OUTCOMES
How to Stay Nimble in PPE
Could a low-fidelity cardiac resuscitation simulation help prepare teams for COVID-19 ?
It ’ s tough to assess the absolute risk of SARS-CoV-2 transmission during cardiac resuscitation , but the evidence suggests it ’ s wise to consider it an aerosolgenerating procedure – and to take appropriate precautions ( 1 ). But those precautions also risk throwing already chaotic procedures even deeper into confusion . At Children ’ s Hospital Colorado , thanks to a simple measure implemented long before the pandemic , the emergency department ’ s cardiac resuscitation team was able to adapt to the COVID-19 paradigm without missing a beat .
Cardiopulmonary resuscitation , or CPR , is pretty simple in theory : open the airway , chest compressions , rescue breaths . In practice , it ’ s well known that the actual effectiveness of CPR declines almost immediately after training .
It takes practice . A lot of it .
In pediatrics , even in the Emergency Department , practice is hard to get . Pediatric cardiac arrest just doesn ’ t happen that often , and children ’ s rates of return to spontaneous circulation ( or ROSC rates ) trail those of adults by statistically significant margins ( 2 ).
“ In 2016 , we started doing high-frequency , low-fidelity cardiac arrest simulations ( 3 ),” says pediatric emergency medicine specialist Tara Neubrand , MD . “ For the last 30 months , we ’ ve been able to maintain ROSC rates of greater than 97 %.”
LOW-FIDELITY , HIGH RETURNS
It happens four times a week , twice for day shift and twice for night shift . The CPR team assembles around a low-fidelity manikin and a defibrillator and spends five minutes running a simulation of cardiac arrest . They ’ ve done it a thousand times . Which is exactly why it works .
CPR is a low-frequency , high-stress procedure that requires several people working together . Everyone needs to know their role . A quick simulation , actively practiced , means everyone in the room knows exactly where to stand , what to do and how to communicate with each other in advance .
“ This project is really focused on effective team training , and the first step was recruiting a dynamic multidisciplinary team to help
4 | CHILDREN ’ S HOSPITAL COLORADO