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.

A Comparison of Efficacy of Treatment and Time to Administration of Naloxone by BLS and ALS Providers

2019 ◽  
Vol 34 (04) ◽  
pp. 350-355
Author(s):  
Kenneth Nugent ◽  
Patrick Matthews ◽  
Jamie Gissendaner ◽  
Mia Papas ◽  
Deborah Occident ◽  
...  
Keyword(s):  
Life Support ◽  
Training Session ◽  
Vital Signs ◽  
Advanced Life Support ◽  
The United States ◽  
Control Group ◽  
Opioid Overdose ◽  
Respiratory Compromise ◽  
Naloxone Administration ◽  
Significant Difference

AbstractIntroduction:The administration of naloxone therapy is restricted by scope of practice to Advanced Life Support (ALS) in many Emergency Medical Services (EMS) systems throughout the United States. In Delaware’s two-tiered EMS system, Basic Life Support (BLS) often arrives on-scene prior to ALS, but BLS providers were not previously authorized to administer naloxone. Through a BLS naloxone pilot study, the researchers sought to evaluate BLS naloxone administration and timing compared to ALS.Hypothesis:After undergoing specialized training, BLS providers would be able to appropriately administer naloxone to opioid overdose patients in a more timely manner than ALS providers.Methods:This was a retrospective, observational study using data collected from February 2014 through May 2015 throughout a state BLS naloxone pilot program. A total of 14 out of 72 state BLS agencies participated in the study. Pilot BLS agencies attended a training session on the indications and administration of naloxone, and then were authorized to carry and administer naloxone. Researchers then compared vital signs and the time of BLS arrival to administration of naloxone by BLS and ALS. Data were analyzed using paired and independent sample t-tests, as well as chi-square, as appropriate.Results:A total of 131 incidents of naloxone administration were reviewed. Of those, 62 patients received naloxone by BLS (pilot group) and 69 patients received naloxone by ALS (control group). After naloxone administration, BLS patients showed improvements in heart rate (HR; P < .01), respiratory rate (RR; P < .01), and pulse oximetry (spO2; P < .01); ALS patients also showed improvement in RR (P < .01), and in spO2 (P = .005). There was no significant improvement in HR for ALS providers (P = .189).There was a significant difference in arrival time of BLS to the time of naloxone administration between the two groups, with shorter times in the BLS group compared to the ALS group (1.9 minutes versus 9.8 minutes; P < .01); BLS administration was 7.8 minutes faster when compared to ALS administration (95% CI, 6.2-9.3 minutes).Conclusions:Patients improved similarly and received naloxone therapy sooner when treated by BLS agencies carrying naloxone than those who awaited ALS arrival. All EMS systems should consider allowing BLS to carry and administer naloxone for an effective and potentially faster naloxone administration when treating respiratory compromise related to opiate overdose.

scholarly journals Knowledge and attitude of cardiopulmonary resuscitation training and automated external defibrillators training among medical interns in a private medical college

2021 ◽  
Vol 12 (11) ◽  
pp. 79-84
Author(s):  
Archana Bhat ◽  
Lulu Sherif Mahmood ◽  
Akshatha Rao Aroor
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Health Care Professionals ◽  
Life Support ◽  
Training Session ◽  
Automated External Defibrillators ◽  
Validated Questionnaire ◽  
Resuscitation Training ◽  
Significant Difference ◽  
Post Test ◽  
The Mean

Background: Knowledge about basic life support (BLS) is mandatory for health-care professionals. Aims and Objectives: This study is done with the objective to evaluate the knowledge about cardiopulmonary resuscitation (CPR) and use of automated external defibrillators (AEDs) among medical students who have completed MBBS course and has enrolled for internship. Materials and Methods: A cross-sectional study using a validated questionnaire was given to MBBS interns before BLS training and same questionnaire was given 1 month after the training. The questionnaire included knowledge and attitudes toward use of CPR and AED and management of choking. Results: Out of the 86 students who answered the questionnaire, the mean score was 11.28 during the pre-test. In the post-test questionnaire, the mean score was 13.91. There was a statistically significant difference (P=0.000) in the post-test scores conducted after 1 month. About 39.6% of students scored average marks (5–10) in the pre-test and 60.4% of students scored good (10–15) marks in the pre-test. After the training session in the post-test, 97.7% of students scored good marks (10–15) while only 2.32% scored average marks. P<0.001, Chi-square=35.97 is highly significant. Conclusion: BLS training helps to increase knowledge of CPR and the use of an AED.

scholarly journals Time for Reflection: The Balance between Repetition and Feedback in Resuscitation Training—A Randomised Controlled Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Kristian Krogh ◽  
Morten Pilegaard ◽  
Berit Eika
Keyword(s):  
Randomised Controlled Trial ◽  
Retention Test ◽  
Life Support ◽  
Controlled Trial ◽  
Intervention Group ◽  
Advanced Life Support ◽  
Control Group ◽  
Resuscitation Training ◽  
Significant Difference ◽  
Randomised Controlled

Background. The simulation literature widely agrees that the reflective learning phase after the simulation is equal to or perhaps of even greater importance than the actual simulated scenario in ensuring learning. Nevertheless, advanced life support (ALS) tends to have many simulated scenarios followed by short feedback sessions. The aim of this study was to compare the ability of two groups of novice learners to stay adherent to the ALS guidelines in their provision of ALS after they had received either 8 or 12 simulated resuscitation scenarios, both in 4 hours. Methods. This study was a randomised controlled trial. Participants were either randomised to the control group with 12 scenarios (15 minutes per scenario) with 5 minutes of feedback or the intervention group with 8 simulations (15 minutes per scenario) with 15 minutes of feedback. Results. There was no statistically significant difference in test scores between the intervention group and control group in the 1-week retention test (p=0.59) and the 12-week retention test (p=0.43).  Conclusion. This study suggests that the lower number of repetitive ALS simulation scenarios does not diminish learning when the feedback is equally prolonged to ensure sufficient time for reflection.

scholarly journals Parada cardiorrespiratória pré-hospitalar: avaliação dos atendimentos segundo o utstein style*

2019 ◽  
Vol 13 ◽  
Author(s):  
Robson Cristiano Zandomenighi ◽  
Eleine Aparecida Penha Martins
Keyword(s):  
Life Support ◽  
Cardiopulmonary Arrest ◽  
Advanced Life Support ◽  
Venous Access ◽  
Orotracheal Intubation ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Epinephrine Administration ◽  
Peripheral Venous Access ◽  
Utstein Style

Objetivo: analisar as ocorrências, respostas e desfechos da parada cardiorrespiratória pré-hospitalar segundo o Utstein Style e identificar os fatores associados à sobrevida. Método: trata-se de um estudo quantitativo, documental e transversal, com vítimas de parada cardiorrespiratória atendidas nas unidades de suporte avançado de vida, no ano de 2015. Coletaram-se os dados a partir dos relatórios de atendimento do socorrista, organizando-os e analisando-os de acordo com o Utstein Style. Apresentaram-se os resultados em forma de tabelas. Resultados: verificaram-se 163 atendimentos, predominando o sexo masculino, não havendo associação entre idade e os desfechos. Identificou-se a maioria das PCRs como sendo de causa clínica, na residência e em assistolia, sendo entubação orotraqueal, acesso venoso periférico e administração de adrenalina os procedimentos mais frequentes. Constatou-se que as ocorrências presenciadas por espectadores leigos e o tempo-resposta da ambulância demonstraram uma associação com o desfecho sobrevida. Calculou-se a taxa de sobrevida em 25,1%. Conclusão: avaliou-se o serviço por meio da análise das ocorrências segundo o Utstein Style e verificaram-se associações entre o desfecho e as lacunas no atendimento, havendo a necessidade de intervenções em cada elo da corrente de sobrevivência. Descritores: Parada Cardíaca Extra-Hospitalar; Ressuscitação Cardiopulmonar; Serviços Médicos de Emergência; Ambulâncias; Emergências; Avaliação de Resultados. ABSTRACTObjective: to analyze the occurrences, responses and outcomes of prehospital cardiopulmonary arrest according to Utstein Style and to identify factors associated with survival. Method: this is a quantitative, documentary and cross-sectional study with victims of cardiopulmonary arrest treated at the advanced life support units in 2015. Data were collected from the rescuer's care reports and organized. and analyzing them according to Utstein Style. Results were presented in tables. Results: 163 cases were observed, predominantly male, with no association between age and outcomes. Most CRPs were identified as being of clinical cause, at home and in asystole, with orotracheal intubation, peripheral venous access and epinephrine administration being the most frequent procedures. It was found that the occurrences witnessed by lay spectators and the ambulance response time demonstrated an association with the survival outcome. The survival rate was calculated at 25.1%. Conclusion: the service was evaluated by analyzing the occurrences according to the Utstein Style and there were associations between the outcome and the gaps in care, requiring interventions in each link of the survival chain. Descriptors:  Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; Emergency Medical Services; Ambulances; Emergencies; Outcome Assessment. RESUMENObjetivo: analizar las ocurrencias, las respuestas y los resultados del paro cardiopulmonar prehospitalario según el Utstein Style e identificar los factores asociados con la supervivencia. Método: este es un estudio cuantitativo, documental y transversal con víctimas de paro cardiopulmonar tratadas en las unidades de soporte vital avanzado en 2015. Los datos se recopilaron de los informes de atención del rescatista, organizándolos y analizándolos según el Utstein Style. Los resultados se presentaron en tablas. Resultados: se observaron 163 casos, predominantemente masculinos, sin asociación entre la edad y los resultados. La mayoría de las PCRs se identificaron como de causa clínica, en el hogar y en la asistolia, siendo los procedimientos más frecuentes la intubación orotraqueal, el acceso venoso periférico y la administración de adrenalina los procedimientos más frecuentes. Se descubrió que las ocurrencias presenciadas por espectadores legos y el tiempo de respuesta de la ambulancia demostraron una asociación con el resultado de supervivencia. La tasa de supervivencia se calculó en 25.1%. Conclusión: el servicio se evaluó analizando las ocurrencias según el Utstein Style y hubo asociaciones entre el resultado y las brechas en la atención, lo que requiere intervenciones en cada eslabón de la cadena de supervivencia. Descriptores: Paro Cardíaco Extra-Hospitalario; Reanimación Cardiopulmonar; Servicios Médicos de Urgencia; Ambulancias, Urgencias Médicas, Evaluación de Resultado. 

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 Peer-led pediatric resuscitation training: effects on self-efficacy and skill performance

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
M. Binkhorst ◽  
J M Th Draaisma ◽  
Y. Benthem ◽  
E. M. R. van de Pol ◽  
M. Hogeveen ◽  
...  
Keyword(s):  
Medical Students ◽  
Self Efficacy ◽  
Basic Life Support ◽  
Life Support ◽  
Controlled Trial ◽  
Training Session ◽  
Real Life ◽  
Pediatric Resuscitation ◽  
Resuscitation Training ◽  
Skill Performance

Abstract Background Peer-led basic life support training in medical school may be an effective and valued way of teaching medical students, yet no research has been conducted to evaluate the effect on the self-efficacy of medical students. High self-efficacy stimulates healthcare professionals to initiate and continue basic life support despite challenges. Methods A randomized controlled trial, in which medical students received pediatric basic life support (PBLS) training, provided by either near-peer instructors or expert instructors. The students were randomly assigned to the near-peer instructor group (n = 105) or expert instructor group (n = 108). All students received two hours of PBLS training in groups of approximately 15 students. Directly after this training, self-efficacy was assessed with a newly developed questionnaire, based on a validated scoring tool. A week after each training session, students performed a practical PBLS exam and completed another questionnaire to evaluate skill performance and self-efficacy, respectively. Results Students trained by near-peers scored significantly higher on self-efficacy regarding all aspects of PBLS. Theoretical education and instructor feedback were equally valued in both groups. The scores for the practical PBLS exam and the percentage of students passing the exam were similar in both groups. Conclusions Our findings point towards the fact that near-peer-trained medical students can develop a higher level of PBLS-related self-efficacy than expert-trained students, with comparable PBLS skills in both training groups. The exact relationship between peer teaching and self-efficacy and between self-efficacy and the quality of real-life pediatric resuscitation should be further explored. Trial registration ISRCTN, ISRCTN69038759. Registered December 12th, 2019 – Retrospectively registered.

The Potential Impact of Cardiopulmonary Cerebral Resuscitation (CPCR) Education

1985 ◽  
Vol 1 (S1) ◽  
pp. 70-74
Author(s):  
Peter Safar
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Heart Association ◽  
Pilot Project ◽  
World Federation ◽  
Ambulance Personnel ◽  
Knowledge And Skills ◽  
Training Systems ◽  
Resuscitation Training ◽  
Potential Impact

This is an introduction for a one-day CPCR course for intended instructors-coordinators. The course is a pilot project using a new manual. Its goal is to explore the feasibility of instructors using semi-self-training modes to acquire the necessary knowledge and skills for the organization of basic and advanced life support courses in CPR for all types of personnel, ranging from the lay public via ambulance personnel and nurses to physician generalists and physician specialists. The American Heart Association (AHA) CPR courses for instructors-to-be were originated in Pittsburgh in the early 1960s; this present course, sponsored by the World Federation of Societies of Anesthesiologists (WFSA) CPR Committee was given in 1981. The traditional 2 to 3 days CPR instructors' courses for physicians have spread knowledge and skills slowly. We believe that the dissemination and uniformity of resuscitation training could be enhanced by wider use of self-training systems, not only for doers but also instructors-to-be.

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.

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.

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