Hands-On Defibrillation Skills of Pediatric Acute Care Providers During a Simulated Ventricular Fibrillation Cardiac Arrest Scenario

Abstract

Introduction: Timely defibrillation in ventricular fibrillation cardiac arrest (VFCA) is associated with good outcome. While defibrillation skills of pediatric providers have been reported to be poor, the factors related to poor hands-on defibrillation skills of pediatric providers are largely unknown. The aim of our study was to evaluate delay in individual steps of the defibrillation and human and non-human factors associated with poor hands-on defibrillation skills among pediatric acute care providers during a simulated VFCA scenario.Methods: We conducted a prospective observational study of video evaluation of hands-on defibrillation skills of pediatric providers in a simulated VFCA in our children's hospital. Each provider was asked to use pads followed by paddles to provide 2 J/kg shock to an infant mannequin in VFCA. The hands-on skills were evaluated for struggle with any step of defibrillation, defined a priori as >10 s delay with particular step. The data was analyzed using chi-square test with significant p-value < 0.05.Results: A total of 68 acute care providers were evaluated. Median time to first shock was 97 s (IQR: 60–122.5 s) and did not correlate with provider factors, except previous experience with the defibrillator used in study. The number of providers who struggled (>10 s delay) with each of connecting the pads/paddles to the device, using pads/paddles on the mannequin and using buttons on the machine was 34 (50%), 26 (38%), and 31 (46%), respectively.Conclusions: The defibrillation skills of providers in a tertiary care children's hospital are poor. Both human and machine-related factors are associated with delay in defibrillation. Prior use of the study defibrillator is associated with a significantly shorter time-to-first shock as compared to prior use of any other defibrillator or no prior use of any defibrillator.

The skills of defibrillation practice and certified life‐support training in the healthcare providers in Turkey

“…To our knowledge, there are scarce data in the literature that evaluates the skills and the theoretical knowledge on the practice of defibrillators. 11 Most of the studies focus on CPR capability. [12][13][14] The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) with respect to two domains (recognising rhythm abnormalities and the use of defibrillator devices) and (b) evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency care and intensive care settings of Turkey.…”

Impact of blended learning on manual defibrillator's use: A simulation‐based randomized trial

“…As the former is uncommon in paediatric care for a single health care provider, it is well recognized that resuscitation skills are often suboptimal with retention decays over time, despite conventional educational programmes. 2,21 An alternative educational strategy is to prefer BL. 14,22,23 By allowing time for self-directed acquisition of theoretical knowledge during e-learning sessions, 14,24 BL allows more time for practical activities during FFL classroom training sessions, such as instructor-led CPR hands-on skills.…”

“…This is typically accomplished by exposure to real‐life resuscitations requiring electrical therapies and educational courses. As the former is uncommon in paediatric care for a single health care provider, it is well recognized that resuscitation skills are often suboptimal with retention decays over time, despite conventional educational programmes 2,21 …”

“…As the former is uncommon in paediatric care for a single health care provider, it is well recognized that resuscitation skills are often suboptimal with retention decays over time, despite conventional educational programmes. 2 , 21 …”

“…Despite the low frequency of these events, doctors and nurses working in PED and paediatric intensive care units (PICUs) should be prepared to manage them without delay as they may rapidly lead to cardiopulmonary compromise and cardiac arrest when left unrecognized or untreated. In addition, arrhythmias like pulseless ventricular tachycardia or ventricular fibrillation, accounting for 27% of paediatric arrhythmia‐related in‐hospital cardiac arrests 2 and 7.8% of out‐of‐hospital, 3 require immediate defibrillation.…”