The Medical Resuscitation Committee

Mittiga, M; Frey, Mary; Kerrey, Benjamin T.; Rinderknecht, Andrea S.; Eckerle, Michelle; Sobolewski, Brad; Johnson, Laurie H.; Oehler, Jennifer; Bennett, Berkeley L.; Chan, Steven; Frey, Theresa; Krummen, Kelly; Lindsay, Claire; Wolfangel, Kelsey; Richert, Alison; Masur, Tonya; Bria, Corinne; Hoehn, Erin F.; Geis, Gary L.

doi:10.1097/pec.0000000000001742

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…Simulation has been shown to enhance retention of resuscitation skills [20]; pediatric care providers particularly benefit from simulation-based resuscitation exercises, as real-life resuscitation events are rare in children [21,22]. However, even high-fidelity simulations are limited in their capacity to replicate real-life scenarios.…”

Section: Introductionmentioning

confidence: 99%

Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial (Preprint)

Toto¹,

Vorel²,

Tay³

et al. 2021

Preprint

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BACKGROUND Septic shock is a low frequency but high stakes condition in children requiring prompt resuscitation, thus making it an important target for simulation based education. OBJECTIVE In this study, we aimed to 1) design and implement an augmented reality (AR) application (PediSepsisAR) for septic shock simulation; 2) test the feasibility of measuring timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR; 3) describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during simulation in 90% of participants. METHODS We performed a randomized controlled feasibility trial with a convenience sample of pediatric providers at a large tertiary-care pediatric center. Participants completed a pre-study questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured participants’ rate of administration of 20 cc/kg, 40 cc/kg, and 60 cc/kg IV fluids during a septic shock simulation using each modality. Participants in the PediSepsisAR arm completed a post-study questionnaire. We analyzed data using descriptive statistics and a Wilcoxson Rank Sum test to compare median time to event variables between groups. RESULTS We enrolled 50 participants with 25 in each arm. The timing and volume of fluid administration was captured in 100% of participants. There was no statistically significant difference in time to administration of IV fluids between the two groups. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient’s perfusion. CONCLUSIONS We developed an AR application for use in pediatric septic shock simulation and demonstrated the feasibility of measuring volume and timing of fluid administration during simulation using this modality. Our findings suggest AR’s promise as an educational tool, particularly for teaching about shock states.

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Section: Introductionmentioning

confidence: 99%

Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial (Preprint)

Toto¹,

Vorel²,

Tay³

et al. 2021

Preprint

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A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

Loftus

Schumacher

Mittiga

et al. 2020

AEM Education and Training

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Objectives: Most children seeking emergency care are evaluated in general emergency departments (EDs). The cumulative pediatric clinical experiences of emergency medicine (EM) residents are largely unknown. This study examined EM resident pediatric clinical experience through the lens of the Accreditation Council for Graduate Medical Education requirements and the Model of the Clinical Practice of Emergency Medicine. Methods: Retrospective, observational study of the cumulative clinical experience of two classes of EM residents from a 4-year training program at two pediatric EDs of a quaternary care pediatric center. A database of resident patient encounters was generated from the electronic medical record. Experiences classified included: diagnosis categories per the Model of the Clinical Practice of Emergency Medicine, procedures, and resuscitations. Results were stratified by age, acuity, and disposition.Results: Twenty-five EM residents evaluated 17,642 patients (median = 723). Most patients (73.5%) were emergent acuity (Emergency Severity Index triage level 2 or 3 or non-intensive care admission); 2% were critical. Residents participated in 598 (median = 22) medical resuscitations and 483 (median = 19) trauma resuscitations. Minor procedures (e.g., laceration repair) were commonly performed; critical procedures (e.g., intubation) were rare. Exposure to neonates was infrequent and pediatric deaths were rare. Abdominal pain (5.7%), asthma exacerbation (4.6%), and fever (3.8%) were the most common diagnoses.Conclusions: Emergency medicine residents encountered a wide array of pediatric diagnoses throughout training and performed a substantial number of common pediatric procedures. Exposure to critical acuity and procedures, neonatal pathology, and certain pediatric-specific diagnoses, such as congenital heart disease, was limited despite training in a large, quaternary care children's hospital. Curriculum development and collaboration should focus on these areas.

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Implementation of a Pediatric Emergency Department Cardiopulmonary Resuscitation Quality Bundle

et al. 2022

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BACKGROUND AND OBJECTIVES: We have previously demonstrated that standardized handoff from prehospital to hospital clinicians can improve cardiopulmonary resuscitation performance for out-of-hospital cardiac arrest (OHCA) patients in a pediatric emergency department (ED). We leveraged our previous quality improvement initiative to standardize performance of a bundle of 5 discrete aspects of resuscitation for OHCA patients: intravenous or intraosseous catheter (IV/IO) access, epinephrine administration, advanced airway placement, end-tidal capnography (ETCO2) application, and cardiac rhythm verbalization. We aimed to reduce time to completion of the bundle from 302 seconds at baseline to less than 120 seconds within 1 year. METHODS: A multidisciplinary team performed video-based review of actual OHCA resuscitations in our pediatric ED. We designed interventions aimed at key drivers of bundle performance. Interventions included specific roles and responsibilities and a standardized choreography for each bundle element. To assess the effect of the interventions, time to performance of each bundle element was measured by standardized review of video recordings from our resuscitation bay. Balancing measures were time off the chest and time to defibrillator pad placement. RESULTS: We analyzed 56 cases of OHCA from May 2019 through May 2021. Time to bundle completion improved from a baseline of 302 seconds to 147 seconds. Four of 5 individual bundle elements also demonstrated significant improvement. These improvements were sustained without any negative impact on balancing measures. CONCLUSIONS: Standardized choreography for the initial minutes of ED cardiac arrest resuscitation shows promise to decrease time to crucial interventions in children presenting to the pediatric ED with OHCA.

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The Medical Resuscitation Committee

Cited by 4 publications

References 25 publications

Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial (Preprint)

Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial (Preprint)

A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

Implementation of a Pediatric Emergency Department Cardiopulmonary Resuscitation Quality Bundle

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