scholarly journals LO38: Does spaced instructional design result in improved retention of pediatric resuscitation skills? A randomized education study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S20-S20
Author(s):  
C. Patocka ◽  
A. Cheng ◽  
M. Sibbald ◽  
J. Duff ◽  
A. Lai ◽  
...  
Keyword(s):  
Rating Scales ◽  
Life Support ◽  
Spacing Effect ◽  
Advanced Life Support ◽  
Course Completion ◽  
Skill Learning ◽  
Global Rating ◽  
Procedural Skills ◽  
Pediatric Resuscitation ◽  
Significant Difference

Introduction: Survival from cardiac arrest has been linked to the quality of resuscitation care. Unfortunately, healthcare providers frequently underperform in these critical scenarios, with a well-documented deterioration in skills weeks to months following advanced life support courses. Improving initial training and preventing decay in knowledge and skills are a priority in resuscitation education. The spacing effect has repeatedly been shown to have an impact on learning and retention. Despite its potential advantages, the spacing effect has seldom been applied to organized education training or complex motor skill learning where it has the potential to make a significant impact. The purpose of this study was to determine if a resuscitation course taught in a spaced format compared to the usual massed instruction results in improved retention of procedural skills. Methods: EMS providers (Paramedics and Emergency Medical Technicians (EMT)) were block randomized to receive a Pediatric Advanced Life Support (PALS) course in either a spaced format (four 210-minute weekly sessions) or a massed format (two sequential 7-hour days). Blinded observers used expert-developed 4-point global rating scales to assess video recordings of each learner performing various resuscitation skills before, after and 3-months following course completion. Primary outcomes were performance on infant bag-valve-mask ventilation (BVMV), intraosseous (IO) insertion, infant intubation, infant and adult chest compressions. Results: Forty-eight of 50 participants completed the study protocol (26 spaced and 22 massed). There was no significant difference between the two groups on testing before and immediately after the course. 3-months following course completion participants in the spaced cohort scored higher overall for BVMV (2.2 ± 0.13 versus 1.8 ± 0.14, p=0.012) without statistically significant difference in scores for IO insertion (3.0 ± 0.13 versus 2.7± 0.13, p= 0.052), intubation (2.7± 0.13 versus 2.5 ± 0.14, p=0.249), infant compressions (2.5± 0.28 versus 2.5± 0.31, p=0.831) and adult compressions (2.3± 0.24 versus 2.2± 0.26, p=0.728) Conclusion: Procedural skills taught in a spaced format result in at least as good learning as the traditional massed format; more complex skills taught in a spaced format may result in better long term retention when compared to traditional massed training as there was a clear difference in BVMV and trend toward a difference in IO insertion.

Pediatric Resuscitation

2020 ◽  
pp. 67-74
Author(s):  
Matthew Mendes ◽  
Taylor McCormick
Keyword(s):  
Respiratory Failure ◽  
Life Support ◽  
Early Recognition ◽  
Cardiopulmonary Arrest ◽  
Advanced Life Support ◽  
High Stakes ◽  
Pediatric Resuscitation ◽  
Critically Ill Child ◽  
Equipment Sizing ◽  
Equipment System

Respiratory failure is the most common cause of cardiopulmonary arrest in children. Early recognition of the critically ill child and aggressive management of respiratory failure and shock are crucial to preventing cardiopulmonary arrest. Although caring for a sick child can be highly stressful for emergency physicians, pediatric resuscitation largely mirrors that of adults, with special consideration of a few key anatomic and physiologic differences. It is important to have a systematic approach to patient assessment, medication dosing, and equipment sizing in order to cognitively offload the emergency provider. The following will help maximize performance in these high-stakes situations: the Pediatric Assessment Triangle combined with the familiar airway, breathing, circulation, disability, exposure approach; an age-, weight-, or length-based medication/equipment system; and routine application of Pediatric Advanced Life Support algorithms.

scholarly journals Effects of Erythropoietin Administration on Adrenal Glands of Landrace/Large White Pigs after Ventricular Fibrillation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Armando Faa ◽  
Gavino Faa ◽  
Apostolos Papalois ◽  
Eleonora Obinu ◽  
Giorgia Locci ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Adrenal Glands ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Control Group ◽  
Swine Model ◽  
Protective Effects ◽  
Large White ◽  
Significant Difference

Aim.To evaluate the effects of erythropoietin administration on the adrenal glands in a swine model of ventricular fibrillation and resuscitation.Methods. Ventricular fibrillation was inducedviapacing wire forwarded into the right ventricle in 20 female Landrace/Large White pigs, allocated into 2 groups: experimental group treated with bolus dose of erythropoietin (EPO) and control group which received normal saline. Cardiopulmonary resuscitation (CPR) was performed immediately after drug administrationas perthe 2010 European Resuscitation Council (ERC) guidelines for Advanced Life Support (ALS) until return of spontaneous circulation (ROSC) or death. Animals who achieved ROSC were monitored, mechanically ventilated, extubated, observed, and euthanized. At necroscopy, adrenal glands samples were formalin-fixed, paraffin-embedded, and routinely processed. Sections were stained with hematoxylin-eosin.Results.Oedema and apoptosis were the most frequent histological changes and were detected in all animals in the adrenal cortex and in the medulla. Mild and focal endothelial lesions were also detected. A marked interindividual variability in the degree of the intensity of apoptosis and oedema at cortical and medullary level was observed within groups. Comparing the two groups, higher levels of pathological changes were detected in the control group. No significant difference between the two groups was observed regarding the endothelial changes.Conclusions. In animals exposed to ventricular fibrillation, EPO treatment has protective effects on the adrenal gland.

scholarly journals Methodology of Specialist Physicians Training: From Traditional to e-Learning

2020 ◽  
Vol 17 (20) ◽  
pp. 7681
Author(s):  
Juan Chaves ◽  
Antonio A. Lorca-Marín ◽  
Emilio José Delgado-Algarra
Keyword(s):  
Life Support ◽  
Medical Training ◽  
Advanced Life Support ◽  
Sample Volume ◽  
Mixed Methodology ◽  
Face To Face ◽  
Significant Difference ◽  
The Face ◽  
E Learning ◽  
The Impact

Different studies show that mixed methodology can be effective in medical training. However, there are no conclusive studies in specialist training on advanced life support (ALS). The main objective of this research is to determine if, with mixed didactic methodology, which includes e-learning, similar results are produced to face-to-face training. The method used was quasi-experimental with a focus on efficiency and evaluation at seven months, in which 114 specialist doctors participated and where the analysis of the sociodemographic and pre-test variables points to the homogeneity of the groups. The intervention consisted of e-learning training plus face-to-face workshops versus standard. The results were the performance in knowledge and technical skills in cardiac arrest scenarios, the perceived quality, and the perception of the training. There were no significant differences in immediate or deferred performance. In the degree of satisfaction, a significant difference was obtained in favour of the face-to-face group. The perception in the training itself presented similar results. The main limitations consisted of sample volume, dropping out of the deferred tests, and not evaluating the transfer or the impact. Finally, mixed methodology including e-learning in ALS courses reduced the duration of the face-to-face sessions and allowed a similar performance.

Pediatric Advanced Life Support (PALS): The Pharmacist's Role

1996 ◽  
Vol 9 (1) ◽  
pp. 42-56
Author(s):  
Paul C. Blahunka
Keyword(s):  
Pharmaceutical Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Heart Association ◽  
Role Playing ◽  
Medication Administration ◽  
Patient Specific ◽  
Needle Stick Injury ◽  
Pediatric Resuscitation ◽  
Syncytial Virus

The provision of pharmaceutical care to the patient undergoing cardiopulmonary resuscitation (CPR) is an important evolving concept. Pediatric resuscitation and advanced cardiac life support (ACLS) presents a particularly challenging situation for the practicing pharmacist. Etiologies of pediatric arrests include pulmonary conditions such as bronchopulmonary dysplasia, respiratory distress syndrome, respiratory syncytial virus (RSV) infection, and a myriad of accidental factors. Important initial determinations on arriving at a pediatric arrest are described, such as determining the correct weight of the patient, assessing the need for vascular access and/or intubation, and establishing the "code" leader. Recent American Heart Association guidelines for the pharmacotherapy of pediatric ACLS are discussed in detail. Included are recommendations on oxygen delivery, routes of fluid and medication administration, recent changes in epinephrine dosing, and guidelines for the proper use of adjunct medications. A detailed description of a method of using adult emergency drug syringes in the pediatric arrest is provided. Proper use of this method can expedite drug dispensing in an arrest, minimize the potential for needle-stick injury, and optimize the delivery of a patient-specific dose of medication. A "mock code" program is described that includes involvement with pharmacists, nurses, medical residents, and respiratory therapists. This program provides a hands-on role-playing model of a simulated pediatric arrest and serves as a valuable teaching tool for those charged with the responsibility of patient care during an actual arrest. While the ultimate role of the pharmacist in the pediatric arrest continues to be defined, developing the competency to provide pharmaceutical care in this clinical setting can be extremely rewarding. Copyright © 1996 by W.B. Saunders Company

Observational Study on the Effect of Duration from Pediatric Advanced Life Support (PALS) Certification on PALS Performance in Pediatric Interns in Simulated Cardiopulmonary Arrest

2021 ◽  
Author(s):  
Nancy M. Tofil ◽  
Stacy L. Gaither ◽  
Charli Cohen ◽  
Carrie Norwood ◽  
Jerry Lynn Zinkan ◽  
...  
Keyword(s):  
Life Support ◽  
Cardiopulmonary Arrest ◽  
Training Session ◽  
Advanced Life Support ◽  
Performance Score ◽  
Performance Skills ◽  
Score Following ◽  
Resuscitation Training ◽  
Significant Difference ◽  
Key Events

AbstractPediatric advanced life support (PALS) training is critical for pediatric residents. It is unclear how well PALS skills are developed during this course or maintained overtime. This study evaluated PALS skills of pediatric interns using a validated PALS performance score following their initial PALS certification. All pediatric interns were invited to a 45-minute rapid cycle deliberate practice (RCDP) training session following their initial PALS certification from July 2017 to June 2019. The PALS score and times for key events were recorded for participants prior to RCDP training. We then compared performance scores for those who took PALS ≥3 months, between 3 days to 3 months and 3 days after PALS. There were 72 participants, 30 (of 30) in 3 days, 18 in 3 days to 3 months, and 24 in ≥3 months groups (42 total of 52 residents, 81%). The average PALS performance score was 53 ± 20%. There was no significant difference between the groups (3 days, 53 ± 15%; 3 days–3 months, 51 ± 19%; ≥3 months, 54 ± 26%, p = 0.922). Chest compressions started later in the ≥3 months groups compared with the 3 days or ≤3 months groups (p = 0.036). Time to defibrillation was longer in the 3 days group than the other groups (p = 0.008). Defibrillation was asked for in 3 days group at 97%, 73% in 3 days to 3 months and 68% in ≥3 months groups. PALS performance skills were poor in pediatric interns after PALS certification and was unchanged regardless of when training occurred. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.

Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein Style

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 765-779 ◽  
Author(s):  
Arno Zaritsky ◽  
Vinay Nadkarni ◽  
Mary Fran Hazinski ◽  
George Foltin ◽  
Linda Quan ◽  
...  
Keyword(s):  
Life Support ◽  
Task Force ◽  
Age Groups ◽  
Advanced Life Support ◽  
Data Set ◽  
Consensus Document ◽  
Eastern Virginia Medical School ◽  
Pediatric Resuscitation ◽  
Recommended Guidelines

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.

Abstract 326: Practice Variation in the Transition from Weight-based to Flat Dosing of Epinephrine During Cardiopulmonary Resuscitation in Pediatric Intensive Care Units

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Martha Kienzle ◽  
Ryan W Morgan ◽  
Maya Dewan ◽  
Ken Tegtmeyer ◽  
Vijay Srinivasan ◽  
...  
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Pediatric Intensive Care ◽  
Ideal Body Weight ◽  
Practice Variation ◽  
Free Standing ◽  
Chi Square ◽  
Actual Weight ◽  
Significant Difference ◽  
Fellowship Programs

Introduction: Pediatric Advanced Life Support (PALS) guidelines include weight-based epinephrine dosing recommendations (0.01 mg/kg with a maximum dose of 1mg), but do not specify the age or weight at which adult (flat) dosing should be provided. Hypothesis: We hypothesized that there would be considerable practice variation in the transition from weight-based to flat dosing of epinephrine in pediatric ICUs (PICUs) and that more providers would prioritize weight than age in making this decision. Methods: We performed an IRB-exempt, multi-institution, internet-based survey. Recipients were U.S. PICU attending physicians (one per institution) involved in resuscitation system oversight. Proportions across categories were compared using Chi-square testing. Results: Of 137 institutions surveyed, 68 (50%) responded. Most responding institutions are children’s hospitals (free-standing or dedicated pediatric hospitals within combined hospitals) (67; 99%) and academic (55; 81%); 41 (60%) have PICU fellowship programs. Thirteen (19%) respondents are PICU medical directors, 16 (24%) are resuscitation committee members and 21 (31%) are PICU attendings with an interest in resuscitation. When choosing between weight-based and flat dosing, a significantly higher proportion of providers consider weight (64/68; 94%) vs. age (23/68; 34%) (p <0.01). Among those using age, there were no significant differences in the proportion of providers transitioning at 12 to <14 years of age (0, 0%), 14 to <16 (4, 17%), 16 to <18 (5, 22%) or ≥18 (6, 26%; p=0.82). Among those prioritizing weight, there was a significant difference between the proportion of providers transitioning at 50 to <60kg (28, 44%), 60 to <80kg (17, 27%), 80 to <100kg (5, 8%) or ≥100kg (8, 13%; p< 0.01). Twenty-nine (43%) institutions use an ideal body weight that is less than the patient’s actual weight when dosing epinephrine in obese patients. Conclusions: There is considerable practice variation in the transition from weight-based to flat epinephrine dosing during CPR in PICUs with most institutions using patient weight. Given the potential for large variation in amount of epinephrine delivered to these patients, prospective study is warranted to inform PALS guidelines.

An Analysis of Invasive Airway Management in a Suburban Emergency Medical Services System

1992 ◽  
Vol 7 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Thomas J. Krisanda ◽  
David R. Eitel ◽  
Dean Hess ◽  
Robert Ormanoski ◽  
Robert Bernini ◽  
...  
Keyword(s):  
Airway Management ◽  
Life Support ◽  
Advanced Life Support ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Successful Intubation ◽  
Success Rates ◽  
Altered Level ◽  
Emergency Medical ◽  
Significant Difference

AbstractIntroduction:Airway management is the most critical and potentially life-saving intervention performed by emergency medical service (EMS) providers. Invasive airway management often is required in non-cardiac-arrest patients who are combative or otherwise uncooperative. The success of prehospital invasive airway management in this patient population was evaluated.Methods:A retrospective review was undertaken of the records of all such patients requiring endotracheal intubation over a three-year period (1987–1989). The study population included 278 patients enrolled by five advanced life support (ALS) units serving a suburban population of 425,000. Field trip sheets were reviewed for diagnosis, intubation method and success, number of intubation attempts, provider experience, reasons for unsuccessful intubations, and complications.Results:A total of 394 invasive airway management attempts were performed on 278 patients. The overall successful intubation rate was 75% (41 % orotracheal, 52% nasotracheal, 7% other or unknown). The most common diagnoses were COPD and pulmonary edema (30%) and trauma (24%). Experienced providers were successful on the first attempt in 57% of cases compared to 50% by inexperienced providers (p=.24). Multiple intubation attempts were required in 33% of the patients. There was no statistically significant difference in success rates between the orotracheal and nasotracheal methods (p=.51). The most common reason for unsuccessful intubation was altered level of consciousness. Complications occurred with 7% of successful attempts and in 18% of unsuccessful attempts (p<.001). Forty-six percent of the patients who were not intubated successfully in the field and required intubation in the emergency department (ED) received a neuromuscular blocking agent prior to successful intubation.Conclusion:Prehospital providers can intubate a high but improvable proportion of non-cardiac-arrested patients by both the orotracheal and nasotracheal routes. The use of pharmacologic adjuncts to facilitate the prehospital intubation of selected, non-cardiac-arrested patients is a promising adjunct that needs further evaluation.

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