The Use of Remote Learning Techniques for Pediatric Cardiopulmonary Resuscitation Simulation Highlighting the Intersection Between Pediatric Advanced Life Support (PALS) and Advanced Cardiac Life Support (ACLS) Pathways

Introduction: Medical simulation education has expanded in the remote learning sphere, providing educational opportunities to under-resourced areas and the ability to engage learners limited by time or geographic location. Pediatric resuscitation training has historically been in-person relying on Pediatric Advanced Life Support (PALS) algorithms, yet many pediatric providers are often faced with treating adult or adult-sized patients. Our goal was to develop a tele-simulation remote learning module highlighting possible diagnoses and scenarios that require adult treatment-minded approaches for the pediatric clinician, including the use of Advanced Cardiac Life Support (ACLS) algorithms.

Methods: This simulation curriculum was offered in 2020 and 2022. The sessions were created for pediatric hospitalists and presented over an online video platform with visual aids to simulate being in a patient room. All three cases had the same base stem scenario and focused on a narcotic overdose, massive pulmonary embolism (PE), and torsades de pointes from polypharmacy-induced QTc prolongation. A multimodal assessment approach captured post-simulation comfort level with case content, information recall up to two years later, and pre- and post-test assessments of clinical knowledge improvement.

Results: Eighty-one simulation slots were filled by 56 clinicians over two years. Fifty-one completed course evaluations averaged a score of 4.95 on a 5-point Likert scale survey. Increased comfort level was statistically significant across all learning objectives. The most significant improvements were in the domains of ACLS algorithm use and understanding when to terminate unsuccessful resuscitation efforts. Pre- and post-test results demonstrated statistically significant (p<0.001) evidence of knowledge transfer in ACLS and PALS content.

Conclusion: Tele-simulation using an online video platform and well-defined visual aids is a useful option when in-person resuscitation simulation is not available. Practice and reinforcement of ACLS algorithms in pediatrics was found to be meaningful to clinicians who take care of patients of varying ages and sizes.