Rapid paediatric fluid resuscitation: a randomised controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques in a simulated setting

Abstract

ObjectivesManual techniques of intravascular fluid administration are commonly used during paediatric resuscitation, although it is unclear which technique is most efficient in the hands of typical healthcare providers. We compared the rate of fluid administration achieved with the disconnect–reconnect and push–pull manual syringe techniques for paediatric fluid resuscitation in a simulated setting.MethodsThis study utilised a randomised crossover trial design and enrolled 16 consenting healthcare provider participants from a Canadian paediatric tertiary care centre. The study was conducted in a non-clinical setting using a model simulating a 15 kg child in decompensated shock. Participants administered 900 mL (60 mL/kg) of normal saline to the simulated patient using each of the two techniques under study. The primary outcome was the rate of fluid administration, as determined by two blinded independent video reviewers. We also collected participant demographic data and evaluated other secondary outcomes including total volume administered, number of catheter dislodgements, number of technical errors, and subjective and objective measures of provider fatigue.ResultsAll 16 participants completed the trial. The mean (SD) rate of fluid administration (mL/s) was greater for the disconnect–reconnect technique at 1.77 (0.145) than it was for the push–pull technique at 1.62 (0.226), with a mean difference of 0.15 (95% CI 0.055 to 0.251; p=0.005). There was no difference in mean volume administered (p=0.778) or participant self-reported fatigue (p=0.736) between techniques. No catheter dislodgement events occurred.ConclusionsThe disconnect–reconnect technique allowed for the fastest rate of fluid administration, suggesting that use of this technique may be preferable in situations requiring rapid resuscitation. These findings may help to inform future iterations of paediatric resuscitation guidelines.Trial registration numberThis trial was registered at ClinicalTrials.gov [NCT01774214] prior to enrolling the first participant.

Fluid resuscitation for toddlers and young children

“…Provider fatigability was also examined in our follow‐up study. Contrary to our hypothesis and to our surprise, fluid administration rate increased with time for both DRT and PPT—likely due to a training or learning effect . Toshniwal et al .…”

“…(iii) DRT facilitates the fastest rate of manual fluid administration, and is optimally performed with either a 30‐ or 60‐ml syringe . (iv) Existing data do not support the contention that healthcare providers experience performance decay while performing manual fluid administration of up to 900 ml, though they may experience subjective fatigue .…”

“…. We have also evaluated healthcare provider manual fluid resuscitation performance, asking providers to administer three boluses of 20 ml·kg −1 in rapid succession . Sixty ml·kg −1 (900 ml for a 15 kg simulated patient) represents an isotonic crystalloid volume frequently administered in the context of pediatric resuscitations.…”

“…In Cole et al . , we then compared the fluid administration speed achievable with DRT vs the push–pull technique (PPT). For PPT, the total fluid administration time is equal to ‘fluid push time’ plus two times triple stopcock ‘toggle time’ (on, then off), plus ‘fluid draw time’ for each cycle.…”

Paediatric trauma resuscitation: an update

“…In a study evaluating the use of simulation and script debriefing, Cheng et al concluded that learning and team leader behavioral performance during simulated cardiopulmonary arrests is improved with the use of standardized script by novice instructors who facilitate team debriefing. Cole at al [ 41 ] performed a randomized controlled trial comparing two provider-endorsed manual paediatric fluid resuscitation techniques in a simulated setting. The authors tested the rate of fluid administration using a model simulating a 5 kg child in decompensated shock.…”