Background and importance 

Pediatric cardiac arrest is a rare emergency with associated high mortality. Its management is challenging and deviations from guidelines can affect clinical outcomes.

Objectives 

To evaluate the adherence to guideline recommendations in the management of a pediatric cardiac arrest scenario by teams of pediatric residents. Secondarily, the association between the use of the Pediatric Advanced Life Support-2015 (PALS-2015) pocket card, and the teams’ adherence to international guidelines, were explored.

Design, settings and participants 

Multicentre observational simulation-based study at three Italian University Hospitals in 2018, including PALS-2015 certified pediatric residents in their 3rd–5th year of residency program, divided in teams of three.

Intervention or exposure 

Each team conducted a standard nonshockable pediatric cardiac arrest scenario and independently decided whether to use the PALS-2015 pocket card.

Outcome measure and analysis 

The primary outcome was the overall number and frequency of individual deviations from the PALS-2015 guidelines, measured by the novel c-DEV15plus score (range 0–15). Secondarily, the performance on the validated Clinical Performance Tool for asystole scenarios, the time to perform resuscitation tasks and cardiopulmonary resuscitation (CPR) quality metrics were compared between the teams that used and did not use the PALS-2015 pocket card.

Main results 

Twenty-seven teams (81 residents) were included. Overall, the median number of deviations per scenario was 7 out of 15 [interquartile range (IQR), 6–8]. The most frequent deviations were delays in positioning of a CPR board (92.6%), calling for adrenaline (92.6%), calling for help (88.9%) and incorrect/delayed administration of adrenaline (88.9%). The median Clinical Performance Tool score was 9 out of 13 (IQR, 7–10). The comparison between teams that used (n = 13) and did not use (n = 14) the PALS-2015 pocket card showed only significantly higher Clinical Performance Tool scores in the former group [9 (IQR 9–10) vs. 7 (IQR 6–8); P = 0.002].

Conclusions 

Deviations from guidelines, although measured by means of a nonvalidated tool, were frequent in the management of a pediatric cardiac arrest scenario by pediatric residents. The use of the PALS-2015 pocket card was associated with better Clinical Performance Tool scores but was not associated with less deviations or shorter times to resuscitation tasks.

中文翻译：

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遵守儿童心脏骤停治疗中的指南建议：一项基于多中心观察模拟的研究

背景和重要性

小儿心脏骤停是一种罕见的紧急情况，死亡率很高。其管理具有挑战性，偏离指南可能会影响临床结果。

 目标

评估儿科住院医师团队在处理儿科心脏骤停情况时对指南建议的遵守情况。其次，探讨了儿科高级生命支持 2015 (PALS-2015) 袖珍卡的使用与团队遵守国际准则之间的关联。

设计、设置和参与者

2018 年，在三所意大利大学医院进行了基于多中心观察模拟的研究，其中包括经过 PALS-2015 认证的儿科住院医师，他们进行了第三至第五年的住院医师计划，分为三人一组。

 干预或暴露

每个团队都进行了标准的不可电击儿童心脏骤停场景，并独立决定是否使用 PALS-2015 袖珍卡。

结果测量和分析

主要结果是个体偏离 PALS-2015 指南的总数和频率，通过新颖的 c-DEV15plus 评分（范围 0-15）进行测量。其次，比较了使用和未使用 PALS-2015 袖珍卡的团队在经验证的临床表现工具上针对心搏停止场景的表现、执行复苏任务的时间和心肺复苏 (CPR) 质量指标。

 主要结果

包括 27 个团队（81 名居民）。总体而言，每种情景的偏差中位数为 15 个中的 7 个[四分位距 (IQR)，6-8]。最常见的偏差是心肺复苏板定位延迟（92.6%）、呼唤肾上腺素（92.6%）、呼救（88.9%）以及不正确/延迟给予肾上腺素（88.9%）。临床表现工具评分中位数为 9 分（满分 13 分）（IQR，7-10）。使用 ( n = 13) 和未使用 ( n = 14) PALS-2015 袖珍卡的团队之间的比较显示，仅前一组的临床表现工具得分显着更高 [9 (IQR 9–10) 与 7 (IQR 9-10) IQR 6–8)； P = 0.002]。

 结论

尽管通过未经验证的工具进行测量，但在儿科住院医生处理儿科心脏骤停情况时，与指南的偏差仍然很常见。 PALS-2015 袖珍卡的使用与更好的临床表现工具分数相关，但与更少的偏差或更短的复苏任务时间无关。