209 - Improving Pediatric Cardiac Arrest Management Through In-Situ Simulation and Video Review
Saturday, April 26, 2025
2:30pm – 4:45pm HST
Publication Number: 209.5310
Emily A. Kelsoe, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Sarah Bowen, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Megan Danzo, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Anne Marie Anderson, Washington University in St. Louis School of Medicine, Ballwin, MO, United States; Joseph Finney, Washington University, SAINT LOUIS, MO, United States; Jill Whiteley, St. Louis Children's Hospital, St. Louis, MO, United States; Lauren E. Buxbaum, St. Louis Children's Hospital, St. Louis, MO, United States; Theresa Timm, University of Michigan Medical School, Ann Arbor, MI, United States; Susan M. Wiltrakis, Washington University in St. Louis, St. Louis, MO, United States
Resident Physician Washington University in St. Louis School of Medicine Saint Louis, Missouri, United States
Background: Pediatric cardiac arrests are rare but critical events that require expert care from medical teams. While resuscitation guidelines are established, the adherence rate is unclear. It is known that simulation improves team performance, yet in-situ simulation’s (ISS) potential to enhance cardiopulmonary resuscitation (CPR) quality metrics is underexplored. Objective: This study investigates if ISS can effectively identify knowledge gaps and improve performance during pediatric resuscitation in the emergency department (ED) and examines how simulation, combined with video review, provides insight into physical and mental demands, team dynamics, and environmental factors influencing performance. Design/Methods: Two in-situ, multidisciplinary, needs assessment simulations were conducted at St. Louis Children’s ED in 2023. Participants included physicians, nurses, technicians and paramedics. An improvement team used failure mode effect analysis to score latent safety threats (LSTs) and opportunities for improvement (OFIs). Additionally, video recordings of pediatric cardiac arrests in patients 18 years and younger from January 2021 to December 2023 were reviewed independently by three reviewers using a validated tool. The LSTs, OFIs, and video review data were used to identify and prioritize educational objectives, culminating in the creation of a CPR bundle score and a 12-month, longitudinal, interdisciplinary ISS curriculum. Four educational simulations were held monthly and improvement in CPR metrics was tracked with quarterly video review. Results: Simulation needs assessments identified 28 LSTs: 20 high priority and 8 medium priority (Table 1). Key OFIs included role assignment issues, role clarity, closed-loop communication, and knowledge gaps in CPR (Figure 1). Video review was conducted on 24 patients, with an average patient age of one year and 58% male. CPR bundle score metrics were met in 42% of cases. An interdisciplinary simulation curriculum was implemented to address gaps in rhythm analysis, Zoll pad usage, CPR interruptions, compressor switch timing, and communication. Quarterly video review of 19 arrests since initiating the ISS curriculum revealed improvement of resuscitation bundle score completion to 83% by summer of 2024 (Figure 2).
Conclusion(s): ISS is an effective method for identifying high-priority interventions and promoting targeted education to bridge knowledge gaps in pediatric arrest management. By integrating needs assessments, simulation, and video review, this study developed a curriculum that has improved the quality of resuscitation care at our institution.
.jpg "Emily A. Kelsoe, MD (she/her/hers) photo")
