CPR coaching during cardiac arrest improves adherence to PALS guidelines: a prospective, simulation-based trial

Michael Buyck; Yasaman Shayan; Jocelyn Gravel; Elizabeth A Hunt; Adam Cheng; Arielle Levy

doi:10.1016/j.resplu.2020.100058

CPR coaching during cardiac arrest improves adherence to PALS guidelines: a prospective, simulation-based trial

Resusc Plus. 2020 Dec 16:5:100058. doi: 10.1016/j.resplu.2020.100058. eCollection 2021 Mar.

Authors

Michael Buyck^{1

2}, Yasaman Shayan^{1

2}, Jocelyn Gravel^{1

2}, Elizabeth A Hunt³, Adam Cheng⁴, Arielle Levy^{1

2}

Affiliations

¹ Department of Pediatric Emergency Medicine, Sainte-Justine Hospital University Centre, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.
² Université de Montreal, Montreal, Québec, Canada.
³ Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Health Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
⁴ Departments of Pediatrics and Emergency Medicine, University of Calgary, Calgary, Canada.

Abstract

Aim: Recent studies have shown that the integration of a trained cardiopulmonary resuscitation (CPR) Coach during resuscitation enhances the quality of CPR during simulated paediatric cardiac arrest. The objective of our study was to evaluate the effect of a CPR Coach on adherence to Paediatric Advanced Life Support (PALS) guidelines during simulated paediatric cardiac arrest.

Methods: This was a secondary analysis of data collected from a multicentre randomized controlled trial assessing the quality of CPR in teams with and without a CPR Coach. Forty paediatric resuscitation teams were equally randomized into 2 groups (with or without a CPR Coach). The primary outcome was adherence to PALS guidelines during a simulated paediatric cardiac arrest case as measured by the Clinical Performance Tool (CPT). Video recordings were assigned to 2 pairs of expert raters. Raters were trained to independently score performances using the tool.

Results: The reliability of the rating was adequate for the Clinical Performance Tool with an intraclass coefficients of 0.67 (95%CI: 0.22 to 0.84). Performance scores of the different teams varied between 51 and 84 points on the Clinical Performance Tool with a mean score of 70. Teams with a CPR Coach demonstrated better adherence to PALS guidelines (i.e. CPT score 73 points) compared to teams without a CPR Coach (68 points, difference 5 points; 95%CI: 1.0-9.3, p = 0.016).

Conclusion: In addition to improving CPR quality, the presence of a CPR Coach improves adherence to PALS guidelines during simulated paediatric cardiac arrests when compared with teams without a CPR Coach.

Keywords: CPR; CPR coach; Emergency; PALS; Pediatric; Resuscitation; Simulation.