Dissertation/Thesis Abstract

An evaluation of the quality of resuscitation delivered during simulated pediatric in-hospital cardiopulmonary arrests
by Hunt, Elizabeth A., Ph.D., The Johns Hopkins University, 2008, 128; 3309820
Abstract (Summary)

Recent data suggest the quality of resuscitation delivered to adults during in-hospital cardiopulmonary arrests (CPA) is low and contributes to poor outcomes, but little data regarding pediatric events exists. This thesis characterizes the quality of resuscitation delivered during simulated CPAs and the resuscitation experiences of pediatric residents.

The objectives of the first manuscript were to measure the median elapsed time to initiate important resuscitation maneuvers by multidisciplinary teams during simulated pediatric medical emergencies (i.e. “mock codes”). We conducted a prospective, observational study of 34 consecutive, hospital based mock codes. We found mistakes are ubiquitous and include problems with adherence to AHA guidelines for Pediatric Basic and Advanced Life Support, communication and leadership.

In the second manuscript our objectives were to characterize the resuscitation training and experience of residents. We conducted a cross-sectional survey and discovered that despite program requirements, 8% of pediatric residents had never had training in cardiopulmonary resuscitation. Despite the perception that residents are rarely exposed to actual pediatric CPAs, 75% of our third year residents had attended ≥ 12 and as many as 20 CPAs. The only variable independently associated with having actually discharged a defibrillator on either a human or a mannequin was exposure to a new institutional code team-training curriculum.

In the third manuscript our objectives were to measure the proportion of residents who complied with AHA guidelines for management of pulseless ventricular tachycardia during a prospective, observational study of pediatric residents leading simulated CPAs. Unfortunately, we observed no clear improvements with increased level of training. The only variable independently associated with time to defibrillation was previous experience with discharging a defibrillator on a human and/or a mannequin.

Almost every pediatric resident will be involved in attempting to resuscitate a child suffering a CPA, yet many are inadequately trained to respond. Future interventions should focus on improving the quality of care delivered during the first 5 minutes of in-hospital resuscitation in order to optimize outcomes. Formal mechanisms are needed to guarantee adequate resuscitation training for pediatric residents, especially the delivery of high quality basic life support and hands-on experience with discharging the defibrillator.

Indexing (document details)
Advisor: Furth, Susan
School: The Johns Hopkins University
School Location: United States -- Maryland
Source: DAI-B 69/04, Dissertation Abstracts International
Subjects: Health education, Public health, Epidemiology
Keywords: Cardiopulmonary arrests, Cardiopulmonary resuscitation, Pediatrics, Resuscitation
Publication Number: 3309820
ISBN: 978-0-549-57824-6
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