Healthcare professionals' knowledge of the systematic ABCDE approach: a cross-sectional study.

BACKGROUND: The Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach is a universal, priority-based approach for the assessment and treatment of critically ill patients. Although the ABCDE approach is widely recommended, adherence in practice appears to be suboptimal. The cause of this non-compliance is unknown. As knowledge is a prerequisite for adherence, the aim of this study was to assess healthcare professionals' knowledge of the ABCDE approach. METHODS: A cross-sectional study was conducted at the Radboud University Medical Center, the Netherlands. A digital multiple-choice assessment tool of the ABCDE approach was developed by an expert panel through a mini-Delphi method and validated by performing test item statistics and an expert-novice comparison. The validated test was sent to healthcare professionals (nurses, residents and medical specialists) of the participating departments: Anaesthesiology, Paediatrics, Emergency Department and the Neonatal, Paediatric and Adult Intensive Care Units. Primary outcome was the test score, reflecting individual level of knowledge. Descriptive statistics, regression analysis and ANOVA were used. RESULTS: Test validation showed a Cronbach's alpha of 0.71 and an expert-novice comparison of 91.9% (standard deviation (SD) 9.1) and 72.4% (15.2) respectively (p < 0.001). Of 954 eligible participants, 240 filled out the questionnaire. The mean (SD) test score (% of correct answers) was 80.1% (12.2). Nurses had significantly lower scores (74.9% (10.9)) than residents (92.3% (7.5)) and medical specialists (88.0% (8.6)) (p < 0.001). The Neonatal Intensive Care Unit (75.9% (12.6)) and Adult Intensive Care Unit (77.4% (11.2)) had significantly lower scores than Paediatric Intensive Care Unit (85.6% (10.6)), Emergency Department (85.5% (10.4)) and Anaesthesiology (85.3% (10.6)) (p < 0.05). Younger participants scored higher than older participants (-0.30% (-0.46;-0.15) in test score/year increase in age). CONCLUSION: Scores of a validated knowledge test regarding the ABCDE approach vary among healthcare professionals caring for critically ill patients. Type of department, profession category and age had a significant influence on the test score. Further research should relate theoretical knowledge level to clinical practice. Tailored interventions to increase ABCDE-related knowledge are recommended.

The new European resuscitation council guidelines on newborn resuscitation and support of the transition of infants at birth: An educational article.

In this educational article, we summarize the changes in the new European Resuscitation Council guidelines on Newborn Resuscitation and Support of the Transition of Infants at Birth, emphasizing important aspects for the pediatric anesthesiologist including umbilical cord management, airway management, inflation pressure, and oxygen in relation with gestational age and situation. Using a fictitious case to illustrate the main points, we give a summary of the changes and the evidence behind them.

New European Resuscitation Council guidelines for pediatric life support and their implications for pediatric anesthesia: An educational article.

In this educational article, we summarize the changes in the new European Resuscitation Council guidelines for Pediatric Life Support, emphasizing the most important aspects for the anesthesiologist. Among these are: the use of two-thumb-encircling technique for thorax compressions in infants, 10 ml/kg as the standard volume fluid bolus and ventilation after intubation at an age-dependent rate. Using a fictitious case, we present a point-by-point summary of the changes and briefly mention some of the evidence behind them, referring the reader to the full guidelines for further evidence. We also give a summary of the incidence, causes, challenges, treatment, and prognosis of pediatric cardiac arrest in the operating room.

[Paediatric Life Support]. / Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS): Leitlinien des European Resuscitation Council 2021.

The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.

European Resuscitation Council Guidelines 2021: Paediatric Life Support.

These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.

Suport vital pediàtric bàsic I avançat. Recomanacions per a la covid-19 del Consell Europeu de Ressuscitació (ERC) / Soporte vital pediátrico básico y avanzado. Recomendaciones para la Covid-19 del Consejo Europeo de Reanimación (ERC) / Basic and advanced pediatric life support. European Resuscitation Council (ERC) Covid-19 guidelines

Suport vital pediàtric bàsic I avançat. Recomanacions per a la covid-19 del Consell Europeu de Ressuscitació (ERC) El grup de redacció de guies pediàtriques de l'ERC ha fet una adaptació «temporal» de les seves recomanacions a l'època de la covid-19. Aquestes s'han d'interpretar dins del context de cada sistema sanitari, considerant el grau de propagació de la malaltia I la seva evolució dins de cada regió, així com l'impacte general sobre els recursos disponibles. Donada l'evidència limitada, les pautes següents són principalment el resultat del consens d'experts. Es fa referència a la protecció de personal sanitari I no sanitari, al reconeixement de l'infant greument malalt, al maneig de la via aèria I la respiració de l'infant críticament malalt amb possible covid-19, al reconeixement de l'aturada cardíaca en infants I l'algoritme de suport vital bàsic, a l'obstrucció de la via aèria per cos estrany, al suport vital avançat I a l'ètica de la reanimació en infants durant la pandèmia de covid-19

El grupo de redacción de guías pediátricas de ERC ha realizado una adaptación «temporal» de sus recomendaciones en la época de la covid-19. Estas deben interpretarse dentro del contexto de cada sistema sanitario, considerando el grado de propagación de la enfermedad y su evolución dentro de esa región, así como el impacto general sobre los recursos disponibles. Dada la evidencia limitada, las siguientes pautas son principalmente el resultado del consenso de expertos. Se hace referencia a la protección de personal sanitario y no sanitario, al reconocimiento del niño gravemente enfermo, al manejo de la vía aérea y la respiración del niño críticamente enfermo con posible covid-19, al reconocimiento de la parada cardíaca en niños y al algoritmo de soporte vital básico, a la obstrucción de la vía aérea por cuerpo extraño, al soporte vital avanzado y a la ética de la reanimación en niños durante la pandemia de covid-19

The ERC paediatric guideline writing group has "temporarily" adapted their recommendations to the context of covid-19. These should be interpreted within the context of each healthcare system, considering the degree of covid-19 spread and evolving disease profile within that region, and the overall impact on available resources. Given the limited evidence, the following guidelines are mainly the result of expert consensus. Reference is made to the protection of bystanders and healthcare professionals, to the recognition of the critically ill child, to the airway and breathing management of a critically child with potential covid-19, to the recognition of cardiac arrest in children and basic life support (BLS) algorithm, foreign body airway obstruction, advanced life support (ALS), and the ethics of resuscitation in children during the covid-19 pandemic

Recent developments in neonatal and paediatric emergencies.

The present article is intended as an update for anaesthesiologists on recent developments in life-threatening paediatric emergencies and paediatric resuscitation. It is assumed that the reader has at least a basic knowledge of the general principles of emergency medicine, such as the ABCDE-approach and the principle of 'treat first what kills first'; and also that the reader is familiar with the anatomical, physiological and psychological differences between adults and children. The article begins with a description of the background to paediatric emergencies followed by a description of a widely used systematic approach to the assessment of the seriously ill child. In the second half of the article, the principles of the initial treatment for acute, life-threatening problems in children and paediatric resuscitation are discussed with reference to the recent literature. The article ends with a discussion of the changes in latest guidelines for resuscitation of babies at birth.

Comparison of instructor-led automated external defibrillation training and three alternative DVD-based training methods.

BACKGROUND: Self-directed BLS-training, using a personal training manikin with video has been shown to be as effective as instructor-led training. This has not previously been investigated for AED-training. MATERIALS AND METHODS: This prospective, randomized study with a non-inferiority design compared traditional instructor-led training with three DVD-based AED-training methods (2.5min DVD without practice; 4.5min DVD with manikin practice; 9min DVD with manikin practice and scenario training). After DVD BLS-training, 396 participants were assigned to one of the four AED-training methods by randomization stratified for age. Participants were tested immediately after the training (post-test) and 2 months later (retention-test) using modified Cardiff criteria. The primary endpoint was the percentage of providers scoring 70% or higher on testing. The secondary endpoints were the mean scores and differences per item per age group. RESULTS: Comparison non-inferiority could not be accepted for the post-test or retention-test. Relative risk (RR) and 95% confidence interval (CI) of passing for DVD without practice, with manikin practice and with manikin practice and scenario training compared to instructor-led training were 0.36 (0.25-0.53), 0.35 (0.24-0.51), 0.55 (0.38-0.79), respectively for the post-test, and 0.82 (0.68-0.97), 0.82 (0.68-0.97), and 0.84 (0.70-1.00), respectively for the retention-test. The performance of participants in all DVD-based training groups was significantly higher on the retention-test than on the post-test. Those receiving scenario training scored higher on the post-test compared to the other DVD-training groups (p<0.001). CONCLUSIONS: DVD-based AED-training without scenario is not recommended. Scenario training is a useful addition, but instructor-facilitated training remains the best method.

The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood loss and use of blood products in major pediatric surgery: a meta-analysis.

OBJECTIVE: Aprotinin reduces the blood loss and transfusion of blood products in children undergoing major surgery. Aprotinin has been associated with severe side effects in adults, and tranexamic acid and aminocaproic acid have been found to be safer alternatives in adults. This systematic review addresses the question of whether tranexamic acid and aminocaproic acid are equally effective as aprotinin for reducing blood loss and transfusion in children undergoing major surgery. DATA SOURCES: A systematic review of the literature was conducted to identify all randomized controlled trials of aprotinin, tranexamic acid, and aminocaproic acid involving children undergoing cardiac or scoliosis surgery. STUDY SELECTION AND DATA EXTRACTION: Twenty-three cardiac studies, totaling 1893 patients, met the inclusion criteria. None of the studies directly compared aprotinin to an alternative antifibrinolytic. Five scoliosis studies, totaling 207 patients, met the inclusion criteria. Data on blood loss and use of blood products in the first 24 postoperative hours were extracted. Only homogenously distributed outcomes were pooled. DATA SYNTHESIS: Tranexamic acid showed a homogeneously distributed reduction of blood loss by 11 mL/kg (95% confidence interval [CI] 9-13 mL/kg). Outcomes of blood loss reduction by aprotinin and aminocaproic acid were too heterogeneously distributed to be pooled, so the effect on blood loss could not be evaluated. Both aprotinin and tranexamic acid significantly reduced packed red cell transfusion (4 mL/kg, 95% CI 2-7 mL/kg and 7 mL/kg, 95% CI 5-10 mL/kg, respectively). Type of antifibrinolytic was not a determining factor that explained differences in outcome among trials in a meta-regression analysis. In the scoliosis studies, aprotinin and tranexamic acid significantly reduced blood loss compared with placebo (385 mL, 95% CI 727-42 mL and 682 mL, 95% CI 1149-214 mL, respectively). CONCLUSIONS: There is no evidence that suggests that, compared with aprotinin, alternative antifibrinolytics such as tranexamic acid were less effective in reducing blood loss in major pediatric surgery.

Validity of the visual analogue scale as an instrument to measure self-efficacy in resuscitation skills.

CONTEXT: Self-efficacy is an important factor in many areas of medical education, including self-assessment and self-directed learning, but has been little studied in resuscitation training, possibly because of the lack of a simple measurement instrument. OBJECTIVE: We aimed to assess the validity of a visual analogue scale (VAS) linked to a single question as an instrument to measure self-efficacy with respect to resuscitation skills by comparing the VAS with a questionnaire and using known-groups comparisons. METHODS: We developed questionnaires to measure self-efficacy for a number of resuscitation tasks and for computer skills. These were compared with VASs linked to a single question per task, using a multi-trait, multi-method matrix. We also used known-groups comparisons of self-efficacy in specific professional groups. RESULTS: There was good correlation between the questionnaires and the VASs for self-efficacy for specific resuscitation tasks. There was a less clear correlation for self-efficacy for paediatric resuscitation overall. There was no correlation between self-efficacy for resuscitation and computer tasks. In specific professional groups, measured self-efficacy accorded with theoretical predictions. CONCLUSIONS: A VAS linked to a single question appears to be a valid method of measuring self-efficacy with respect to specific well defined resuscitation tasks, but should be used with caution for multi-faceted tasks.