Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool

Bahr, Nathan; Meckler, Garth; Hansen, Matthew; Guise, Jeanne‐Marie

doi:10.1016/j.ajem.2021.06.061

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…The common types of deviations that occurred in our study are known to be associated with lower survival ( 8 , 16 ), and are comparable to those that occurred in a previous simulation study ( 11 ). Achieving vascular access through IV or IO is associated with survival in POHCA ( 5 ) but this was frequently delayed in our study.…”

Section: Discussionsupporting

confidence: 88%

“…Our results are better than reported across North America and Taiwan, where, on average, epinephrine was administered at >10 min in 54 and 97%, respectively ( 4 , 24 ). A recent POHCA simulation study conducted in Oregon found the mean time from paramedic arrival to epinephrine administration was 9.2 min, with 59% of patients receiving either epinephrine after 10 min or no epinephrine at all ( 11 ). Our local median time of 8.6 min is less compared to 17.3 min after paramedic arrival in Taiwan and the recent simulation findings ( 11 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…A recent POHCA simulation study conducted in Oregon found the mean time from paramedic arrival to epinephrine administration was 9.2 min, with 59% of patients receiving either epinephrine after 10 min or no epinephrine at all ( 11 ). Our local median time of 8.6 min is less compared to 17.3 min after paramedic arrival in Taiwan and the recent simulation findings ( 11 , 24 ). Rapid epinephrine administration, namely as soon as possible, is known to increase the chance of survival in pediatric cardiac arrest and it is now reflected in the PALS guidelines ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…Deviations from hospital protocols for care of pediatric in-hospital cardiac arrests are also associated with worse outcomes ( 10 ). In addition, in a POHCA simulation study with non-shockable arrests, many key resuscitation tasks were not routinely performed in line with Pediatric Advanced Life Support guidelines ( 11 ). However, deviations from protocols during on-scene management for POHCA events have not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Local Pediatric Out-of-Hospital Cardiac Arrest and Emergency Services Response

et al. 2022

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BackgroundSurvival after pediatric out-of-hospital cardiac arrest is poor. Paramedic services provide critical interventions that impact survival outcomes. We aimed to describe local pediatric out-of-hospital cardiac arrest (POHCA) events and evaluate the impact of the paramedic service response to POHCA.MethodsThe Canadian Resuscitation Outcomes Consortium and corresponding ambulance call records were used to evaluate deviations from best practice by paramedics for patients aged 1 day to <18 years who had an atraumatic out-of-hospital cardiac arrest between 2012 and 2020 in Middlesex-London County. Deviations were any departure from protocol as defined by Middlesex-London Paramedic Services.ResultsFifty-one patients were included in this study. All POHCA events had at least one deviation, with a total of 188 deviations for the study cohort. Return of spontaneous circulation (ROSC) was achieved in 35.3% of patients and 5.8% survived to hospital discharge. All survivors developed a new, severe neurological impairment. Medication deviations were most common (n = 40, 21.3%) followed by process timing (n = 38, 20.2%), vascular access (n = 27, 14.4%), and airway (n = 27, 14.4%). A delay in vascular access was the most common deviation (n = 25, 49.0%). The median (IQR) time to epinephrine administration was 8.6 (5.90–10.95) min from paramedic arrival. Cardiac arrests occurring in public settings had more deviations than private settings (p = 0.04). ROSC was higher in events with a deviation in any circulation category (p = 0.03).ConclusionPatient and arrest characteristics were similar to other POHCA studies. This cohort exhibited high rates of ROSC and bystander cardiopulmonary resuscitation but low survival to hospital discharge. The study was underpowered for its primary outcome of survival. The total deviations scored was low relative to the total number of tasks in a resuscitation. Epinephrine was frequently administered outside of the recommended timeframe, highlighting an important quality improvement opportunity.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Local Pediatric Out-of-Hospital Cardiac Arrest and Emergency Services Response

et al. 2022

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“…2 In contrast to adult OHCA resuscitation, previous studies have raised concerns regarding the quality of CPR, timelines of critical actions during pediatric OHCA, medication delivery, and airway management. [7][8][9] Pediatric arrests are potentially more complex to manage given the need to adapt CPR and airway techniques, equipment size, and medication dose to patient size and weight. This raises the hypothesis that the lack of improvement in pediatric outcomes could be due to lower quality of resuscitative care.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Resuscitation Quality in Simulated Pediatric and Adult Out-of-Hospital Cardiac Arrest

et al. 2023

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ImportanceMortality from pediatric out-of-hospital cardiac arrest (OHCA) is high and has not improved in decades, unlike adult mortality. The low frequency of pediatric OHCA and weight-based medication and equipment needs may lead to lower quality of pediatric resuscitation compared with adults.ObjectiveTo compare the quality of pediatric and adult resuscitation from OHCA in a controlled simulation environment and to evaluate whether teamwork, knowledge, experience, and cognitive load are associated with resuscitation performance.Design, Setting, and ParticipantsThis cross-sectional in-situ simulation study was conducted between September 2020 and August 2021 in the metropolitan area of Portland, Oregon, and included engine companies from fire-based emergency services (EMS) agencies.ExposuresParticipating EMS crews completed 4 simulation scenarios presented in random order: (1) adult female with ventricular fibrillation; (2) adult female with pulseless electrical activity; (3) school-aged child with ventricular fibrillation; and (4) infant with pulseless electrical activity. All patients were pulseless on EMS arrival. Data were captured by the research team in real time during the scenarios.Main outcomes and measuresThe primary outcome was defect-free care, which included correct cardiopulmonary resuscitation depth, rate, and compression to ventilation ratio, time to bag-mask ventilation, and time to defibrillation, if applicable. Outcomes were determined by direct observation by an experienced physician. Secondary outcomes included additional time-based interventions and the use of correct medication doses and equipment size. We measured teamwork using the clinical teamwork scale, cognitive load with the National Aeronautics and Space Administration task load index (NASA-TLX), and knowledge using advanced life support resuscitation tests.ResultsAmong the 215 clinicians (39 crews) who participated in 156 simulations, 200 (93%) were male, and the mean (SD) age was 38.7 (0.6) years. No pediatric shockable scenario was defect free and only 5 pediatric nonshockable scenarios (12.8%) were defect free, while 11 (28.2%) adult shockable scenarios and 27 adult nonshockable scenarios (69.2%) were defect free. The mental demand subscale of the NASA-TLX was higher in the pediatric compared with the adult scenarios (mean [SD] pediatric score, 59.1 [20.7]; mean [SD] adult score, 51.4 [21.1]; P = .01). Teamwork scores were not associated with defect-free care.Conclusions and RelevanceIn this simulation study of OHCA, resuscitation quality was significantly lower for pediatric than adult resuscitation. Mental demand may have been a contributor.

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A randomized crossover comparison of the bébé VieScope and direct laryngoscope for pediatric airway management by nurses in medical simulation settings

Wieczorek,

Pruc,

Krajsman

et al. 2023

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Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool

Cited by 5 publications

References 26 publications

Evaluation of Local Pediatric Out-of-Hospital Cardiac Arrest and Emergency Services Response

Evaluation of Local Pediatric Out-of-Hospital Cardiac Arrest and Emergency Services Response

Comparison of Resuscitation Quality in Simulated Pediatric and Adult Out-of-Hospital Cardiac Arrest

A randomized crossover comparison of the bébé VieScope and direct laryngoscope for pediatric airway management by nurses in medical simulation settings

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