First name
Aaron
Middle name
J
Last name
Donoghue

Title

Analysis of CPR quality by individual providers in the pediatric emergency department.

Year of Publication

2020

Number of Pages

37-44

Date Published

2020 08

ISSN Number

1873-1570

Abstract

<p><strong>OBJECTIVES: </strong>To describe chest compression (CC) quality by individual providers in two pediatric emergency departments (EDs) using video review and compression monitor output during pediatric cardiac arrests.</p>

<p><strong>METHODS: </strong>Prospective observational study. Patients &lt;18 yo receiving CC for &gt;1 min were eligible. Data was collected from video review and CC monitor device in a synchronized fashion and reported in 'segments' by individual providers. Univariate comparison by age (&lt;1 yo, 1-8 yo, &gt;8 yo) was performed by chi-square testing for dichotomous variables ('high-quality' CPR) and nonparametric testing for continuous variables (CC rate and depth). Univariate comparison of ventilation rate (V) was made between segments with an advanced airway versus without.</p>

<p><strong>RESULTS: </strong>524 segments had data available; 42/524 (8%) met criteria for 'high-quality CC'. Patients &gt;8 yo had more segments meeting criteria (18% vs. 2% and 0.5%; p &lt; 0.001). Segments compliant for rate were less frequent in &lt;1 yo (17% vs. 24% vs. 27%; p = 0.03). Segments compliant for depth were less frequent in &lt;1 year olds and 1-8 year olds (5% and 9% vs. 20%, p &lt; 0.001.) Mean V for segments with an advanced airway was higher than with a natural airway (24 ± 18 vs. 14 ± 10 bpm, p &lt; 0.001). Hyperventilation was more prevalent in CPR segments with an advanced airway (66% vs. 32%, p &lt; 0.001).</p>

<p><strong>CONCLUSIONS: </strong>CC depth is rarely guideline compliant in infants. Hyperventilation is more prevalent during CPR periods with an advanced airway in place. Measuring individual provider CPR quality is feasible, allowing future studies to evaluate the impact of CPR training.</p>

DOI

10.1016/j.resuscitation.2020.05.026

Alternate Title

Resuscitation

PMID

32505613

Title

Repurposing Video Review Infrastructure for Clinical Resuscitation Care in the Age of COVID-19.

Year of Publication

2020

Date Published

2020 Aug 25

ISSN Number

1097-6760

Abstract

<p>Within the context of the coronavirus disease 2019 (COVID-19) pandemic, minimizing health care worker exposure to the novel coronavirus has become a paramount part of the provision of health care in all settings across the world. Limited supply of personal protective equipment, personnel shortages as a result of exposure, and ensuring the safety and health of workers have all dictated the need to minimize the number of health care workers with direct patient contact. In resuscitation events, there is high likelihood of multiple aerosol-generating procedures and increased risk of viral transmission; therefore, limiting personnel is of particular importance. The development of creative solutions to allow vital team contributions to occur outside of the direct patient care space whenever possible is critical.</p>

DOI

10.1016/j.annemergmed.2020.08.030

Alternate Title

Ann Emerg Med

PMID

33160721

Title

Videography in Pediatric Emergency Research: Establishing a Multicenter Collaborative and Resuscitation Registry.

Year of Publication

2020

Number of Pages

222-228

Date Published

2020 May

ISSN Number

1535-1815

Abstract

<p><strong>OBJECTIVES: </strong>High-quality clinical research of resuscitations in a pediatric emergency department is challenging because of the limitations of traditional methods of data collection (chart review, self-report) and the low frequency of cases in a single center. To facilitate valid and reliable research for resuscitations in the pediatric emergency department, investigators from 3 pediatric centers, each with experience completing successful single-center, video-based studies, formed the Videography In Pediatric Emergency Research (VIPER) collaborative.</p>

<p><strong>METHODS: </strong>Our initial effort was the development of a multicenter, video-based registry and simulation-based testing of the feasibility and reliability of the VIPER registry. Feasibility of data collection was assessed by the frequency of an indeterminate response for all data elements in the registry. Reliability was assessed by the calculation of Cohen κ for dichotomous data elements and intraclass correlation coefficients for continuous data elements.</p>

<p><strong>RESULTS: </strong>Video-based data collection was completed for 8 simulated pediatric resuscitations, with at least 2 reviewers per case. Data were labeled as indeterminate by at least 1 reviewer for 18 (3%) of 524 relevant data fields. The Cohen κ for all dichotomous data fields together was 0.81 (95% confidence interval, 0.61-1.0). For all continuous (time-based) variables combined, the intraclass correlation coefficient was 0.88 (95% confidence interval, 0.70-0.96).</p>

<p><strong>CONCLUSIONS: </strong>Initial simulation-based testing suggests video-based data collection using the VIPER registry is feasible and reliable. Our next step is to assess feasibility and reliability for actual pediatric resuscitations and to complete several prospective, hypothesis-based studies of specific aspects of resuscitative care, including of cardiopulmonary resuscitation, tracheal intubation, and teamwork and communication.</p>

DOI

10.1097/PEC.0000000000001531

Alternate Title

Pediatr Emerg Care

PMID

32356959

Title

Pauses in compressions during pediatric CPR: Opportunities for improving CPR quality.

Year of Publication

2019

Date Published

2019 Aug 14

ISSN Number

1873-1570

Abstract

<p><strong>OBJECTIVE: </strong>Minimizing pauses in chest compressions during cardiopulmonary resuscitation (CPR) is recommended by the American Heart Association (AHA) and is associated with improved patient outcomes. We studied the quality of pediatric CPR performed in a tertiary pediatric emergency department (ED) with a focus on pauses in chest compressions.</p>

<p><strong>METHODS: </strong>We conducted an observational study of CPR quality in two pediatric EDs using video review during pediatric cardiac arrest. Events were reviewed for AHA guideline adherence. Parameters of CPR performance were described according to individual compressor segment. Pauses in compressions were analyzed for duration and pause activities.</p>

<p><strong>RESULTS: </strong>From a 30-month period, 81 cardiac arrests were analyzed, including 1003 individual compressor segments and 900 pauses. Median chest compression fraction was 91%, with a median pause duration of 4 s (IQR 2, 10); 22% of pauses were prolonged (&gt;10 s). Pulse checks occurred in 23% of pauses; 62% were prolonged. Checking a single pulse site (p &lt; 0.001) and having fingers ready pre-pause (p = 0. 001) were associated with significantly shorter pause duration. Pause duration was correlated with the number of pause tasks (r = 0.559, p &lt; 0.001). "Coordinated pauses" (pulse check, rhythm check and compressor change) were rare (6%) and long in duration (19 s; IQR 11, 30).</p>

<p><strong>CONCLUSIONS: </strong>Prolonged pauses in chest compressions occurred frequently during CPR and were associated with pulse checks and multiple simultaneous tasks. Checking a single pulse site with fingers ready on the pulse site pre-pause could decrease pause duration and improve CPR quality.</p>

DOI

10.1016/j.resuscitation.2019.08.015

Alternate Title

Resuscitation

PMID

31421191

Title

Quality improvement and crisis resource management in pediatric resuscitation.

Year of Publication

2019

Date Published

2019 Apr 24

ISSN Number

1531-698X

Abstract

<p><strong>PURPOSE OF REVIEW: </strong>The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change.</p>

<p><strong>RECENT FINDINGS: </strong>Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in resuscitation.</p>

<p><strong>SUMMARY: </strong>Striving toward a learning healthcare system model in resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the resuscitation environment, all providers who could possibly face a resuscitation event - no matter how rare - should consider how they are evaluating the quality of their care delivery in this arena.</p>

DOI

10.1097/MOP.0000000000000772

Alternate Title

Curr. Opin. Pediatr.

PMID

31033607

Title

Quality improvement and crisis resource management in pediatric resuscitation.

Year of Publication

2019

Number of Pages

297-305

Date Published

2019 Jun

ISSN Number

1531-698X

Abstract

PURPOSE OF REVIEW: The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change.

RECENT FINDINGS: Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in resuscitation.

SUMMARY: Striving toward a learning healthcare system model in resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the resuscitation environment, all providers who could possibly face a resuscitation event - no matter how rare - should consider how they are evaluating the quality of their care delivery in this arena.

DOI

10.1097/MOP.0000000000000772

Alternate Title

Curr. Opin. Pediatr.

PMID

31090568

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