Anesthesiology residents' performance of pediatric resuscitation during a simulated hyperkalemic cardiac arrest.
BACKGROUND
Anesthesiologists are responsible for the management of perioperative cardiopulmonary arrest in children. This study used simulation to assess the pediatric resuscitation skills of experienced anesthesia residents.


METHODS
Nineteen anesthesia residents were evaluated using a pediatric pulseless electrical activity scenario. The authors used a standardized checklist to evaluate the residents' diagnostic and therapeutic interventions.


RESULTS
After the onset of pulseless electrical activity, 79% of residents initiated cardiopulmonary resuscitation within 1 min. Approximately one third (31%) performed chest compressions at the recommended rate. Epinephrine was administered by 95% of residents, but only one third used the correct pediatric dose. All residents administered fluid boluses, but only 16% administered the recommended volume. Only one fourth of the residents considered hyperkalemia as a cause of pulseless electrical activity. None of the residents asked for dosing aids.


CONCLUSIONS
During this simulated pediatric emergency, anesthesia residents demonstrated an acceptable knowledge of general resuscitation maneuvers. However, a subset of resuscitation skills was incorrectly performed, mostly related to age or weight. Importantly, many residents did not consider the full differential diagnosis of pulseless electrical activity. Anesthesia residents may benefit from additional pediatric resuscitation training and practice using cognitive aids to access dosages and complicated diagnostic algorithms.
Howard-Quijano
Kimberly J
KJ
Department of Anesthesiology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California 90095-7403, USA.
Stiegler
Marjorie A
MA
Huang
Yue Ming
YM
Canales
Cecilia
C
Steadman
Randolph H
RH
D000776:Anesthesiology / Q000193:education*; D016887:Cardiopulmonary Resuscitation; D057189:Checklist; D002648:Child; D002983:Clinical Competence; D004569:Electroencephalography; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D006947:Hyperkalemia / Q000150:complications*; D007223:Infant; D007396:Internship and Residency; D008297:Male; D016544:Patient Simulation; D012151:Resuscitation; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D004837:Epinephrine