ABSTRACT

BackgroundVideo analyses of real-life newborn resuscitations have shown that Neonatal Resuscitation Program (NRP) guidelines are followed in fewer than 50 % of cases. Multidisciplinary simulation is used as a first-rate tool for the improvement of teamwork among health professionals. In the study we evaluated the impact of the crisis resource management (CRM) and anesthesia non-technical skills instruction on teamwork during simulated newborn emergencies.MethodsNinety-nine participants of two delivery units (17 pediatricians, 16 anesthesiologists, 14 obstetricians, 31 midwives, and 21 neonatal nurses) were divided to an intervention group (I-group, 9 teams) and a control group (C-group, 6 teams). The I-group attended a CRM and ANTS instruction before the first scenario. After each scenario the I-group performed either self- or peer-assessment depending on whether they had acted or observed in the scenario. All the teams participated in two and observed another two scenarios. All the scenarios were video-recorded and scored by three experts with Team Emergency Assessment Measure (TEAM). SPSS software and nlme package were used for the statistical analyses.ResultsThe total TEAM scores of the first scenario between the I- and C-group did not differ from each other. Neither there was an increase in the TEAM scoring between the first and second scenario between the groups. The CRM instruction did not improve the I-group’s teamwork performance. Unfortunately the teams were not comparable because the teams had been allowed to self-select their members in the study design. The total TEAM scores varied a lot between the teams. Mixed-model linear regression revealed that the background of the team leader had an impact on differences of the total teamwork scores (D = 6.50, p = 0.039). When an anesthesia consultant was the team leader the mean teamwork improved by 6.41 points in comparison to specialists of other disciplines (p = 0.043).ConclusionThe instruction of non-technical skills before simulation training did not enhance the acquisition of teamwork skills of the intervention groups over the corresponding set of skills of the control groups. The teams led by an anesthesiologist scored the best. Experience of team leaders improved teamwork over the CRM instruction.

Many clinicians exhibited inadequate skills to resuscitate a newborn infant in a standard scenario. The neonatologists, as clinical experts, performed best in both technical and non-technical skills testing.

The dynamics and homogeneity of the QT interval have been used as indicators of susceptibility to ventricular arrhythmias. We determined the relationship between QT intervals and heart rate during exercise testing and subsequent recovery in 18 healthy children. The QT intervals were measured to the apex (early QT), to the end (total QT), and from the apex to the end of the T wave (late QT) (inhomogeneity of repolarization) at heart rates from 60 by steps of 10 to 180 beats.min-1. Group mean total QT and early QT exhibited better linear correlations with heart rate (r 0.998 and 0.999) than with cardiac cycle length (r 0.954 and 0.959). The slope relating total QT to heart rate was -1.30 during exercise and -1.42 during recovery (P < 0.05). The corresponding slopes relating early QT to heart rate were -1.11 and -1.30 (P < 0.05). Late QT, as a proportion of total QT, increased at high heart rates. Rate correction using Bazett's method gave abnormal total QT values (> 440 ms) in 12 children (67%) whereas linear correction gave values below 440 ms only. In conclusion, the relationship between QT and heart rate is linear and differs during exercise and recovery. Inhomogeneity of repolarization increases at high heart rates. Linear correction of total QT and early QT intervals improves the evaluation of repolarization duration in exercise testing in children.