Effect of a positive pressure ventilation-refresher program on ventilation skill performance during simulated newborn resuscitation

Dana E Niles, Christiane Skåre, Elizabeth E Foglia, Elena Insley, Courtney Cines, Theresa Olasveengen, Lance S Ballester, Anne Ades, Michael Posencheg, Vinay M Nadkarni, Jo Kramer-Johansen, Dana E Niles, Christiane Skåre, Elizabeth E Foglia, Elena Insley, Courtney Cines, Theresa Olasveengen, Lance S Ballester, Anne Ades, Michael Posencheg, Vinay M Nadkarni, Jo Kramer-Johansen

Abstract

Aim: Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses.

Methods: Subjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10-21 mL) and rate (40-60 ventilations per minute [vpm]). Baseline and post assessments were compared for total number PPV delivered, number target PPV delivered (volume 10-21 mL), mean volume and mean rate (Wilcoxon signed-rank test, median[IQR]).

Results: Twenty-six subjects were enrolled and completed a baseline assessment; 24 (92%) completed a post-assessment; 2 (8%) were lost to follow-up. Over 3 months, a mean 3.2 (range 1-6) PPV-Refreshers/subject were completed. Compared to baseline, subjects demonstrated significant improvement for total (57 [36-74] vs. 33 [26-46]; p = 0.0007) and target PPV (23 [13-23] vs. 11 [5-21]; p = 0.024), and a significant change in mean volume (mL) (11.5 [10.2-13] vs. 13.4 [11-16]; p = 0.02) and mean rate (vpm) (54 [45-61] vs. 40 [28-49]; p = 0.019).

Conclusions: A PPV-Refresher program with brief, repeated psychomotor skill practice significantly improved PPV performance with the greatest improvement in total PPV and target PPV. Additional investigation is warranted to determine optimal PPV-Refresher frequency.Registered at ClinicalTrials.gov #NCT02347241.

Keywords: Newborn; Positive pressure ventilation; Psychomotor skill training; Refresher; Resuscitation; Simulation.

© 2021 The Author(s).

Figures

Fig. 1
Fig. 1
PPV Assessments: Image of infant ventilation-recording manikin (count, volume, rate), flow-inflating bag, and infant mask placed on a standard infant warmer. Each simulation session was 2 min in duration however, the last 90 s of the scenario was analyzed for PPV performance. Providers did not receive feedback on their performance during or after their assessment.
Fig. 2
Fig. 2
PPV-Refreshers: Image of infant training manikin with Newborn Lung Simulator (NLS), flow-inflating bag and infant mask on a mobile cart. The console provides visual feedback on PPV volume (mL, center cylinder) and pressure (mmHg, right analogue dial). Providers practiced until PPV competence (defined as PPV volume 10-21 mL and rate 40-60 vpm) could be demonstrated for at least 30 s. Providers were coached and remediated, as needed, during their PPV-Refresher.
Fig. 3
Fig. 3
Enrollment and study flow diagram.
Fig. 4
Fig. 4
Boxplot diagrams demonstrating PPV performance summaries at Baseline and Post PPV Refresher assessments.

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