Exploration of the impact of a voice activated decision support system (VADSS) with video on resuscitation performance by lay rescuers during simulated cardiopulmonary arrest.

AIM: To assess whether access to a voice activated decision support system (VADSS) containing video clips demonstrating resuscitation manoeuvres was associated with increased compliance with American Heart Association Basic Life Support (AHA BLS) guidelines. METHODS: This was a prospective, randomised controlled trial. Subjects with no recent clinical experience were randomised to the VADSS or control group and participated in a 5-min simulated out-of-hospital cardiopulmonary arrest with another 'bystander'. Data on performance for predefined outcome measures based on the AHA BLS guidelines were abstracted from videos and the simulator log. RESULTS: 31 subjects were enrolled (VADSS 16 vs control 15), with no significant differences in baseline characteristics. Study subjects in the VADSS were more likely to direct the bystander to: (1) perform compressions to ventilations at the correct ratio of 30:2 (VADSS 15/16 (94%) vs control 4/15 (27%), p=<0.001) and (2) insist the bystander switch compressor versus ventilator roles after 2 min (VADSS 12/16 (75%) vs control 2/15 (13%), p=0.001). The VADSS group took longer to initiate chest compressions than the control group: VADSS 159.5 (±53) s versus control 78.2 (±20) s, p<0.001. Mean no-flow fractions were very high in both groups: VADSS 72.2% (±0.1) versus control 75.4 (±8.0), p=0.35. CONCLUSIONS: The use of an audio and video assisted decision support system during a simulated out-of-hospital cardiopulmonary arrest prompted lay rescuers to follow cardiopulmonary resuscitation (CPR) guidelines but was also associated with an unacceptable delay to starting chest compressions. Future studies should explore: (1) if video is synergistic to audio prompts, (2) how mobile technologies may be leveraged to spread CPR decision support and (3) usability testing to avoid unintended consequences.

Knowledge of procedural sedation and analgesia of emergency medicine physicians.

OBJECTIVES: Pediatric procedural sedation and analgesia (PSA) is unique. The goals of this study were to examine emergency medicine (EM) physicians' baseline knowledge of general and pediatric PSA compared with that of other nonanesthesiologist physicians and to test effectiveness of a seminar required for credentialing in PSA. METHODS: This was a retrospective, before and after interventional study of participants in a major university teaching hospital's PSA course. Analysis was conducted to determine: (1) performance of EM physicians on questions related to general and pediatric PSA compared with other participating physicians, and (2) effect of seminar on participants' knowledge of PSA. RESULTS: The mean +/- SE PSA pretest score for EM physicians was higher than that of other physicians (63.7% +/- 1.1% vs 50.2% +/- 2.2%, P < 0.001), but not for the pediatric PSA pretest scores (54.8% +/- 1.7% vs 51.0% +/- 1.8%, P = 0.17). The EM practitioners performed worse on the pediatric versus the adult portion of the PSA pretest (55.2% +/- 1.8% vs 66.8% +/- 1.4%, P < 0.001). Practitioners trained in American Heart Association advanced life support classes performed better than the untrained (52.1 +/- 1.4 vs 41.6+/- 2.5, P < 0.001). Total and pediatric PSA test scores improved significantly after educational intervention in all practitioners. CONCLUSIONS: The EM physicians have stronger knowledge about general PSA than other nonanesthesiologist physician participants, but not for pediatric PSA, thus providing a target for future interventions. This course on PSA improved practitioners' knowledge of general and pediatric PSA and can be used as an educational model for PSA training. Further study is needed to determine decay rates for this knowledge and impact on patient care.

Simulated pediatric trauma team management: assessment of an educational intervention.

OBJECTIVES: Trauma is the leading cause of death in children. The quality of initial medical care received by injured children contributes to outcomes. Our objective was to assess effectiveness of an educational intervention on performance of emergency department (ED) teams during simulated pediatric trauma resuscitations. METHODS: A prospective, preinterventional and postinterventional study was performed on a random, convenience sample of 17% of EDs in North Carolina. An unannounced simulated pediatric trauma resuscitation was conducted at each site, followed by an educational intervention and a second visit 6 months later. The key outcome measure was team performance on a clinical assessment tool previously described that included 44 resuscitation tasks deemed critical to appropriate management of pediatric trauma resuscitation. RESULTS: All 18 sites consented and completed the study. Interrater reliability was excellent, weighted kappa = 0.80 (95% confidence interval, 0.76-0.84). After the educational intervention, the mean (+/- SD) number of the 44 tasks passed by each ED team increased from 17.7 +/- 4.3 to 26.6 +/- 5.8 (P < 0.001). At the individual task level, the scores on 37 (84%) of the 44 tasks improved, of which 11 (25%) of the 44 tasks improved significantly. CONCLUSIONS: This study demonstrated that an on-site educational intervention was effective in improving the performance of ED teams during simulated pediatric trauma resuscitations. Postintervention performance was more consistent with the Pediatric Advanced Life Support and Advanced Trauma Life Support guidelines. Further studies are needed to determine if improved performance in a simulated scenario leads to improved performance and better clinical outcomes of critically injured children.