Delays and errors in cardiopulmonary resuscitation and defibrillation by pediatric residents during simulated cardiopulmonary arrests.
BACKGROUND
The quality of life support delivered during cardiopulmonary resuscitation affects outcomes. However, little data exist regarding the quality of resuscitation delivered to children and factors associated with adherence to American Heart Association (AHA) resuscitation guidelines.


METHODS
Pediatric residents from an academic, tertiary care hospital.


METHODS
Prospective, observational cohort study of residents trained in the AHA PALS 2000 guidelines managing a high-fidelity mannequin simulator programmed to develop pulseless ventricular tachycardia (PVT).


METHODS
Proportion of residents who: (1) started compressions in < or =1min from onset of PVT, (2) defibrillated in < or =3min and (3) factors associated with time to defibrillation.


RESULTS
Seventy of eighty (88%) residents participated. Forty-six of seventy (66%) failed to start compressions within 1min of pulselessness and 23/70 (33%) never started compressions. Only 38/70 (54%) residents defibrillated the mannequin in < or =3min of onset of PVT. There was no significant difference in time elapsed between onset of PVT and defibrillation by level of post-graduate training. However, residents who had previously discharged a defibrillator on either a patient or a simulator compared to those who had not were 87% more likely to successfully defibrillate the mannequin at any point in time (hazard ratio 1.87, 95% CI: 1.08-3.21, p=0.02).


CONCLUSIONS
Pediatric residents do not meet performance standards set by the AHA. Future curricula should focus training on identified defects including: (1) equal emphasis on "airway and breathing" and "circulation" and (2) hands-on training with using and discharging a defibrillator in order to improve safety and outcomes.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States. ehunt@jhmi.edu
Elizabeth A
EA
Hunt
Kimberly
K
Vera
Marie
M
Diener-West
Jamie A
JA
Haggerty
Kristen L
KL
Nelson
Donald H
DH
Shaffner
Peter J
PJ
Pronovost
D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002648:Child; D002983:Clinical Competence; D015331:Cohort Studies; D004554:Electric Countershock; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D019300:Medical Errors; D020380:Needs Assessment; D010372:Pediatrics / Q000193:education*; D017410:Practice Guidelines as Topic