Effect of a positive pressure ventilation-refresher program on ventilation skill performance during simulated newborn resuscitation

Dana E Niles; Christiane Skåre; Elizabeth E Foglia; Elena Insley; Courtney Cines; Theresa Olasveengen; Lance S Ballester; Anne Ades; Michael Posencheg; Vinay M Nadkarni; Jo Kramer-Johansen

doi:10.1016/j.resplu.2021.100091

Effect of a positive pressure ventilation-refresher program on ventilation skill performance during simulated newborn resuscitation

Resusc Plus. 2021 Feb 16:5:100091. doi: 10.1016/j.resplu.2021.100091. eCollection 2021 Mar.

Authors

Affiliations

¹ The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Philadelphia, PA, USA.
² The Children's Hospital of Philadelphia, The Center for Simulation, Innovation and Advanced Education, Philadelphia, PA, USA.
³ Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
⁴ The Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA, USA.
⁵ The Children's Hospital of Philadelphia, Biostatistics and Data Management Core (BDMC), Philadelphia, PA, USA.
⁶ Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.

Abstract

Aim: Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses.

Methods: Subjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10-21 mL) and rate (40-60 ventilations per minute [vpm]). Baseline and post assessments were compared for total number PPV delivered, number target PPV delivered (volume 10-21 mL), mean volume and mean rate (Wilcoxon signed-rank test, median[IQR]).

Results: Twenty-six subjects were enrolled and completed a baseline assessment; 24 (92%) completed a post-assessment; 2 (8%) were lost to follow-up. Over 3 months, a mean 3.2 (range 1-6) PPV-Refreshers/subject were completed. Compared to baseline, subjects demonstrated significant improvement for total (57 [36-74] vs. 33 [26-46]; p = 0.0007) and target PPV (23 [13-23] vs. 11 [5-21]; p = 0.024), and a significant change in mean volume (mL) (11.5 [10.2-13] vs. 13.4 [11-16]; p = 0.02) and mean rate (vpm) (54 [45-61] vs. 40 [28-49]; p = 0.019).

Conclusions: A PPV-Refresher program with brief, repeated psychomotor skill practice significantly improved PPV performance with the greatest improvement in total PPV and target PPV. Additional investigation is warranted to determine optimal PPV-Refresher frequency.Registered at ClinicalTrials.gov #NCT02347241.

Keywords: Newborn; Positive pressure ventilation; Psychomotor skill training; Refresher; Resuscitation; Simulation.

Associated data

ClinicalTrials.gov/NCT02347241