First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study

Abstract

Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3–4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants’ neurologic affiliation was associated with performance of fewer checks (regression coefficient −0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.

Treatment Guideline Nonadherence Pretransport Associated With Need for Higher Level of Care in Children Transferred to a Pediatric Tertiary Care Center for Status Epilepticus

“…23 Current efforts at our center include the development of pocket-sized cards, educational outreach, and seizure simulation activities, in collaboration with our most frequent referring hospitals. [16][17][18]24 Given the retrospective and single-center design, our study has several limitations. First, although we attempted to obtain as complete and accurate data as possible by reviewing outside hospital records, transport records, and receiving hospital EMR, there were still 21 patients with insufficient data to assign guideline compliance.…”

“…Previous work has found that medical teams who had a pocket-sized seizure emergency card had shorter times to first benzodiazepine dose although with similar rates of adequate dosing 23 . Current efforts at our center include the development of pocket-sized cards, educational outreach, and seizure simulation activities, in collaboration with our most frequent referring hospitals 16–18,24 …”

Treatment of status epilepticus in pediatrics: curriculum learning combined with in-situ simulations

“…For example, Yara et al showed that the SBML course significantly improved residents’ SE identification and management skills and that these skills were largely retained and transferred to the hospital setting [ 18 ]. In the study by Paulina et al, physicians were found to treat the sequence and frequency of simulated SE according to the systemic airway-breath-circulation-disability-exposure (ABCDE) approach to better protect the airway in a prospective high-fidelity simulation study [ 32 ]. In addition, in-situ simulations have been successfully used for communication skills in end-of-life discussions.…”

Physicians’ Knowledge of the Systematic ABCDE Approach in Riyadh, Saudi Arabia

“…4 Furthermore, in a previous study by Kliem et al, it was noted that ABCDE approach compliance was not frequent in a simulated status epileptic, but, if followed, it resulted in more frequent airway protection and adherence to treatment steps. 5 Likewise, in previous studies conducted by Mohamed et al, in 2018 concerning the adherence to the ABCDE approach in evaluating critically ill patients, it was found that there was a suboptimal level of adherence to the ABCDE approach. 6 Moreover, as found by Linders et al, in their study, some factors may affect the application of the ABCDE approach as well as impede the reliance of healthcare workers on ABCDE; this include guidelines themselves, professional considerations, patient factors, team factors, incentives and also resources.…”