Simulation-Based Training in High-Quality Cardiopulmonary Resuscitation Among Neonatal Intensive Care Unit Providers

Pratik Parikh, Ravi Samraj, Henry Ogbeifun, Lydia Sumbel, Kelli Brimager, Mohammed Alhendy, James McElroy, Dottie Whitt, Cody Henderson, Utpal Bhalala, Pratik Parikh, Ravi Samraj, Henry Ogbeifun, Lydia Sumbel, Kelli Brimager, Mohammed Alhendy, James McElroy, Dottie Whitt, Cody Henderson, Utpal Bhalala

Abstract

Introduction: American Heart Association guidelines recommend the use of feedback devices for CPR provider resuscitation training. There is paucity of published literature regarding the utility of these devices especially in neonates and infants. We sought to evaluate if simulation-based education and debriefing using a CPR feedback device would improve CPR performance on an infant manikin in a cohort of NICU nurses as evaluated by CPR feedback device.

Methods: We conducted a prospective, observational simulation study to assess the quality of chest compressions by NICU nurses before and after debriefing using CPR quality data captured by an accelerometer-based device. Chest compression (CC) depth, rate, recoil, CC fraction and nursing confidence level related to performing a high-quality CPR were compared before and after debriefing using paired t-test and Wilcoxon rank sum test.

Results: A total of 62 NICU nurses participated in the study and all of them were Neonatal Resuscitation Program (NRP) certified. There was a significant improvement in CC depth and CC fraction [mean + SD values = 0.79 in + 0.17 (pre-debrief), 0.86 in + 0.21 (post-debrief) (p = 0.034) and 56.8% + 17.7 (pre-debrief), 70.8% + 18.4 (post-debrief) (0.0014), respectively]. There was no difference in CC rate (p = 0.36) and recoil (p = 0.25) between pre and post structured debriefing. The confidence level of nurses in all CPR dynamics (appropriate CC rate, CC depth, team communication, minimizing interruption in CC and coordinating CC with ventilation) was significantly higher after simulation and structured debriefing. All the nurses used 3:1 compression: ventilation ratio of NRP despite the patient being a 4 month old premature baby in the NICU.

Conclusions: Simulation training and debriefing of NICU nurses using CPR feedback device improved their chest compression quality on an infant mannequin and their confidence level for performing high-quality CPR. NICU providers tend to use NRP protocol of 3:1 compression: ventilation ratio during CPR in the NICU irrespective of age of the infant.

Keywords: CPR—cardiopulmonary resuscitation; NICU—neonatal ICU; chest compression quality; debriefing; quality improvement; simulation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Parikh, Samraj, Ogbeifun, Sumbel, Brimager, Alhendy, McElroy, Whitt, Henderson and Bhalala.

Figures

Figure 1
Figure 1
Display of RescueNet CPR quality data for debriefing.
Figure 2
Figure 2
Quality parameters of chest compression between predebriefing and postdebriefing during NICU CPR.
Figure 3
Figure 3
Comparison of presimulation and postsimulation nursing survey.

References

    1. Holmberg MJ, Ross CE, Fitzmaurice GM, Chan PS, Duval-Arnould J, Grossestreuer AV, et al. . Annual Incidence of Adult and Pediatric In-Hospital Cardiac Arrest in the United States. Circ Cardiovasc Qual Outcomes. (2019) 12:e005580. 10.1161/CIRCOUTCOMES.119.005580
    1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. . Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. (2020) 141:e139–596. 10.1161/CIR.0000000000000757
    1. Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, et al. . Part 4: Pediatric basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. (2020) 142:S469–523. 10.1161/CIR.0000000000000901
    1. van Vonderen JJ, van Zanten HA, Schilleman K, Hooper SB, Kitchen MJ, Witlox RSGM. and te Pas AB. Cardiorespiratory monitoring during neonatal resuscitation for direct feedback and audit. Front Pediatr. (2016) 4:38. 10.3389/fped.2016.00038
    1. Vahedian-Azimi A, Hajiesmaeili M, Amirsavadkouhi A, Jamaati H, Izadi M, Madani SJ, et al. . Effect of the Cardio First Angel™ device on CPR indices: a randomized controlled clinical trial. Crit Care. (2016) 20:147. 10.1186/s13054-016-1296-3
    1. Sutton RM, French B, Niles DE, Donoghue A, Topjian AA, Nishisaki A, et al. . 2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival. Resuscitation. (2014) 85:1179–84. 10.1016/j.resuscitation.2014.05.007
    1. Abella BS, Alvarado JP, Myklebust H, Edelson DP, Barry A, O'Hearn N, et al. . Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA. (2005) 293:305–10. 10.1001/jama.293.3.305
    1. Perlman JM, Risser R. Cardiopulmonary resuscitation in the delivery room. Associated clinical events. Arch Pediatr Adolesc Med. (1995) 149:20–5. 10.1001/archpedi.1995.02170130022005
    1. Foglia EE, Langeveld R, Heimall L, Deveney A, Ades A, Jensen EA, et al. . Incidence, characteristics, and survival following cardiopulmonary resuscitation in the quaternary neonatal intensive care unit. Resuscitation. (2017) 110:32–6.
    1. Barr P, Courtman SP. Cardiopulmonary resuscitation in the newborn intensive care unit. J Paediatr Child Health. (1998) 34:503–7. 10.1046/j.1440-1754.1998.00294.x
    1. Ahmad KA, Velasquez SG, Kohlleppel KL, Henderson CL, Stine CN, LeVan JM, et al. . The characteristics and outcomes of cardiopulmonary resuscitation within the neonatal intensive care unit based on gestational age and unit level of care. Am J Perinatol. (2020 D: ) 37:1455–61.
    1. Ahmad KA, Henderson CL, Velasquez SG, LeVan JM, Kohlleppel KL, Stine CN, et al. . Endotracheal tube manipulation during cardiopulmonary resuscitation in the neonatal intensive care unit. J Perinatol. (2021) 41:1566–70. 10.1038/s41372-021-00953-7
    1. Ali N, Lam T, Gray MM, Clausen D, Riley M, Grover TR, et al. . Cardiopulmonary resuscitation in quaternary neonatal intensive care units: a multicenter study. Resuscitation. (2021 F: ) 159:77–84.
    1. Halamek LP. Simulation and debriefing in neonatology 2016: Mission incomplete. Semin Perinatol. (2016) 40:489–93. 10.1053/j.semperi.2016.08.010
    1. Garvey AA, Dempsey EM. Simulation in neonatal resuscitation. Front Pediatr. (2020) 8:59. 10.3389/fped.2020.00059
    1. Yeung J, Meeks R, Edelson D, Gao F, Soar J, Perkins GD. The use of CPR feedback/prompt devices during training and CPR performance: A systematic review. Resuscitation. (2009) 80:743–51. 10.1016/j.resuscitation.2009.04.012
    1. Bhanji F, Donoghue AJ, Wolff MS, Flores GE, Halamek LP, Berman JM, et al. . Part 14: Education: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. (2015) 132:S561–73. 10.1161/CIR.0000000000000268
    1. Wagner M, Bibl K, Hrdliczka E, Steinbauer P, Stiller M, Gropel P, et al. . Effects of feedback on chest compression quality: a randomized simulation study. Pediatrics. (2019) 143:e20182441. 10.1542/peds.2018-2441
    1. Levett-Jones T, Lapkin S. A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse Educ Today. (2014) 34:e58–63. 10.1016/j.nedt.2013.09.020
    1. Edelson DP, Litzinger B, Arora V, Walsh D, Kim S, Lauderdale DS, et al. . Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch Intern Med. (2008) 168:1063–9. 10.1001/archinte.168.10.1063
    1. Savoldelli GL, Naik VN, Park J, Joo HS, Chow R, Hamstra SJ. Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback. Anesthesiology. (2006) 105:279–85. 10.1097/00000542-200608000-00010
    1. Gruber J SD, Zapletal B, Neuhold S, Fischer H. Real-time feedback systems in CPR. Trends Anaesth Crit Care. (2012) 2:287–94. 10.1016/j.tacc.2012.09.004
    1. Buleon C, Parienti JJ, Halbout L, Arrot X, De Facq Regent H, Chelarescu D, et al. . Improvement in chest compression quality using a feedback device (CPRmeter): a simulation randomized crossover study. Am J Emerg Med. (2013) 31:1457–61. 10.1016/j.ajem.2013.07.029
    1. Noordergraaf GJ, Drinkwaard BW, van Berkom PF, van Hemert HP, Venema A, Scheffer GJ, et al. . The quality of chest compressions by trained personnel: the effect of feedback, via the CPREzy, in a randomized controlled trial using a manikin model. Resuscitation. (2006) 69:241–52. 10.1016/j.resuscitation.2005.08.008
    1. Peberdy MA, Silver A, Ornato JP. Effect of caregiver gender, age, and feedback prompts on chest compression rate and depth. Resuscitation. (2009) 80:1169–74. 10.1016/j.resuscitation.2009.07.003
    1. Yeung J, Meeks R, Edelson D, Gao F, Soar J, Perkins GD. The use of CPR feedback/prompt devices during training and CPR performance: a systematic review. Resuscitation. (2009 J: ) 80:743–51.
    1. Dine CJ, Gersh RE, Leary M, Riegel BJ, Bellini LM, Abella BS. Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing. Crit Care Med. (2008) 36:2817–22. 10.1097/CCM.0b013e318186fe37
    1. Aziz K, Lee HC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia VS, et al. . Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. (2020) 142:S524–S50. 10.1161/CIR.0000000000000902
    1. Ali N, Sawyer T, Barry J, Grover T, Ades A. Resuscitation practices for infants in the NICU, PICU and CICU: results of a national survey. J Perinatol. (2017) 37:172–6. 10.1038/jp.2016.193
    1. Solevåg AL. and Schmölzer GM. Optimal Chest Compression Rate and Compression to Ventilation Ratio in Delivery Room Resuscitation: Evidence from Newborn Piglets and Neonatal Manikins. Front Pediatr. (2017) 5:3. 10.3389/fped.2017.00003
    1. Christman C, Hemway RJ, Wyckoff MH, Perlman JM. The two-thumb is superior to the two-finger method for administering chest compressions in a manikin model of neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed. (2011) 96:F99–F101. 10.1136/adc.2009.180406
    1. Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O'Hearn N, Wigder HN, et al. . Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation. (2005) 111:428–34. 10.1161/01.CIR.0000153811.84257.59
    1. Zuercher M, Hilwig RW, Ranger-Moore J, Nysaether J, Nadkarni VM, Berg MD, et al. . Leaning during chest compressions impairs cardiac output and left ventricular myocardial blood flow in piglet cardiac arrest. Crit Care Med. (2010) 38:1141–6. 10.1097/CCM.0b013e3181ce1fe2
    1. Kovacs A, Vadeboncoeur TF, Stolz U, Spaite DW, Irisawa T, Silver A, et al. . Chest compression release velocity: association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest. Resuscitation. (2015) 92:107–14. 10.1016/j.resuscitation.2015.04.026
    1. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. . Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. (2015) 132:S543–60. 10.1161/CIR.0000000000000267
    1. Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, et al. . Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation. (2009) 120:1241–7. 10.1161/CIRCULATIONAHA.109.852202
    1. Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al. . Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. (2013) 128:417–35. 10.1161/CIR.0b013e31829d8654
    1. Panchal AR, Bartos JA, Cabanas JG, Donnino MW, Drennan IR, Hirsch KG, et al. . Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. (2020) 142:S366–468. 10.1161/CIR.0000000000000916

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다