TY - JOUR
T1 - Causes for pauses during simulated pediatric cardiac arrest
AU - Kessler, David Oren
AU - Peterson, Dawn Taylor
AU - Bragg, Alexis
AU - Lin, Yiqun
AU - Zhong, John
AU - Duff, Jonathan
AU - Adler, Mark
AU - Brown, Linda
AU - Bhanji, Farhan
AU - Davidson, Jennifer
AU - Grant, David
AU - Cheng, Adam
AU - for the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE) CPR Investigators
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Objectives: Pauses in cardiopulmonary resuscitation negatively impact clinical outcomes; however, little is known about the contributing factors. The objective of this study is to determine the frequency, duration, and causes for pauses during cardiac arrest. Design: This is a secondary analysis of video data collected from a prospective multicenter trial. Twenty-six simulated pediatric cardiac arrest scenarios each lasting 12 minutes in duration were analyzed by two independent reviewers to document events surrounding each pause in chest compressions. Setting: Ten children's hospitals across Canada, the United, and the United Kingdom. Subjects: Resuscitation teams composed of three healthcare providers trained in cardiopulmonary resuscitation. Interventions: A simulated pediatric cardiac arrest case in a 5 year old. Measurements and Main Results: The frequency, duration, and associated factors for each pause were recorded. Communication was rated using a four-point scale reflecting the team's shared mental model. Two hundred fifty-six pauses were reviewed with a median of 10 pauses per scenario (interquartile range, 7-12). Median pause duration was 5 seconds (interquartile range, 2-9 s), with 91% chest compression fraction per scenario (interquartile range, 88-94%). Only one task occurred during most pauses (66%). The most common tasks were a change of chest compressors (25%), performing pulse check (24%), and performing rhythm check (15%). Forty-nine (19%) of the pauses lasted greater than 10 seconds and were associated with shock delivery (p < 0.001), performing rhythm check (p < 0.001), and performing pulse check (p < 0.001). When a shared mental model was rated high, pauses were significantly shorter (mean difference, 4.2 s; 95% CI, 1.6-6.8 s; p = 0.002). Conclusions: Pauses in cardiopulmonary resuscitation occurred frequently during simulated pediatric cardiac arrest, with variable duration and underlying causes. A large percentage of pauses were greater than 10 seconds and occurred more frequently than the recommended 2-minute interval. Future efforts should focus on improving team coordination to minimize pause frequency and duration.
AB - Objectives: Pauses in cardiopulmonary resuscitation negatively impact clinical outcomes; however, little is known about the contributing factors. The objective of this study is to determine the frequency, duration, and causes for pauses during cardiac arrest. Design: This is a secondary analysis of video data collected from a prospective multicenter trial. Twenty-six simulated pediatric cardiac arrest scenarios each lasting 12 minutes in duration were analyzed by two independent reviewers to document events surrounding each pause in chest compressions. Setting: Ten children's hospitals across Canada, the United, and the United Kingdom. Subjects: Resuscitation teams composed of three healthcare providers trained in cardiopulmonary resuscitation. Interventions: A simulated pediatric cardiac arrest case in a 5 year old. Measurements and Main Results: The frequency, duration, and associated factors for each pause were recorded. Communication was rated using a four-point scale reflecting the team's shared mental model. Two hundred fifty-six pauses were reviewed with a median of 10 pauses per scenario (interquartile range, 7-12). Median pause duration was 5 seconds (interquartile range, 2-9 s), with 91% chest compression fraction per scenario (interquartile range, 88-94%). Only one task occurred during most pauses (66%). The most common tasks were a change of chest compressors (25%), performing pulse check (24%), and performing rhythm check (15%). Forty-nine (19%) of the pauses lasted greater than 10 seconds and were associated with shock delivery (p < 0.001), performing rhythm check (p < 0.001), and performing pulse check (p < 0.001). When a shared mental model was rated high, pauses were significantly shorter (mean difference, 4.2 s; 95% CI, 1.6-6.8 s; p = 0.002). Conclusions: Pauses in cardiopulmonary resuscitation occurred frequently during simulated pediatric cardiac arrest, with variable duration and underlying causes. A large percentage of pauses were greater than 10 seconds and occurred more frequently than the recommended 2-minute interval. Future efforts should focus on improving team coordination to minimize pause frequency and duration.
KW - Cardiopulmonary resuscitation
KW - Communication
KW - Crew resource management
KW - Heart arrest
KW - Simulation
UR - http://www.scopus.com/inward/record.url?scp=85020681604&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85020681604&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001218
DO - 10.1097/PCC.0000000000001218
M3 - Article
C2 - 28598948
AN - SCOPUS:85020681604
SN - 1529-7535
VL - 18
SP - e311-e317
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 8
ER -