NRP Versus PALS for Infants Outside the Delivery Room: Not If, but When?

Background Both the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines can be used for infants requiring cardiopulmonary resuscitation outside the delivery room. Each set of guidelines has supporting algorithms for resuscitation; however, there are no current recommendations for transitioning older infants outside the delivery room. Objective To provide background information on the algorithms in the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines and to discuss the role that nurses and advanced practice nurses play in advancing scientific research on resuscitation. Content Covered Summaries of both sets of guidelines, differences in practices, and recommendations for practice changes will be discussed. Discussion Provider preference and unit practice determine which guidelines are used for infants outside the delivery room. Providers in pediatric intensive care units and pediatric cardiac intensive care units often use the Pediatric Advanced Life Support guidelines, whereas providers in neonatal intensive care units use the Neonatal Resuscitation Program guidelines for infants of the same age. The variation in resuscitation practices for infants outside the delivery room can negatively affect resuscitation outcomes.

EP.WE.31A snapshot audit on the current practice of minimal access surgery in the UK during COVID-19 pandemic

Aims COVID-19 is an ongoing global pandemic that poses potential increase in the risk of post-operative complications. Early guidelines placed an embargo on minimal access surgery, aiming to minimise risk to patients and the surgical team through aerolisation of the virus. We aimed to assess the practice of minimal access surgery during the peak of the pandemic and associated surgical outcomes. Methods An email link to an online questionnaire was distributed to a variety of surgical specialties via the Royal College of Surgeons COVID group and ALSGBI members. Data collection was carried out over a 4-month period. Data assessed included screening methods, case volume, surgical approach and patient outcomes. Results A total of 118 responses from a variety of surgical specialties were collected over 59 units, ranging in grade from Consultant to SHO/Core Trainee. The volume of minimal access procedures decreased during the pandemic from 94.9% of units to 39.0% (P < 0.001), with a greater percentage opting for an open approach (54.2% vs 39.0%, P < 0.001). Combining screening methods was a favoured approach, and it was frequently used alongside a designated ‘Clean’ theatre. A small proportion of patients suffered from post-operative COVID-19 complications (15.3%), but COVID-19 mortality was low. Conclusions Whilst the risk of COVID-19 infection was not completely abolished perioperatively throughout the pandemic, it appears to be minimised by use of adequate screening with designated clean areas. It would therefore support guidelines advocating continued use of minimal access surgery during peaks of COVID-19 if prudent peri-operative measures are taken.

JUDICIAL DISCRETION IN THE DETERMINATION OF POST-DIVORCE CHILD SUPPORT: A BRIEF OVERVIEW OF THE APPLICATION OF THE SOUTH AFRICAN MAINTENANCE ACT 99 OF 1998 AS COMPARED TO THE CANADIAN FEDERAL CHILD SUPPORT GUIDELINES OF 1997

There are various models for determining and allocating child support obligations post-divorce and many different principles upon which such a policy can be based. In most legal systems the parents retain the duty to support their needy children after divorce as it is primarily their obligation to ensure the adequate financial welfare of their children. This principle is applicable in both the South African and Canadian legal systems. In South Africa, in terms of both the common law and legislation, both parents must maintain their children “according to their respective means”. The awarding of a specific amount of maintenance is, however, a complex process calculated by the courts on a case-by-case basis mainly by considering two issues: the needs of the children and the parents’ ability to maintain their children within the circumstances and means of each of the parents. Although both aspects are important in a maintenance enquiry, the focus of this note is on the interpretation of the calculation of the contribution of each of the parents, especially the non-custodial parent. The interpretation of the concept “means” obviously has important consequences for the parties: the broader the interpretation of the “means” of a parent, the higher the proportion of the contribution of that parent would be towards the support of the children. This is especially important in South Africa where a substantial proportion of those who are obligated to pay maintenance is impecunious. The Canadian law rested on similar principles until 1997 when the federal government promulgated the Federal Child Support Guidelines as an amendment to the Divorce Act. The impact of these Guidelines on the calculation of the parental share of post-divorce child support has been far-reaching. The aim of this note is firstly to examine the meaning of the term “means” within the South African legal system as set out in the common law, the various statutes and as these have been interpreted by the majority of courts over the past century. The second aim is to give a brief overview of the Canadian Guidelines and to compare their current system with the South African scenario. The rationale for choosing this jurisdiction is (i) the fact that in both jurisdictions the courts have the ultimate say over the amount of support paid; and (ii) as the Canadian position before their 1997 amendments was similar to the current South Africa system, it was envisaged that by exploring their reasons for change and evaluating their current system, some useful insights might be gained in solving some problems experienced in the South African maintenance system. The note will conclude with some suggestions for reform in South Africa in light of the Canadian experience.

75 A Snapshot Audit on the Current Practice of Minimal Access Surgery in the UK During COVID-19 Pandemic

Aim COVID-19 is an ongoing global pandemic that poses potential increase in the risk of post-operative complications. Early guidelines placed an embargo on minimal access surgery, aiming to minimise risk to patients and the surgical team through aerolisation of the virus. We aimed to assess the practice of minimal access surgery during the peak of the pandemic and associated surgical outcomes. Method An email link to an online questionnaire was distributed to a variety of surgical specialties via the Royal College of Surgeons COVID group and ALSGBI members. Data collection was carried out over a 4-month period. Data assessed included screening methods, case volume, surgical approach and patient outcomes. Results A total of 118 responses from a variety of surgical specialties were collected over 59 units, ranging in grade from Consultant to SHO/Core Trainee. The volume of minimal access procedures decreased during the pandemic from 94.9% of units to 39.0% (P < 0.001), with a greater percentage opting for an open approach (54.2% vs 39.0%, P < 0.001). Combining screening methods was a favoured approach, and it was frequently used alongside a designated ‘Clean’ theatre. A small proportion of patients suffered from post-operative COVID-19 complications (15.3%), but COVID-19 mortality was low. Conclusions Whilst the risk of COVID-19 infection was not completely abolished perioperatively throughout the pandemic, it appears to be minimised by use of adequate screening with designated clean areas. It would therefore support guidelines advocating continued use of minimal access surgery during peaks of COVID-19 if prudent peri-operative measures are taken.

Singapore Advanced Cardiac Life Support Guidelines 2021

Advanced cardiac life support (ACLS) emphasises the use of advanced airway management and ventilation, circulatory support and the appropriate use of drugs in resuscitation, as well as the identification of reversible causes of cardiac arrest. Extracorporeal cardiopulmonary resuscitation and organ donation, as well as special circumstances including drowning, pulmonary embolism and pregnancy are addressed. Resuscitation does not end with ACLS but must continue in post-resuscitation care. ACLS also covers the recognition and management of unstable pre-arrest tachy- and bradydysrhythmias that may deteriorate further.

Healthcare Simulation Use to Support Guidelines Implementation: An Integrative Review

Introduction: Simulation-based education is a useful teaching and learning strategy that can help to implement guidelines into healthcare settings. Therefore, the purpose of this paper is to collate, synthesize, and analyze the literature focusing on the use of simulation as an educational strategy to support guidelines implementation among healthcare providers (HCPs). Materials and Methods: Integrative literature review using the methodology proposed by Ganong. Results/Discussion: Twenty-three articles were selected, the majority (n=19, 82%) used simulation in practice settings and pre- and post-test measurement (n=16, 69%). All studies that assessed simulation effects highlighted that the use of simulation improved the measured outcomes related to guideline implementation. Simulation-based education can be an effective strategy to support guidelines implementation among HCPs, but aspects such as cost involved, time constraints, training of educators, and the HCPs’ learning needs can affect its applicability. Future research should focus on more transparent reports related to the guidelines for simulation content, virtual learning, costs of simulation, and measurement of the long-term effects of simulation-based education.

Performing newborn life support in advance of neonatal advanced life support course—back to basics?

In this retrospective analysis, the Newborn Life Support (NLS) test scenario performance of participants of the Dutch Neonatal Advanced Life Support (NALS) course was assessed. Characteristics of participants and total amount of failures were collected. Failures were subdivided in (1) errors of omission; (2) errors of commission; and (3) unspecified if data was missing. Pearson’s chi-squared test was used to assess differences between participant groups. In total, 23 out of 86 participants (27%) failed their NLS test scenario. Life support course instructors in general (20/21) passed their test scenario more often compared to other participants (43/65) (p = 0.008). In total 110 fail items were recorded; the most common errors being not assessing heart rate (error of omission) (n = 47) and inadequate performance of airway management (error of commission) (n = 24).Conclusion: A substantial part of NALS participants failed their NLS test scenario. Errors of omission could be reduced by the availability of a checklist/NLS algorithm. Life support course instructors possibly make less errors of commission due to retention of skills by teaching these skills at least twice a year. Therefore, our study suggests that neonatal basic life support skills should be retained by local assurance of training programmes. What is Known:• Retention of skills after life support courses decreases after three months.• Adherence to newborn life support guidelines is suboptimal. What is New:• NLS performance is suboptimal in participants for advanced neonatal life support.• Most common failures are not assessing heart rate and inadequate airway management.