Feasibility and Preliminary Outcomes of a Simulated Prehospital Pediatric Ventilation Scenario Using a Ventilation Feedback Device.

Abstract

Objectives: Appropriate ventilation technique is critical to support a child who isn't breathing. The inadequacies of manual ventilation in hospitalized patients are well known but the performance of this skill by emergency medical services (EMS) clinicians has not been fully evaluated. This study examined the feasibility and preliminary efficacy of implementing a ventilation feedback device (VFD) into a high-risk low-frequency pediatric simulation scenario for EMS clinicians.

Methods: We enrolled EMS clinicians in a metropolitan area during active-duty shifts. Participants were randomized into one of two groups and completed two 2-min pediatric respiratory arrest scenarios sequentially, separated by a 10-minute washout period. During the first scenario, Group 1 received feedback from the VFD while Group 2 was blinded. After a 10-minute washout period, both groups crossed over and completed the scenario a second time (Group 2 unblinded and Group 1 blinded). With each breath delivered, the VFD recorded tidal volume (TV), ventilation rate (VR), and airway leak. Participants were further randomized to wear a head-mounted camera (HMC) for skill evaluation and completed a survey regarding simulation fidelity.

Results: Eighty-one participants were enrolled and 75 had complete data. Feasibility outcomes were the perceived impact of the VFD and HMC on skill performance and the fidelity of the scenario. Of 74 participants who completed the post-participation survey, 98.6% believed the VFD positively impacted performance and 97.3% believed the scenario was realistic. Of the 27 participants assigned to wear the HMC, 98.6% did not believe it impacted skill performance. Unblinded participants better adhered to guidelines than blinded participants for TV (73.3% vs. 13.5%) and VR (96% vs. 57%) with lower rates of significant airway leakage (10% vs 21.2%). Findings remained significant regardless of blinded-unblinded sequence. The HMC did not impact performance.

Conclusions: Enrolling EMS clinicians and capturing real-time VFD output were feasible during shifts. Using a VFD improved ventilation in a simulated pediatric respiratory arrest scenario. Our methodology offers a model for incorporating pediatric in-situ training. Use of a HMC is a potential novel skill performance assessment tool. Larger, multi-center studies and real-world application of a VFD to evaluate patient-centered outcomes are necessary.