Study Objectives: To evaluate effectiveness of teaching emergency advanced cardiopulmonary resuscitation (CPR) to medical providers and staff at a Liberian hospital by assessing comfort level of performing resuscitation and CPR knowledge.Methods: A team of American Heart Association (AHA)-certified medical providers from the United States taught a two-day adult and pediatric advanced cardiopulmonary resuscitation course to staff at a regional hospital in Liberia. The curriculum included lectures and practicing on manikins. Participants provided written consent and completed a survey assessing comfort level of performing resuscitation and CPR knowledge before and after the course. The participants ranked comfort level of performing CPR between 1 to 5, with 5 representing "very comfortable" and knowledge questions were based on AHA CPR guidelines. The primary outcome was assessing the difference in skills, comfort, and knowledge before and after the course.Results: There were 75 participants total and 52 individuals completed both the pre-test and post-test. The median participant age was 34 years old, ranging between 24 to 62 years old. Occupations included technicians (14%), nurses (55%), and physicians (20%). The aggregated median pre-test score was 45% and median post-test score was 82%. Participants had an average 33% increase on the post-test score. Linear regression analysis of post-test scores suggested that pre-test score, sex, prior CPR education, age, and occupation had minimal effects on the post-test scores and none were significant. A paired t-test comparing pre-test and post-test scores predicted a 32% increase in scores (P<.00001). The aggregated median provider comfort level score pre-test was 4 and post-test was 5. Ordered logistic regression analysis demonstrated that prior CPR education, age, sex, occupation, and post-test scores did not have a significant effect on performing CPR comfort level. A Wilcox on rank test showed a significant expected increase in provider comfort level after the curriculum (P<.00001).Conclusion: A significant increase in cardiopulmonary resuscitation knowledge was noted after the two-day curriculum, accounting for possible confounders such as age, sex, pre-test score, prior CPR education, and occupation. A slight, but statistically significant improvement in comfort level of performing CPR was also seen, accounting for age, sex, post-test score, prior CPR education, and occupation. The two-day CPR curriculum was effective and demonstrated a significant improvement in the Liberian medical providers' comfort level in performing CPR as well as their cardiopulmonary resuscitation knowledge base.

Central venous access devices (CVADs) play an essential role in the care of critically ill children. Significant challenges exist for teams in managing CVADs particularly in a community setting. The authors aimed to assess the experience of general practitioners (GPs) caring for children with CVADs. From 200 CVADs inserted in a pediatric hospital in 2009, 50 patients were randomly selected and 44 GPs were forwarded a questionnaire. Twenty (46%) GPs responded. The main reasons (n = 22) for using CVADs were medication administration (n = 11), nutrition (n = 6), and blood sampling (n = 5). Thirteen (65%) GPs had no education in CVAD management and 14 (70%) were unaware of existing guidelines. Those identified by GPs as having primary responsibility for care of CVADs in the community included hospital/pediatric teams (n = 9), parents (n = 3), GPs (n = 2), public health nurses (n = 1), and palliative care ("home care") teams (n = 1). The main challenges (n = 15) identified by GPs were lack of education (n = 4), line management difficulties (n = 3), infection risk (n = 3), infrequent exposure to CVADs (n = 3), and poor communication (n = 1). GPs felt that these challenges could be addressed through: education (n = 8), increased manpower and community support (n = 1), and improved communication (n = 1). This study highlights the inconsistency and challenges for GPs surrounding CVAD use in children. Further education and support is necessary to assist GPs in their use particularly when providing end-of-life care for children in the community.

Perinatal palliative care requires effective multidisciplinary work, whether delivered in the inpatient setting or in the community. With appropriate support, end-of-life care can be delivered in the community.