Abstract 2835: A Comparative Analysis of Pediatric Resident Performance During High-fidelity Simulated Cardiopulmonary Arrests
Background The quality of basic and advanced life support delivered is directly associated with survival rates for victims of cardiopulmonary arrest. However, in a previous study of simulated cardiopulmonary arrests (sCPAs) pediatric residents performed poorly. We designed an enhanced pediatric resuscitation curriculum (EPRC) focused on identified deficiencies.
Methods Prospective pre-post interventional study of pediatric residents from an academic, tertiary care medical center managing an sCPA of a high-fidelity mannequin simulator. Main outcome measures evaluated were: the interval between the onset of pulseless ventricular tachycardia (PVT) to initiation of compressions and successful defibrillation, pre-shock pause interval, no-blow fraction and no-flow fraction.
Results One hundred twenty-one pediatric residents participated. There were no significant differences in the baseline characteristics of the two cohorts. The EPRC was associated with a significant decrease in the median (inter-quartile range-IQR): pre-shock pause: [pre: 84 sec (26 –162) vs. post: 8 (4 –18); p<0.001], no-blow fraction: [pre: 39% (22%– 64%) vs. post: 30% (22%– 41%); p=0.01], and no-flow fraction: [pre: 74% (5%–100%) vs. 34% (26%–53%); p<0.001)]. Multivariable survival analysis revealed that the EPRC was associated with an increased likelihood of starting compressions within 1 minute of onset of PVT: [Hazard Ratio: 3.8 (95% CI: 2.0 –7.2)] and defibrillating within 3 minutes of onset of PVT: [HR: 1.7 (95% CI: 1.03–2.65)]. Of note, analysis also revealed that women were less likely to defibrillate within three minutes than men: [HR: 0.57 (95% CI: 0.36 – 0.92)].
Conclusions Implementation of the EPRC was associated with improvement in performance across virtually all measures of quality CPR and defibrillation evaluated in our study. More research is needed to 1) explore potential factors related to gender and performance and 2) determine feasibility and generalizability of this curriculum to other settings and 3) whether improved performance in a simulated setting translates into actual clinical practice.