The Impact of Mock Code Simulation on the Resuscitation Practice and Patient Outcome for Children With Cardiopulmonary Arrest

Abstract

Background Cardiopulmonary arrest is an uncommon event in pediatric patients. Additionally, physicians-in-training see far fewer cardiopulmonary arrest events. Therefore, they have limited confidence in their resuscitation skills. Mock code training with active participation and debriefing may be an effective tool to fill this gap in experience. The aims of the study were to assess the impact of a mock code simulation program on patient outcome for children with cardiopulmonary arrest in a tertiary pediatric academic center and provide evidence that code simulations can improve the quality of cardiopulmonary resuscitation (CPR). Methods This was a retrospective cohort study conducted in a tertiary academic center. This study had two phases: Phase 1 before the mock code simulation program began (pre-intervention) and Phase 2 after the mock code program began (post-intervention). The data were collected from pediatric patients with cardiopulmonary arrest during the study period who met the inclusion criteria, and variables included the survival rate at hospital discharge, CPR initiation time, time to the first dose of epinephrine, and the adherence rate to American Heart Association (AHA) guidelines. Results A total of 13 patients in the pre-intervention period and 19 patients in the post-intervention period were included. The results showed a significant improvement in team performance represented by a decrease in CPR initiation time post-intervention and improvement in AHA adherence; however, the results did not show a significant difference in the survival rate or mortality within 28 days of the cardiopulmonary arrest event between the pre- and post-intervention groups. Conclusions Mock code simulation was a helpful tool to enhance team performance and improve the quality of cardiac resuscitation and cardiac arrest recognition, while its impact on the survival rate was not significant in our study.

Educational and Patient Care Impacts of In Situ Simulation in Healthcare

“…Eight of the 24 studies assessed patient mortality. 22,24,26,30,31,36,37,42 Meta-analysis of these studies revealed a small but statistically significant association between the use of in situ simulation and reduced risk of death (OR, 0.66; 95% CI, 0.55 to 0.78), although individual studies were heterogeneous in terms of quality and the specific implementation of in situ simulation used. Figure 2 displays the results of this metaanalysis.…”

“…Nine of the 24 studies assessed metrics of clinical care such as time to initiate cardiopulmonary resuscitation, frequency of use of key clinical interventions, and scores on clinical quality checklists. 22,24,26,[28][29][30]33,34,37,39,42 Meta-analysis of these results showed a small but statistically significant pooled standardized mean difference (SMD) of −0.34 (95% CI, −0.45…”

Society for Simulation in Healthcare Guidelines for Simulation Training

“…Summary of the evidence: Nineteen studies [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] addressed a range of in situ simulation outcomes, including mortality, clinical metrics of patient care delivery, nontechnical skill levels as measured during actual patient care, latent safety threat mitigation, and diagnostic decision-making. Clinical areas addressed included neonatal resuscitation, pediatric and adult resuscitation, obstetric care, outpatient care, stroke care, and trauma.…”

Pharmacist perceptions of CliftonStrengths ® themes important for success in advanced cardiovascular life support

“…The optimal mode of ACLS training, however, is unclear. Didactic lectures, simulation using low‐ or high‐fidelity mannequins and formal American Heart Association (AHA) ACLS certification have been used by different health professions 2‐4 …”