Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills

Abstract

Objective: To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED). Methods and Material: This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded. Results: There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n 5 115, 35%), trauma (n 5 50, 15%), sepsis (n 5 36, 11%), seizures (n 5 37, 11%), and cardiac disease (n 5 22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions. Conclusion: Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed. RÉ SUMÉObjectif: Dé crire la fré quence des manoeuvres de ré animation et le taux de succè s dans un service des urgences pé diatriques (SUP). Ré sultats: Il y a eu 75 133 visites à l'urgence des soins pé diatriques; 304 des 329 visites (92,4 %) ré pondant aux critè res d'inclusion ont é té analysé es. Les diagnostics comprenaient : dé tresse respiratoire (n 5 115, 35 %), traumatismes (n 5 50, 15 %), sepsis (n 5 36, 11 %), convulsions (n 5 37, 11 %), et maladie cardiaque (n 5 22, 7 %). Quatre-vingt-dix-neuf patients ont né cessité une intubation. Les intubations au SUP ont é té ré alisé es par les ré sidents (20 %), les moniteurs cliniques (fellows) en mé decine d'urgence pé diatrique (15 %), les mé decins traitants du SUP (29 %), les moniteurs cliniques à l'USIP (12 %). Le taux de succè s de ces intubations à la premiè re tentative é tait de 81 %. Au SUP, 7 cathé ters centraux et 7 abords veineux intra-osseux ont é té mis en place, des inotropes ont é té administré s à 15 patients et des compressions thoraciques pratiqué es chez 9 patients. Conclusion: Des cas de maladies graves sont rares à notre service d'urgence. Les occasions de pratiquer des manoeuvres de ré animation, d'ouvrir les voies aé riennes et de poser un cathé ter central sont donc limité es. Il faut envisager une formation supplé mentaire, des relations de travail é troites entre les é quipes du SUP et de l'USIP et la mise en place de protocoles de ré animation pour une intervention pré coce de l'USIP.

Rapid Sequence Intubation for Pediatric Emergency Patients: Higher Frequency of Failed Attempts and Adverse Effects Found by Video Review

“…1 To our knowledge, there are few studies that report pediatric-specific data for RSI in an ED, all of which have important limitations. 3,5–9 …”

Frequency and outcomes of endotracheal intubation in the pediatric emergency department

“…This is consistent with previously published data which demonstrated the mean range of ETIs per 1,000 PED patients to be 0.8 to 3.3. 5,10,11 This study is first to report the scope of ETI practice among PEDs in Turkey. The fact that our data is statistically similar to previous studies from other developed and developing countries, which also found low volumes of encounters with critical illness requiring resuscitation interventions in the PED, shows that our experience in a tertiary care PED is not unique.…”

“…That is, most pediatric ETIs are performed due to respiratory failure, cardiopulmonary arrest, seizure and trauma. 10,15,16 Conversely however, Sagarin et al 7 found that the majority of the patients requiring ETI had presented with status epilepticus, followed by trauma. Due to the fact that adult EM in our institute cares for pediatric trauma patients, there were no trauma patients requiring ETI in our study.…”

“…10,20 Because the majority of intubators were pediatric residents and they have limited experience in airway mangament procedures, RSI was generally not performed.…”

An Innovative Nonanimal Simulation Trainer for Chest Tube Insertion in Neonates

“…27 A review of the critical events and procedures in the first 24 hours in 304 pediatric patients who were admitted to the PICU from a tertiary-level Canadian emergency department over 2 years found that 3 patients required intercostal chest drainage. 28 A survey of 117 physicians who treated pediatric patients in 23 general community emergency departments found that more than 25% expressed significant discomfort ("uncomfortable and would perform in an emergency" or "uncomfortable and would never perform") with performing certain potentially lifesaving pediatric procedures, including chest tube placement. The residency training of these physicians included internal medicine, family practice, surgery, general practice, pediatrics, and emergency medicine.…”