2011 to 2021. Front Med (Lausanne) 2022; 8:801277. [PMID: 35198570 PMCID: PMC8860229 DOI: 10.3389/fmed.2021.801277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent decades, an increasing number of studies have focused on the clinical translational effect of simulation-based medical education (SBME). However, few scientific bibliometric studies have analyzed the research hotspots and publication trends. This study aimed to investigate research hotspots and future direction in the clinical translational outcome of SBME via bibliometrics. METHOD Relevant publications on the clinical translational outcomes of SBME from 2011 to 2021 were identified and retrieved from the Web of Science Core Collection (WOSCC). Software including VOSviewer (1.6.17) and CiteSpace (5.8R3) and a platform (bibliometric.com) were employed to conduct bibliographic and visualized analysis on the literature. RESULTS A total of 1,178 publications were enrolled. An increasing number of publications were observed in the past decades from 48 in 2011 to 175 in 2021. The United States accounted for the largest number of publications (488, 41.4%) and citations (10,432); the University of Toronto and Northwestern University were the leading institutions. Academic Medicine was the most productive journal concerning this field. McGaghie W C and Konge L were the most influential authors in this area. The hot topic of the translational outcome of SBME was divided into 3 stages, laboratory phase, individual skill improvement, and patient outcome involving both technical skills and non-technical skills. Translational research of comprehensive impact and collateral outcomes could be obtained in the future. CONCLUSION From the overall trend of 10 years of research, we can see that the research is roughly divided into three phases, from laboratory stage, individual skill improvement to the patient outcomes, and comprehensive impacts such as skill retention and collateral effect as cost-effectiveness is a major trend of future research. More objective evaluation measurement should be designed to assess the diverse impact and further meta-analysis and randomized controlled trials are needed to provide more clinical evidence of SBME as translational science.
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Affiliation(s)
- Shun Yao
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yabin Tang
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chenyue Yi
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yao Xiao
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Frazier M, Dewan M, Keller-Smith R, Shoemaker J, Stewart C, Tegtmeyer K. Improving CPR Quality by Using a Real-Time Feedback Defibrillator During Pediatric Simulation Training. Pediatr Emerg Care 2022; 38:e993-e996. [PMID: 35100789 DOI: 10.1097/pec.0000000000002370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effectiveness of a defibrillator with real-time feedback during code team training to improve adherence to the American Heart Association (AHA) resuscitation guidelines. METHODS This is a retrospective cohort study designed to compare pediatric resident adherence to the AHA cardiopulmonary resuscitation guidelines before and after use of real-time feedback defibrillator during code team training simulation. After institution of a real-time feedback defibrillator, first-year resident's adherence to the AHA guidelines for chest compression rate (CCR), fraction, and depth during code team training from January 2017 to December 2018 was analyzed. It was then compared with results of a previously published study from our institution that analyzed the CCR and fraction from January 2015 to January 2016, before the implementation of a defibrillator with real-time feedback. RESULTS We compared 19 eligible session preintervention and 36 postintervention sessions. Chest compression rate and chest compression fraction (CCF) were assessed preintervention and postintervention. The depth of compression was only available postintervention. There was improvement in the proportion of code team training sessions with mean compression rate (74% preintervention vs 100% postintervention, P = 0.003) and mean CCF (79% vs 97%, P = 0.04) in adherence with the AHA guideline. CONCLUSIONS The use of real-time feedback defibrillators improved the adherence to the AHA cardiopulmonary resuscitation guidelines for CCF and CCR during pediatric resident simulation.
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Affiliation(s)
- Maria Frazier
- From the Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | | | - Rachel Keller-Smith
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Jamie Shoemaker
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Claire Stewart
- Division of Critical Care, Nationwide Children's Hospital, Columbus, OH
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Comparison of a virtual reality compression-only Cardiopulmonary Resuscitation (CPR) course to the traditional course with content validation of the VR course - A randomized control pilot study. Ann Med Surg (Lond) 2022; 73:103241. [PMID: 35079374 PMCID: PMC8767287 DOI: 10.1016/j.amsu.2022.103241] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/01/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Technology has been a major contributor to recent changes in education, where simulation plays a huge role by providing a unique safe environment, especially with the recent incorporation of immersive virtual reality (VR) training. Cardiopulmonary Resuscitation (CPR) is said to double, even triple survival from cardiac arrest, and hence it is crucial to ensure optimal acquisition and retention of these skills. In this study, we aim to compare a VR CPR teaching program to current teaching methods with content validation of the VR course. Methods A randomized single-blinded simulation-based pilot study where 26 participants underwent baseline assessment of their CPR skills using a validated checklist and Laerdal QCPR®. Participants were randomly allocated and underwent their respective courses. This was followed by a final assessment and a questionnaire for content validation, knowledge and confidence. The data was analysed using STATA 16.2 to determine the standardized mean difference using paired and unpaired t-test. Results Subjective assessment using the checklist showed statistically significant improvement in the overall scores of both groups (traditional group mean improved from 6.92 to 9.61 p-value 0.0005, VR group from 6.61 to 8.53 p-value 0.0016). However, no statistically significant difference was noted between the final scores in both the subjective and objective assessments. As for the questionnaire, knowledge and confidence seemed to improve equally. Finally, the content validation showed statistically significant improvement in ease of use (mean score 3 to 4.23 p-value of 0.0144), while for content, positivity of experience, usefulness and appropriateness participants showed similar satisfaction before and after use. Conclusion This pilot study suggests that VR teaching could deliver CPR skills in an attractive manner, with no inferiority in acquisition of these skills compared to traditional methods. To corroborate these findings, we suggest a follow-up study with a larger sample size after adding ventilation and Automated External Defibrillator (AED) skills to the VR course with re-examination after 3–6 months to test retention of the skills.
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Hirayama Y, Ito Y, Ogawa M, Fukushima Y, Ikeyama T. Quantitative assessment of chest compression techniques on an infant manikin. Pediatr Int 2022; 64:e15118. [PMID: 35616194 DOI: 10.1111/ped.15118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/01/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current cardiopulmonary resuscitation (CPR) guidelines recommend the two-finger technique (TFT) of chest compression (CC) in infants for a single rescuer. We hypothesized that healthcare providers cannot achieve adequate CC depth with TFT, even if using real-time visual feedback (RVF). METHODS This was a cross-over study, randomizing participants to perform three sets of 2-min continuous CC, comparing (i) TFT with RVF, (ii) the one-hand technique (OHT) without RVF, and (iii) OHT with RVF. A standard CPR trainer manikin of a 3-month-old infant and a monitor/defibrillator that displays and records the quantitative CC quality were used. We set a target compression depth of 40-50 mm and a target compression rate of 100-120/min. Data were analyzed using the Friedman test and Bonferroni correction. Statistical significance was defined as P-value of< 0.05. RESULTS Fifty-nine healthcare providers participated in the study. The mean compression depth was 24 mm (interquartile range [IQR], 22-26 mm) in TFT with RVF and 43 mm (IQR, 38-48 mm) in OHT without RVF, P < 0.001. The proportion of adequate CC depth was 0% (IQR, 0-0%) in TFT with RVF, 22% (IQR, 5-54%) in OHT without RVF, and 62% (IQR, 29-83%) in OHT with RVF. The mean compression rate was within the target range in all three techniques. CONCLUSIONS The TFT cannot produce the CC depth that meets the recommendation of the current CPR guidelines for an infant with RVF, whereas the OHT does.
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Affiliation(s)
- Yuji Hirayama
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Yurie Ito
- Division of Pediatric Emergency Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Mariko Ogawa
- Nursing Department, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Yasuhiro Fukushima
- Nursing Department, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Takanari Ikeyama
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
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Toto RL, Vorel ES, Tay KYE, Good GL, Berdinka JM, Peled A, Leary M, Chang TP, Weiss AK, Balamuth FB. Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial. JMIR MEDICAL EDUCATION 2021; 7:e29899. [PMID: 34612836 PMCID: PMC8529461 DOI: 10.2196/29899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Septic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education. OBJECTIVE In this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps. METHODS We performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants' time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups. RESULTS We enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient's perfusion. CONCLUSIONS We developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants' awareness of abnormal perfusion.
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Affiliation(s)
- Regina L Toto
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ethan S Vorel
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Khoon-Yen E Tay
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Grace L Good
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Adam Peled
- BrickSimple, LLC, Doylestown, PA, United States
| | - Marion Leary
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| | - Todd P Chang
- Division of Emergency Medicine & Transport, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Anna K Weiss
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Frances B Balamuth
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Effect of the Use of Metronome Feedback on the Quality of Pediatric Cardiopulmonary Resuscitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158087. [PMID: 34360379 PMCID: PMC8345427 DOI: 10.3390/ijerph18158087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/11/2022]
Abstract
Although the use of audio feedback with devices such as metronomes during cardiopulmonary resuscitation (CPR) is a simple method for improving CPR quality, its effect on the quality of pediatric CPR has not been adequately evaluated. In this study, 64 healthcare providers performed CPR (with one- and two-handed chest compression (OHCC and THCC, respectively)) on a pediatric resuscitation manikin (Resusci Junior QCPR), with and without audio feedback using a metronome (110 beats/min). CPR was performed on the floor, with a compression-to-ventilation ratio of 30:2. For both OHCC and THCC, the rate of achievement of an adequate compression rate during CPR was significantly higher when performed with metronome feedback than that without metronome feedback (CPR with vs. without feedback: 100.0% (99.0, 100.0) vs. 94.0% (69.0, 99.0), p < 0.001, for OHCC, and 100.0% (98.5, 100.0) vs. 91.0% (34.5, 98.5), p < 0.001, for THCC). However, the rate of achievement of adequate compression depth during the CPR performed was significantly higher without metronome feedback than that with metronome feedback (CPR with vs. without feedback: 95.0% (23.5, 99.5) vs. 98.5% (77.5, 100.0), p = 0.004, for OHCC, and 99.0% (95.5, 100.0) vs. 100.0% (99.0, 100.0), p = 0.003, for THCC). Although metronome feedback during pediatric CPR could increase the rate of achievement of adequate compression rates, it could cause decreased compression depth.
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Rideout JM, Ozawa ET, Bourgeois DJ, Chipman M, Overly FL. Can hospital adult code-teams and individual members perform high-quality CPR? A multicenter simulation-based study incorporating an educational intervention with CPR feedback. Resusc Plus 2021; 7:100126. [PMID: 34223393 PMCID: PMC8244252 DOI: 10.1016/j.resplu.2021.100126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
Aims A multicenter simulation-based research study to assess the ability of interprofessional code-teams and individual members to perform high-quality CPR (HQ-CPR) at baseline and following an educational intervention with a CPR feedback device. Methods Five centers recruited ten interprofessional teams of AHA-certified adult code-team members with a goal of 200 participants. Baseline testing of chest compression (CC) quality was measured for all individuals. Teams participated in a baseline simulated cardiac arrest (SCA) where CC quality, chest compression fraction (CCF), and peri-shock pauses were recorded. Teams participated in a standardized HQ-CPR and abbreviated TeamSTEPPS® didactic, then engaged in deliberate practice with a CPR feedback device. Individuals were assessed to determine if they could achieve ≥80% combined rate and depth within 2020 AHA guidelines. Teams completed a second SCA and CPR metrics were recorded. Feedback was disabled for assessments except at one site where real-time CPR feedback was the institutional standard. Linear regression models were used to test for site effect and paired t-tests to evaluate significant score changes. Logistic univariate regression models were used to explore characteristics associated with the individual achieving competency. Results Data from 184 individuals and 45 teams were analyzed. Baseline HQ-CPR mean score across all sites was 18.5% for individuals and 13.8% for teams. Post-intervention HQ-CPR mean score was 59.8% for individuals and 37.0% for teams. There was a statistically significant improvement in HQ-CPR mean scores of 41.3% (36.1, 46.5) for individuals and 23.2% (17.1, 29.3) for teams (p < 0.0001). CCF increased at 3 out of 5 sites and there was a mean 5-s reduction in peri-shock pauses (p < 0.0001). Characteristics with a statistically significant association were height (p = 0.01) and number of times performed CPR (p = 0.01). Conclusion Code-teams and individuals struggle to perform HQ-CPR but show improvement after deliberate practice with feedback as part of an educational intervention. Only one site that incorporated real-time CPR feedback devices routinely achieved ≥80% HQ-CPR.
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Affiliation(s)
- Jesse M Rideout
- Department of Emergency Medicine, Tufts Medical Center, United States
| | - Edwin T Ozawa
- Department of Anesthesiology, Lahey Hospital & Medical Center, United States
| | - Darlene J Bourgeois
- Center for Professional Development & Simulation, Lahey Hospital & Medical Center, United States
| | - Micheline Chipman
- Hannaford Center for Safety, Innovation & Simulation, Maine Medical Center, United States
| | - Frank L Overly
- Brown Emergency Medicine and Pediatrics, Hasbro Children's Hospital, United States
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Rinaldi A, Katsaros D, Hawthorne J, D'Auria M, Brigham K, Bajars E, Franzese C, Coyne M. The current paradigm for biologic initiation: a mixed-methods exploration of practices, unmet needs, and innovation opportunities in self-injection training. Expert Opin Drug Deliv 2021; 18:1151-1168. [PMID: 33896303 DOI: 10.1080/17425247.2021.1912009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Self-injection, particularly of biologics, has become a mainstay of chronic disease management. Despite labeling requirement for healthcare provider (HCP) training, current injection initiation experiences have been shown to be suboptimal. This study characterizes gaps in training and support during initiation and identifies rationales to inform solutions. METHODS We enrolled HCPs (n = 18) performing routine biologic initiation and patients (n = 24) currently self-injecting biologics. Participants completed activities through an online, remote ethnography tool. We conducted two focus groups with biologic-naïve patients (n = 5). Data was analyzed using thematic frameworks, Q methodology, and quantitative assessments. RESULTS Our results suggest considerable gaps exist. Analysis revealed five common themes that could explain these gaps: 1) minimal biologic-specific professional instruction is provided to HCPs; 2) nuanced injection use-steps are not universally understood; 3) no one stakeholder currently 'owns' training; 4) support offered by HCPs and manufacturers is perceived as biased; and 5) emotional burden is not accounted for. CONCLUSIONS Our study suggests optimizing several elements to facilitate successful initiations, including structured sessions, improved HCP injection device knowledge, demo-device practice, and focus on both emotional and mechanical aspects. Aligning these factors has potential to increase patient confidence, reduce burden on HCPs, and improve probability of success on therapy.
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Affiliation(s)
| | - Dimos Katsaros
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - James Hawthorne
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | | | | | | | - Chris Franzese
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Marty Coyne
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
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Gugelmin-Almeida D, Tobase L, Polastri TF, Peres HHC, Timerman S. Do automated real-time feedback devices improve CPR quality? A systematic review of literature. Resusc Plus 2021; 6:100108. [PMID: 34223369 PMCID: PMC8244494 DOI: 10.1016/j.resplu.2021.100108] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/20/2022] Open
Abstract
AIM Automated real-time feedback devices have been considered a potential tool to improve the quality of cardiopulmonary resuscitation (CPR). Despite previous studies supporting the usefulness of such devices during training, others have conflicting conclusions regarding its efficacy during real-life CPR. This systematic review aimed to assess the effectiveness of automated real-time feedback devices for improving CPR performance during training, simulation and real-life resuscitation attempts in the adult and paediatric population. METHODS Articles published between January 2010 and November 2020 were searched from BVS, Cinahl, Cochrane, PubMed and Web of Science, and reviewed according to a pre-defined set of eligibility criteria which included healthcare providers and randomised controlled trial studies. CPR quality was assessed based on guideline compliance for chest compression rate, chest compression depth and residual leaning. RESULTS The selection strategy led to 19 eligible studies, 16 in training/simulation and three in real-life CPR. Feedback devices during training and/or simulation resulted in improved acquisition of skills and enhanced performance in 15 studies. One study resulted in no significant improvement. During real resuscitation attempts, three studies demonstrated significant improvement with the use of feedback devices in comparison with standard CPR (without feedback device). CONCLUSION The use of automated real-time feedback devices enhances skill acquisition and CPR performance during training of healthcare professionals. Further research is needed to better understand the role of feedback devices in clinical setting.
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Affiliation(s)
- Debora Gugelmin-Almeida
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England, United Kingdom
- Department of Anaesthesiology, Main Theatres, Royal Bournemouth and Christchurch Hospitals, Castle Lane East, Bournemouth, BH7 7DW, England, United Kingdom
| | - Lucia Tobase
- Centro Universitário São Camilo, Rua Raul Pompeia, 144, São Paulo, Brazil
| | - Thatiane Facholi Polastri
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
| | | | - Sergio Timerman
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
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EEG-Based Prediction of the Recovery of Carotid Blood Flow during Cardiopulmonary Resuscitation in a Swine Model. SENSORS 2021; 21:s21113650. [PMID: 34073915 PMCID: PMC8197348 DOI: 10.3390/s21113650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022]
Abstract
The recovery of cerebral circulation during cardiopulmonary resuscitation (CPR) is important to improve the neurologic outcomes of cardiac arrest patients. To evaluate the feasibility of an electroencephalogram (EEG)-based prediction model as a CPR feedback indicator of high- or low-CBF carotid blood flow (CBF), the frontal EEG and hemodynamic data including CBF were measured during animal experiments with a ventricular fibrillation (VF) swine model. The most significant 10 EEG parameters in the time, frequency and entropy domains were determined by neighborhood component analysis and Student’s t-test for discriminating high- or low-CBF recovery with a division criterion of 30%. As a binary CBF classifier, the performances of logistic regression, support vector machine (SVM), k-nearest neighbor, random forest and multilayer perceptron algorithms were compared with eight-fold cross-validation. The three-order polynomial kernel-based SVM model showed the best accuracy of 0.853. The sensitivity, specificity, F1 score and area under the curve of the SVM model were 0.807, 0.906, 0.853 and 0.909, respectively. An automated CBF classifier derived from non-invasive EEG is feasible as a potential indicator of the CBF recovery during CPR in a VF swine model.
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Kuyt K, Mullen M, Fullwood C, Chang TP, Fenwick J, Withey V, McIntosh R, Herz N, MacKinnon RJ. The assessment of a manikin-based low-dose, high-frequency cardiac resuscitation quality improvement program in early UK adopter hospitals. Adv Simul (Lond) 2021; 6:14. [PMID: 33883025 PMCID: PMC8058602 DOI: 10.1186/s41077-021-00168-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adult and paediatric basic life support (BLS) training are often conducted via group training with an accredited instructor every 24 months. Multiple studies have demonstrated a decline in the quality of cardio-pulmonary resuscitation (CPR) performed as soon as 3-month post-training. The 'Resuscitation Quality Improvement' (RQI) programme is a quarterly low-dose, high-frequency training, based around the use of manikins connected to a cart providing real-time and summative feedback. We aimed to evaluate the effects of the RQI Programme on CPR psychomotor skills in UK hospitals that had adopted this as a method of BLS training, and establish whether this program leads to increased compliance in CPR training. METHODS The study took place across three adopter sites and one control site. Participants completed a baseline assessment without live feedback. Following this, participants at the adopter sites followed the RQI curriculum for adult CPR, or adult and infant CPR. The curriculum was split into quarterly training blocks, and live feedback was given on technique during the training session via the RQI cart. After following the curriculum for 12/24 months, participants completed a second assessment without live feedback. RESULTS At the adopter sites, there was a significant improvement in the overall score between baseline and assessment for infant ventilations (N = 167, p < 0.001), adult ventilations (n = 129, p < 0.001), infant compressions (n = 163, p < 0.001) adult compressions (n = 205, p < 0.001), and adult CPR (n = 249, p < 0.001). There was no significant improvement in the overall score for infant CPR (n = 206, p = 0.08). Data from the control site demonstrated a statistically significant improvement in mean score for adult CPR (n = 22, p = 0.02), but not for adult compressions (N = 18, p = 0.39) or ventilations (n = 17, p = 0.08). No statistically significant difference in improvement of mean scores was found between the grouped adopter sites and the control site. The effect of the duration of the RQI curriculum on CPR performance appeared to be minimal in this data set. Compliance with the RQI curriculum varied by site, one site maintained hospital compliance at 90% over a 1 year period, however compliance reduced over time at all sites. CONCLUSIONS This data demonstrated an increased adherence with guidelines for high-quality CPR post-training with the RQI cart, for all adult and most infant measures, but not infant CPR. However, the relationship between a formalised quarterly RQI curriculum and improvements in resuscitation skills is not clear. It is also unclear whether the RQI approach is superior to the current classroom-based BLS training for CPR skill acquisition in the UK. Further research is required to establish how to optimally implement the RQI system in the UK and how to optimally improve hospital wide compliance with CPR training to improve the outcomes of in-hospital cardiac arrests.
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Affiliation(s)
- Katherine Kuyt
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Montana Mullen
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Catherine Fullwood
- Medical Statistics Group, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Todd P Chang
- Division of Emergency Medicine and Transport, Children's Hospital of Los Angeles, Los Angeles, USA
| | - James Fenwick
- Resuscitation Service, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, UK
| | | | - Rod McIntosh
- Department of Resuscitation, Borders General Hospital, Borders NHS, Selkirk, UK
| | | | - Ralph James MacKinnon
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
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Kuyt K, Park SH, Chang TP, Jung T, MacKinnon R. The use of virtual reality and augmented reality to enhance cardio-pulmonary resuscitation: a scoping review. Adv Simul (Lond) 2021; 6:11. [PMID: 33845911 PMCID: PMC8040758 DOI: 10.1186/s41077-021-00158-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Virtual reality (VR) and augmented reality (AR) have been proposed as novel methods to enhance cardio-pulmonary resuscitation (CPR) performance and increase engagement with CPR training. A scoping review was conducted to map the global evolution of these new approaches to CPR training, to assess their efficacy and determine future directions to meet gaps in current knowledge. METHODS A standardised five-stage scoping methodology was used to (1) identify the research question, (2) identify relevant studies, (3) select the studies, (4) chart the data and (5) summarise the findings. The Kirkpatrick model levels of evidence were used to chart and assess the efficacy of each intervention reported. A multi-pronged search term strategy was used to search the Web of Science, PubMed, CINAHL and EMBASE databases up to June 2020. RESULTS A total of 42 articles were included in this review. The first relevant paper identified was published in 2009 and based on VR, from 2014 onwards there was a large increase in the volume of work being published regarding VR and AR uses in CPR training. This review reports Kirkpatrick level one to three evidence for the use of VR/AR-CPR. Inconsistencies in the specific language, keywords used and methodologies are highlighted. CONCLUSION VR and AR technologies have shown great potential in the area of CPR, and there is continuing evidence of new novel applications and concepts. As VR/AR research into CPR reaches an inflection point, it is key to bring collaboration and consistency to the wider research community, to enable the growth of the area and ease of access to the wider medical community.
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Affiliation(s)
- Katherine Kuyt
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Sang-Hee Park
- Korea Institute of Civil Engineering and Building Technology, Seoul, South Korea
| | - Todd P Chang
- Children's Hospital Los Angeles, Los Angeles, USA
| | - Timothy Jung
- Manchester Metropolitan University, Manchester, UK
| | - Ralph MacKinnon
- Manchester University NHS Foundation Trust, Manchester, UK.
- Manchester Metropolitan University, Manchester, UK.
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Misztal-Okońska P, Goniewicz K, Goniewicz M, Ranse J, Hertelendy AJ, Gray L, Carlström E, Løwe Sørensen J, Khorram-Manesh A. Importance of Immediate Electronic-Based Feedback to Enhance Feedback for First-Time CPR Trainees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083885. [PMID: 33917203 PMCID: PMC8067975 DOI: 10.3390/ijerph18083885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
Sudden cardiac arrest is one of the leading causes of death globally. The recommended clinical management in out-of-hospital cardiac arrest cases is the immediate initiation of high-quality cardiopulmonary resuscitation (CPR). Training mannequins should be combined with technology that provides students with detailed immediate feedback on the quality of CPR performance. This study aimed to verify the impacts of the type of feedback (basic or detailed) the responders receive from the device while learning CPR and how it influences the quality of their performance and the motivation to improve their skills. The study was conducted at the Medical University of Lublin among 694 multi-professional health students during first aid classes on basic life support (BLS). The students first practiced on an adult mannequin with a basic control panel; afterward, the same mannequin was connected to a laptop, ensuring a detailed record of the performed activities through a projector. Next, the participants expressed their subjective opinion on how the feedback provided during the classes, basic vs. detailed, motivated them to improve the quality of their CPR performance. Additionally, during the classes, the instructor conducted an extended observation of students’ work and behavior. In the students’ opinion, the CPR training with detailed feedback devices provided motivation for learning and improving CPR proficiency than that with a basic control panel. Furthermore, the comments given from devices seemed to be more acceptable to the students, who did not see any bias in the device’s evaluation compared to that of the instructor. Detailed device feedback motivates student health practitioners to learn and improve the overall quality of CPR. The use of mannequins that provide detailed feedback during BLS courses can improve survival in out-of-hospital cardiac arrest.
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Affiliation(s)
- Patrycja Misztal-Okońska
- Department of Emergency Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
- Correspondence:
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08-521 Dęblin, Poland;
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4215, Australia;
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD 4215, Australia
| | - Attila J. Hertelendy
- Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, MA 02215, USA;
- Department of Emergency Medicine, Harvard Medical School, Boston, MA 02215, USA
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL 33119, USA
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand;
- Joint Centre for Disaster Research, Massey University, Wellington 6021, New Zealand
| | - Eric Carlström
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden;
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3616 Kongsberg, Norway;
| | - Jarle Løwe Sørensen
- USN School of Business, University of South-Eastern Norway, 3616 Kongsberg, Norway;
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden;
- Department of Development and Research, Armed Forces Center for Defense Medicine, 426 76 Gothenburg, Västra Frölunda, Sweden
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Duff JP, Bhanji F, Lin Y, Overly F, Brown LL, Bragg EA, Kessler D, Tofil NM, Bank I, Hunt EA, Nadkarni V, Cheng A. Change in Cardiopulmonary Resuscitation Performance Over Time During Simulated Pediatric Cardiac Arrest and the Effect of Just-in-Time Training and Feedback. Pediatr Emerg Care 2021; 37:133-137. [PMID: 33651758 DOI: 10.1097/pec.0000000000002359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Effective cardiopulmonary resuscitation (CPR) is critical to ensure optimal outcomes from cardiac arrest, yet trained health care providers consistently struggle to provide guideline-compliant CPR. Rescuer fatigue can impact chest compression (CC) quality during a cardiac arrest event, although it is unknown if visual feedback or just-in-time training influences change of CC quality over time. In this study, we attempt to describe the changes in CC quality over a 12-minute simulated resuscitation and examine the influence of just-in-time training and visual feedback on CC quality over time. METHODS We conducted secondary analysis of data collected from the CPRCARES study, a multicenter randomized trial in which CPR-certified health care providers from 10 different pediatric tertiary care centers were randomized to receive visual feedback, just-in-time CPR training, or no intervention. They participated in a simulated cardiac arrest scenario with 2 team members providing CCs. We compared the quality of CCs delivered (depth and rate) at the beginning (0-4 minutes), middle (4-8 minutes), and end (8-12 minutes) of the resuscitation. RESULTS There was no significant change in depth over the 3 time intervals in any of the arms. There was a significant increase in rate (128 to 133 CC/min) in the no intervention arm over the scenario duration (P < 0.05). CONCLUSIONS There was no significant drop in CC depth over a 12-minute cardiac arrest scenario with 2 team members providing compressions.
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Affiliation(s)
| | | | - Yiqun Lin
- University of Calgary, Calgary, Canada
| | | | | | | | - David Kessler
- Columbia University Vagelos College of Physicians and Surgeons New York, NY
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Caregiver Characteristics Associated With Quality of Cardiac Compressions on an Adult Mannequin With Real-Time Visual Feedback: A Simulation-Based Multicenter Study. Simul Healthc 2021; 15:82-88. [PMID: 32168293 DOI: 10.1097/sih.0000000000000410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chest compression (CC) quality directly impacts cardiac arrest outcomes. Provider body type can influence the quality of cardiopulmonary resuscitation (CPR); however, the magnitude of this impact while using visual feedback is not well described. The aim of the study was to determine the association between provider anthropometric variables on fatigue and CC adherence to 2015 American Heart Association CPR while receiving visual feedback. METHODS This was a planned secondary analysis of healthcare professionals from multiple hospitals performing continuous CC for 2 minutes on an adult CPR mannequin with dynamic visual feedback. Main outcome measures include compression data (depth, rate, and lean) evaluated in 30-second epochs to explore performance fatigue. Multivariable models examined the relationship of provider anthropometrics to CC quality. Binomial mixed effects models were used to characterize fatigue by examining performance for 4 epochs. RESULTS Three hundred seventy-seven 2-minute CC episodes were analyzed. Extreme (low and high) BMI and weight are associated with poorer CC. Larger size (height, weight, and BMI) is associated with better depth but worse lean compliance. Performance fatigued for all providers for 2 minutes, but shorter, lighter weight, female participants had the greatest decline. On multivariable analysis, rate compliance did not deteriorate regardless of provider anthropometrics. CONCLUSIONS Anthropometrics impact provider CC quality. Despite visual feedback, variable effects are seen on compression depth, rate, recoil, and fatigue depending on the provider sex, weight, and BMI. The 2-minute interval for changing chest compressors should be reconsidered based on individual provider characteristics and risk of fatigue's impact on high-quality CPR.
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Lee S, Song Y, Lee J, Oh J, Lim TH, Ahn C, Kim IY. Development of Smart-Ring-Based Chest Compression Depth Feedback Device for High Quality Chest Compressions: A Proof-of-Concept Study. BIOSENSORS-BASEL 2021; 11:bios11020035. [PMID: 33525710 PMCID: PMC7912179 DOI: 10.3390/bios11020035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/11/2022]
Abstract
Recently, a smart-device-based chest compression depth (CCD) feedback system that helps ensure that chest compressions have adequate depth during cardiopulmonary resuscitation (CPR) was developed. However, no CCD feedback device has been developed for infants, and many feedback systems are inconvenient to use. In this paper, we report the development of a smart-ring-based CCD feedback device for CPR based on an inertial measurement unit, and propose a high-quality chest compression depth estimation algorithm that considers the orientation of the device. The performance of the proposed feedback system was evaluated by comparing it with a linear variable differential transformer in three CPR situations. The experimental results showed compression depth errors of 2.0 ± 1.1, 2.2 ± 0.9, and 1.4 ± 1.1 mm in the three situations. In addition, we conducted a pilot test with an adult/infant mannequin. The results of the experiments show that the proposed smart-ring-based CCD feedback system is applicable to various chest compression methods based on real CPR situations.
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Affiliation(s)
- Seungjae Lee
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea; (S.L.); (J.L.)
| | - Yeongtak Song
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (Y.S.); (J.O.); (T.H.L.)
- Convergence Technology Center for Disaster Preparedness, Hanyang University, Seoul 04763, Korea
| | - Jongshill Lee
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea; (S.L.); (J.L.)
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (Y.S.); (J.O.); (T.H.L.)
- Convergence Technology Center for Disaster Preparedness, Hanyang University, Seoul 04763, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (Y.S.); (J.O.); (T.H.L.)
- Convergence Technology Center for Disaster Preparedness, Hanyang University, Seoul 04763, Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Korea;
| | - In Young Kim
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea; (S.L.); (J.L.)
- Correspondence:
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Buyck M, Shayan Y, Gravel J, Hunt EA, Cheng A, Levy A. CPR coaching during cardiac arrest improves adherence to PALS guidelines: a prospective, simulation-based trial. Resusc Plus 2020; 5:100058. [PMID: 34223330 PMCID: PMC8244489 DOI: 10.1016/j.resplu.2020.100058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 10/31/2022] Open
Abstract
Aim Recent studies have shown that the integration of a trained cardiopulmonary resuscitation (CPR) Coach during resuscitation enhances the quality of CPR during simulated paediatric cardiac arrest. The objective of our study was to evaluate the effect of a CPR Coach on adherence to Paediatric Advanced Life Support (PALS) guidelines during simulated paediatric cardiac arrest. Methods This was a secondary analysis of data collected from a multicentre randomized controlled trial assessing the quality of CPR in teams with and without a CPR Coach. Forty paediatric resuscitation teams were equally randomized into 2 groups (with or without a CPR Coach). The primary outcome was adherence to PALS guidelines during a simulated paediatric cardiac arrest case as measured by the Clinical Performance Tool (CPT). Video recordings were assigned to 2 pairs of expert raters. Raters were trained to independently score performances using the tool. Results The reliability of the rating was adequate for the Clinical Performance Tool with an intraclass coefficients of 0.67 (95%CI: 0.22 to 0.84). Performance scores of the different teams varied between 51 and 84 points on the Clinical Performance Tool with a mean score of 70. Teams with a CPR Coach demonstrated better adherence to PALS guidelines (i.e. CPT score 73 points) compared to teams without a CPR Coach (68 points, difference 5 points; 95%CI: 1.0-9.3, p = 0.016). Conclusion In addition to improving CPR quality, the presence of a CPR Coach improves adherence to PALS guidelines during simulated paediatric cardiac arrests when compared with teams without a CPR Coach.
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Affiliation(s)
- Michael Buyck
- Department of Pediatric Emergency Medicine, Sainte-Justine Hospital University Centre, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.,Université de Montreal, Montreal, Québec, Canada
| | - Yasaman Shayan
- Department of Pediatric Emergency Medicine, Sainte-Justine Hospital University Centre, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.,Université de Montreal, Montreal, Québec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Sainte-Justine Hospital University Centre, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.,Université de Montreal, Montreal, Québec, Canada
| | - Elizabeth A Hunt
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Health Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Adam Cheng
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Calgary, Canada
| | - Arielle Levy
- Department of Pediatric Emergency Medicine, Sainte-Justine Hospital University Centre, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.,Université de Montreal, Montreal, Québec, Canada
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