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      The Impact of Mock Code Simulation on the Resuscitation Practice and Patient Outcome for Children With Cardiopulmonary Arrest

      research-article
      Author(s): 1 , 2 , , 3 , 4 , 5 , 6 , 7
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: simulation, mock code, resuscitation, outcome, cardiac arrest, team performance

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          Abstract

          Background

          Cardiopulmonary arrest is an uncommon event in pediatric patients. Additionally, physicians-in-training see far fewer cardiopulmonary arrest events. Therefore, they have limited confidence in their resuscitation skills. Mock code training with active participation and debriefing may be an effective tool to fill this gap in experience. The aims of the study were to assess the impact of a mock code simulation program on patient outcome for children with cardiopulmonary arrest in a tertiary pediatric academic center and provide evidence that code simulations can improve the quality of cardiopulmonary resuscitation (CPR).

          Methods

          This was a retrospective cohort study conducted in a tertiary academic center. This study had two phases: Phase 1 before the mock code simulation program began (pre-intervention) and Phase 2 after the mock code program began (post-intervention). The data were collected from pediatric patients with cardiopulmonary arrest during the study period who met the inclusion criteria, and variables included the survival rate at hospital discharge, CPR initiation time, time to the first dose of epinephrine, and the adherence rate to American Heart Association (AHA) guidelines.

          Results

          A total of 13 patients in the pre-intervention period and 19 patients in the post-intervention period were included. The results showed a significant improvement in team performance represented by a decrease in CPR initiation time post-intervention and improvement in AHA adherence; however, the results did not show a significant difference in the survival rate or mortality within 28 days of the cardiopulmonary arrest event between the pre- and post-intervention groups.

          Conclusions

          Mock code simulation was a helpful tool to enhance team performance and improve the quality of cardiac resuscitation and cardiac arrest recognition, while its impact on the survival rate was not significant in our study.

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          Most cited references29

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          Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation.

          Mary Ann Peberdy, William A Kaye, Joseph Ornato … (2003)
          The National Registry of Cardiopulmonary Resuscitation (NRCPR) is an American Heart Association (AHA)-sponsored, prospective, multisite, observational study of in-hospital resuscitation. The NRCPR is currently the largest registry of its kind. The purpose of this article is to describe the NRCPR and to provide the first comprehensive, Utstein-based, standardized characterization of in-hospital resuscitation in the United States. All adult (>/=18 years of age) and pediatric (<18 years of age) patients, visitors, employees, and staff within a facility (including ambulatory care areas) who experience a resuscitation event are eligible for inclusion in the NRCPR database. Between January 1, 2000, and June 30, 2002, 14720 cardiac arrests that met inclusion criteria occurred in adults at the 207 participating hospitals. An organized emergency team is available 24 h a day, 7 days a week in 86% of participating institutions. The three most common reasons for cardiac arrest in adults were (1) cardiac arrhythmia, (2) acute respiratory insufficiency, and (3) hypotension. Overall, 44% of adult in-hospital cardiac arrest victims had a return of spontaneous circulation (ROSC); 17% survived to hospital discharge. Despite the fact that a primary arrhythmia was one of the precipitating events in nearly one half of adult cardiac arrests, ventricular fibrillation (VF) was the initial pulseless rhythm in only 16% of in-hospital cardiac arrest victims. ROSC occurred in 58% of VF cases, yielding a survival-to-hospital discharge rate of 34% in this subset of patients. An automated external defibrillator was used to provide initial defibrillation in only 1.4% of patients whose initial cardiac arrest rhythm was VF. Neurological outcome in discharged survivors was generally good. Eighty-six percent of patients with Cerebral Performance Category-1 (CPC-1) at the time of hospital admission had a postarrest CPC-1 at the time of hospital discharge.
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            Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

            M. E. Kleinman, L. Chameides, S. Schexnayder … (2010)
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              Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates.

              Romaine Saxton, Maureen Thompson, C P Andreatta … (2010)
              To evaluate the viability and effectiveness of a simulation-based pediatric mock code program on patient outcomes, as well as residents' confidence in performing resuscitations. A resident's leadership ability is integral to accurate and efficient clinical response in the successful management of cardiopulmonary arrest (CPA). Direct experience is a contributing factor to a resident's code team leadership ability; however, opportunities to gain experience are limited by relative infrequency of pediatric arrests and code occurrences when residents are on service. Longitudinal, mixed-methods research design. Children's hospital at an tertiary care academic medical center. Pediatric. Clinicians responsible for pediatric resuscitations responded to mock codes randomly called at increasing rates over a 48-month period, just as they would an actual CPA event. Events were recorded and used for immediate debriefing facilitated by clinical faculty to provide residents feedback about their performance. Self-assessment data were collected from all team members. Hospital records for pediatric CPA survival rates were examined for the study duration. Survival rates increased to approximately 50% (p = .000), correlating with the increased number of mock codes (r = .87). These results are significantly above the average national pediatric CPA survival rates and held steady for 3 consecutive years, demonstrating the stability of the program's outcomes. This study suggests that a simulation-based mock code program may significantly benefit pediatric patient CPA outcomes-applied clinical outcomes-not simply learner perceived value, increased confidence, or simulation-based outcomes. The use of mock codes as an integral part of residency programs could provide residents with the resuscitation training they require to become proficient in their practice. Future programs that incorporate transport scenarios, ambulatory care, and other outpatient settings could further benefit pediatric patients in prehospital contexts.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 15 July 2020
                Publication date (Electronic, collection): July 2020
                Volume: 12
                Issue: 7
                Electronic Location Identifier: e9197
                Affiliations
                [1 ] Pediatric Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, SAU
                [2 ] Pediatric Critical Care, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
                [3 ] Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
                [4 ] Family Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
                [5 ] Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, SAU
                [6 ] Nursing, Ministry of National Guard - Health Affairs, Riyadh, SAU
                [7 ] Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, SAU
                Author notes
                Article
                DOI: 10.7759/cureus.9197
                PMC ID: 7417123
                PubMed ID: 32789097
                SO-VID: 881f6f01-244b-4dd6-bf82-c16b4bd6ffe8
                Copyright © Copyright © 2020, Hazwani et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 15 June 2020
                Date accepted : 15 July 2020
                Categories
                Subject: Pediatrics

                Keywords: simulation,mock code,resuscitation,outcome,cardiac arrest,team performance
                Data availability:
                Keywords: simulation, mock code, resuscitation, outcome, cardiac arrest, team performance

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