Influence of Cardiopulmonary Resuscitation Coaching on Interruptions in Chest Compressions During Simulated Pediatric Cardiac Arrest

Cardiopulmonary resuscitation coaching for resuscitation teams: A systematic review

Aim

Cardiopulmonary resuscitation (CPR) quality is often substandard to guidelines for resuscitation teams. We aimed to investigate if the use of a CPR coach as part of the resuscitation team can improve teamwork, quality of care, and patient outcomes during simulated and clinical cardiac arrest resuscitation.

Methods

We searched PubMed, Embase, and Cochrane from inception until October 9, 2024 for randomized trials and observational studies. We assessed risk of bias using Cochrane tools and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. PROSPERO CRD42024603212.

Results

We screened 505 records and included 7 studies. Overall, 6 were randomized studies involving pediatric resuscitation of which 4 studies were secondary analyses of one simulation-based trial, and one was an observational study on adult out-of-hospital cardiac arrest. Reported outcomes were: CPR performance in a simulated setting (n = 3), workload in a simulated setting (n = 2), adherence to guidelines in a simulated setting (n = 1), team communication in a simulated setting (n = 1), and clinical CPR performance (n = 1). All studies suggested improved CPR quality and guideline adherence when using a CPR coach compared to not using a coach. Risk of bias varied from low to critical and the certainty of evidence across outcomes was low or very low.

Conclusions

We identified low- to very-low certainty of evidence supporting the use of a CPR coach as part of the resuscitation team in order to improve CPR quality and guideline adherence. However, further research is needed, in particular for clinical performance and patient outcomes.

Impact of a Quality Cardiopulmonary Resuscitation Coach on Pediatric Intensive Care Unit Resuscitation Teams

BACKGROUND

The quality cardiopulmonary resuscitation (CPR) coach role was developed for hospital-based resuscitation teams. This supplementary team member (CPR coach) provides real-time, verbal feedback on chest compression quality to compressors during a cardiac arrest.

OBJECTIVES

To evaluate the impact of a quality CPR coach training intervention on resuscitation teams, including presence of coaches on teams and physiologic metrics of quality CPR delivery in real compression events.

METHODS

The quality CPR coach curriculum and role implementation were designed and evaluated using a logic model framework. Medical records of patients who had in-unit cardiopulmonary arrests were reviewed retrospectively. Data included physiologic metrics of quality CPR delivery. Analysis included descriptive statistics and comparison of arrest data before and after the intervention.

RESULTS

A total of 79 cardiopulmonary arrests were analyzed: 40 before and 39 after the intervention. Presence of a quality CPR coach on resuscitation teams was more frequent after training, increasing from 35% before the intervention to 72% after (P = .002). No significant difference was found in the frequency of application of Zoll defibrillator pads. Metrics of quality CPR delivery and adherence with American Heart Association recommendations were either unchanged or improved after the intervention.

CONCLUSIONS

The quality CPR coach training intervention significantly increased coach presence on code teams, which was associated with clinically significant improvements in some metrics of quality CPR delivery in real cardiopulmonary arrests.

Chest compression quality and patient outcomes with the use of a CPR feedback device: A retrospective study

Feedback devices were developed to guide resuscitations as targets recommended by various guidelines are difficult to achieve. Yet, there is limited evidence to support their use for in-hospital cardiac arrests (IHCA), and they did not correlate with patient outcomes. Therefore, this study has investigated the compression quality and patient outcomes in IHCA with the use of a feedback device via a retrospective study of inpatient code blue activations in a Singapore hospital over one year. The primary outcome was compression quality and secondary outcomes were survival, downtime and neurological status. 64 of 110 (58.2%) cases were included. Most resuscitations (71.9%) met the recommended chest compression fraction (CCF, defined as the proportion of time spent on compressions during resuscitation) despite overall quality being suboptimal. Greater survival to discharge and better neurological status in resuscitated patients respectively correlated with higher median CCF (p = 0.040 and 0.026 respectively) and shorter downtime (p < 0.001 and 0.001 respectively); independently, a higher CCF correlated with a shorter downtime (p = 0.014). Overall, this study demonstrated that reducing interruptions is crucial for good outcomes in IHCA. However, compression quality remained suboptimal despite feedback device implementation, possibly requiring further simulation training and coaching. Future multicentre studies incorporating these measures should be explored.

A recorder/time coach decreases time errors during neonatal resuscitation: A randomized, simulation-based clinical trial

Aim

To evaluate the effects of a hands-off recorder/time coach versus an additional hands-on healthcare provider on Neonatal Resuscitation Program (NRP) algorithm compliance and team member workload in neonatal resuscitations.

Methods

Two interventions were studied using a 2 × 2 factorial design: an additional hands-on team member and the presence of a designated, hands-off recorder/time coach. The recorder/time coach documented interventions and delivered pre-specified prompts at defined points during the resuscitation. The primary outcome was cumulative time error. Secondary outcomes were time to first dose of IV epinephrine, overall team performance as assessed by the Neonatal Resuscitation Performance Evaluation (NRPE) score, and workload assessed by the NASA Task Load Index (NASA TLX).

Results

64 teams were studied. Teams with a recorder had a significantly lower cumulative time error compared to teams without a recorder (p < 0.001). An additional hands-on team member did not change cumulative time error. There was no difference in time to first dose of IV epinephrine or NRPE score in these comparisons. Ad-hoc analysis did reveal a significant increase in time to IV epinephrine in teams with the minimum of four total members (p = 0.025). A recorder/time coach increased team leader NASA TLX overall workload score (p = 0.047), but an additional hands-on team member did not.

Conclusion

A designated, hands-off recorder/time coach improved compliance by decreasing cumulative time error in teams performing complex simulated neonatal resuscitations.

A randomized crossover comparison of the bébé VieScope and direct laryngoscope for pediatric airway management by nurses in medical simulation settings

BACKGROUND

Airway management in life-threatening emergencies is essential for children, and endotracheal intubation is the gold standard. It protects against regurgitation and enables mechanical ventilation. New types of airway management equipment are being developed and implemented to meet the needs of medical personnel.

RESEARCH DESIGN AND METHODS

This prospective, randomized, cross-over simulation trial evaluated the success of endotracheal intubation in three scenarios: normal airway (scenario-A), tongue edema (scenario-B), and continuous chest compression (scenario-C), using the bébé Vie Scope™ laryngoscope (VieScope) and the Macintosh blade laryngoscope (MAC) as a comparative tool performed by nurses with limited tracheal intubation experience.

RESULTS

The results of the study showed that in scenario-A, there were no significant differences in the first attempt success rate or endotracheal intubation time between VieScope and MAC. However, VieScope was associated with better visualization of the glottis. In scenarios B and C, VieScope was significantly more effective than MAC in terms of first-pass success rate, time to intubate, Cormack-Lehane grade, POGO score, and ease of endotracheal intubation.

CONCLUSIONS

Bébé VieScope may be useful for endotracheal intubation in pediatric patients, particularly in cases of tongue edema and ongoing chest compression, providing a higher first-pass success rate than conventional laryngoscopes.

Telecoaching Improves Positive Pressure Ventilation Performance During Simulated Neonatal Resuscitations

INTRODUCTION

Positive pressure ventilation (PPV) is a critical skill for neonatal resuscitation. We hypothesized that telecoaching would improve PPV performance in neonatal providers during simulated neonatal resuscitations.

SETTING

Level IV neonatal intensive care unit (NICU).

METHODS

This prospective crossover study included 14 experienced NICU nurses and respiratory therapists who performed PPV on a mannequin that recorded parameters of ventilation efficiency. Participants were randomized to practice independently (control) or with live feedback from a remote facilitator through audiovisual connection (intervention) and then switched to the opposite group. Participants' mask leak percentage, ventilation rates, and pressure delivery were analyzed.

RESULTS

The primary outcome of mask leak percentage was significantly increased in the telecoaching group (19% [interquartile range {IQR} 14-59.25] vs. 100% [IQR 88-100] leak, p = 0.0001). The secondary outcome of peak inspiratory pressure (PIP) delivery was also increased (median 27.6 [IQR 23.5-34.7] vs. 23.3 [IQR 19.1-32.8] cmH₂O, p < 0.001). Differences in ventilation rates were not statistically significant (55 vs. 58 breaths/min, p = 0.51).

CONCLUSION

Participants demonstrated better PPV performance during telecoaching with less mask leak. The intervention group also had higher measured peak inspiratory pressures. Telecoaching may be a feasible method to provide real-time feedback to health care providers during simulated neonatal resuscitations.

HYPOTHESIS

Neonatal providers who receive telecoaching during simulated resuscitations will perform PPV more effectively than those who do not receive telecoaching.