Simulation of In-Hospital Pediatric Medical Emergencies and Cardiopulmonary Arrests: Highlighting the Importance of the First 5 Minutes

OBJECTIVES. Outcomes of in-hospital pediatric cardiopulmonary arrest are dismal. Recent data suggest that the quality of basic and advanced life support delivered to adults is low and contributes to poor outcomes, but few data regarding pediatric events have been reported. The objectives of this study were to (1) measure the median elapsed time to initiate important resuscitation maneuvers in simulated pediatric medical emergencies (ie, “mock codes”) and (2) identify the types and frequency of errors committed during pediatric mock codes. METHODS. A prospective, observational study was conducted of 34 consecutive hospital-based mock codes. A mannequin or computerized simulator was used to enact unannounced, simulated crisis situations involving children with respiratory distress or insufficiency, respiratory arrest, hemodynamic instability, and/or cardiopulmonary arrest. Assessment included time elapsed to initiation of specific resuscitation maneuvers and deviation from American Heart Association guidelines. RESULTS. Among the 34 mock codes, the median time to assessment of airway and breathing was 1.3 minutes, to administration of oxygen was 2.0 minutes, to assessment of circulation was 4.0 minutes, to arrival of any physician was 3.0 minutes, and to arrival of first member of code team was 6.0 minutes. Among cardiopulmonary arrest scenarios, elapsed time to initiation of compressions was 1.5 minutes and to request for defibrillator was 4.3 minutes. In 75% of mock codes, the team deviated from American Heart Association pediatric basic life support protocols, and in 100% of mock codes there was a communication error. CONCLUSIONS. Alarming delays and deviations occur in the major components of pediatric resuscitation. Future educational and organizational interventions should focus on improving the quality of care delivered during the first 5 minutes of resuscitation. Simulation of pediatric crises can identify targets for educational intervention to improve pediatric cardiopulmonary resuscitation and, ideally, outcomes.

[1]  J. Tibballs,et al.  A prospective study of outcome of in-patient paediatric cardiopulmonary arrest. , 2006, Resuscitation.

[2]  Naoki Shimizu,et al.  2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Advanced Life Support , 2006, Pediatrics.

[3]  Devashish Saini,et al.  Relationship between knowledge of cardiopulmonary resuscitation guidelines and performance. , 2006, Resuscitation.

[4]  J. Ornato,et al.  First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. , 2006, JAMA.

[5]  M. Hazinski,et al.  PALS provider manual , 2006 .

[6]  Max Harry Weil,et al.  In-hospital cardiac arrest. , 2005, Critical care medicine.

[7]  P. Steen,et al.  Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. , 2005, JAMA.

[8]  B. Abella,et al.  Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. , 2005, JAMA.

[9]  F. Tschan,et al.  Human factors affect the quality of cardiopulmonary resuscitation in simulated cardiac arrests. , 2004, Resuscitation.

[10]  J. Finn,et al.  Cardiac arrest resuscitation policies and practices: a survey of Australian hospitals. , 2003, The Medical journal of Australia.

[11]  M. Chauvin,et al.  Prise en charge des arrêts cardiaques intrahospitaliers: évaluation des connaissances théoriques du personnel médical et paramédical , 2003 .

[12]  P. Finne,et al.  Evaluation of the in-hospital Utstein template in cardiopulmonary resuscitation in secondary hospitals. , 2003, Resuscitation.

[13]  F. Jewkes,et al.  Resuscitation training of paediatricians , 2003, Archives of disease in childhood.

[14]  G. Conti,et al.  A survey of the in-hospital response to cardiac arrest on general wards in the hospitals of Rome. , 2003, Resuscitation.

[15]  M. Galinski,et al.  [In-hospital cardiac arrest resuscitation: medical and paramedical theory skill assessment in an university hospital]. , 2003, Annales francaises d'anesthesie et de reanimation.

[16]  T. Iirola,et al.  Teaching hospital physicians' skills and knowledge of resuscitation algorithms are deficient , 2002, Acta anaesthesiologica Scandinavica.

[17]  Kenji Hira,et al.  Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training. , 2002, The Journal of trauma.

[18]  J. Herlitz,et al.  Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to the interval between collapse and start of CPR. , 2002, Resuscitation.

[19]  M. Castrén,et al.  In‐hospital cardiopulmonary resuscitation: organization, management and training in hospitals of different levels of care , 2002, Acta anaesthesiologica Scandinavica.

[20]  R. Berg,et al.  A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style. , 2002, Pediatrics.

[21]  D. Durbin,et al.  Teaching resuscitation to pediatric residents: the effects of an intervention. , 2000, Archives of pediatrics & adolescent medicine.

[22]  J. Räsänen,et al.  Utstein style reporting of in-hospital paediatric cardiopulmonary resuscitation. , 2000, Resuscitation.

[23]  S. Cooper,et al.  Leadership of resuscitation teams: "Lighthouse Leadership'. , 1999, Resuscitation.

[24]  K. D. Young,et al.  Pediatric cardiopulmonary resuscitation: a collective review. , 1999, Annals of emergency medicine.

[25]  L. Quan,et al.  Performance of advanced resuscitation skills by pediatric housestaff. , 1998, Archives of pediatrics & adolescent medicine.

[26]  J. Soar,et al.  A revised role for the hospital cardiac arrest team? , 1998, Resuscitation.

[27]  A. Slonim,et al.  Cardiopulmonary resuscitation in pediatric intensive care units. , 1997, Critical care medicine.

[28]  S. Cooper,et al.  Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness. , 1997, Resuscitation.

[29]  E. Krane.  Textbook of Pediatric Intensive Care. 3rd Ed , 1997 .

[30]  J P Ornato,et al.  Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. A statement for healthcare professionals from the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Aus , 1997, Resuscitation.

[31]  M. Hazinski,et al.  In-hospital resuscitation: a statement for healthcare professionals from the American Heart Association Emergency Cardiac Care Committee and the Advanced Cardiac Life Support, Basic Life Support, Pediatric Resuscitation, and Program Administration Subcommittees. , 1997, Circulation.

[32]  J. Ornato,et al.  Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. American Heart Association. , 1997, Circulation.

[33]  W. Kaye,et al.  A reliable and valid method for evaluating cardiopulmonary resuscitation training outcomes. , 1996, Resuscitation.

[34]  B. Brenner,et al.  Response to cardiac arrests in a hospital setting: delays in ventilation. , 1996, Resuscitation.

[35]  R. Willoughby,et al.  Textbook of Pediatric Intensive Care , 1996 .

[36]  M. Hazinski,et al.  Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. , 1995, Pediatrics.

[37]  M. Hazinski,et al.  Recommended guidelines for uniform reporting of pediatric advanced life support: the Pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. , 1995, Resuscitation.

[38]  G A Ewy,et al.  Chest compression and ventilation rates during cardiopulmonary resuscitation: the effects of audible tone guidance. , 1995, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[39]  D. Bishop-Kurylo,et al.  Pediatric resuscitation: development of a mock code program and evaluation tool. , 1995, Pediatric nursing.

[40]  F. Moler,et al.  Simulated pediatric cardiopulmonary resuscitation: initial events and response times of a hospital arrest team. , 1994, Respiratory care.

[41]  Lewis Fh,et al.  Revisiting CPR knowledge and skills among registered nurses. , 1993 .

[42]  J. Brock‐Utne,et al.  The Effect of Cricoid Pressure on Preventing Gastric Insufflation in Infants and Children , 1993, Anesthesiology.

[43]  F. Lewis,et al.  Revisiting CPR knowledge and skills among registered nurses. , 1993, Journal of continuing education in nursing.

[44]  M. Yarnin.  Cardiopulmonary resuscitation: a mandatory training program for nursing staff. , 1990, Confederation of Australian Critical Care Nurses journal.

[45]  J. McMurray,et al.  The Basic and Advanced Cardiopulmonary Resuscitation Skills of Trained Hospital Nursing Staff , 1989, Scottish medical journal.

[46]  M. Schreiner.  TEXTBOOK OF PEDIATRIC INTENSIVE CARE , 1988 .

[47]  G Wynne,et al.  Inability of trained nurses to perform basic life support. , 1987, British medical journal.

[48]  G. Guyatt,et al.  SIMULATED CARDIAC ARRESTS FOR MONITORING QUALITY OF IN-HOSPITAL RESUSCITATION , 1986, The Lancet.