Management of Paediatric Cardiac Arrest due to Shockable Rhythm : A Simulation-Based Study at Children’s Hospitals in a German Federal State
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Philipps-Universität Marburg
Abstract
(1) Background: To improve the quality of emergency care for children, the Hessian Ministry
for Social Affairs and Integration offered paediatric simulation-based training (SBT) for all children’s
hospitals in Hesse. We investigated the quality of paediatric life support (PLS) in simulated paediatric
resuscitations before and after SBT. (2) Methods: In 2017, a standardised, high-fidelity, two-day
in-house SBT was conducted in 11 children’s hospitals. Before and after SBT, interprofessional
teams participated in two study scenarios (PRE and POST) that followed the same clinical course
of apnoea and cardiac arrest with a shockable rhythm. The quality of PLS was assessed using a
performance evaluation checklist. (3) Results: 179 nurses and physicians participated, forming
47 PRE and 46 POST interprofessional teams. Ventilation was always initiated. Before SBT, chest
compressions (CC) were initiated by 87%, and defibrillation by 60% of teams. After SBT, all teams
initiated CC (p = 0.012), and 80% defibrillated the patient (p = 0.028). The time to initiate CC decreased
significantly (PRE 123 ± 11 s, POST 76 ± 85 s, p = 0.030). (4) Conclusions: The quality of PLS in
simulated paediatric cardiac arrests with shockable rhythm was poor in Hessian children’s hospitals
and improved significantly after SBT. To improve children’s outcomes, SBT should be mandatory for
paediatric staff and concentrate on the management of shockable rhythms.