Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations

Nathan Bahr; Trang Kieu Huynh; William Lambert; Jeanne-Marie Guise

doi:10.1016/j.resplu.2022.100248

Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations

Resusc Plus. 2022 May 18:10:100248. doi: 10.1016/j.resplu.2022.100248. eCollection 2022 Jun.

Authors

Nathan Bahr¹, Trang Kieu Huynh², William Lambert³, Jeanne-Marie Guise¹

Affiliations

¹ Department of Obstetrics and Gynecology, Oregon Health and Science University.
² Department of Pediatrics, Oregon Health and Science University, United States.
³ Public Health and Preventative Medicine, Oregon Health and Science University.

Abstract

Aim: Neonatal cardiopulmonary arrests are rare but serious events. There is limited information on compliance to best-practice guidelines due to rarity, but deviations can have dire consequences. This research aimed to characterize compliance with and deviations from Neonatal Resuscitation Program (NRP) guidelines and their association with teamwork.

Methods: We observed Emergency Medical Service (EMS) teams responding to standardized neonatal resuscitation simulations following a precipitous home delivery. A Clinical expert evaluated teamwork during simulations using the Clinical Teamwork Scale (CTS™). A neonatologist evaluated technical performance in blinded video review according to NRP guidelines. We report the types, counts, and severity of observed deviations. Logistic regression tested the association of CTS™ factors with the occurrence of deviations.

Results: Forty-five (45) teams of 265 EMS personnel from fire and transport agencies participated in the simulations. Eighty-seven percent (39/45) of teams were rated as having good teamwork according to CTS™. Nearly all teams (44 of 45) delayed or did not perform one or more of the initial steps of dry, warm, or stimulate; delayed bag-valve mask ventilation (BVM); or performed continuous compressions instead of the recommended 3:1 compression-to-ventilation ratio. Logistic regression revealed an 82% (p < 0.04) decrease in the odds of airway errors for each level of improvement in teams' decision-making.

Conclusion: Drying, warming, and stimulating, and ventilation tailored to the physiologic needs of infants continue to be top priorities in neonatal care for out-of-hospital settings. EMS teamwork is good and higher quality of decision-making appears to decrease the odds of ventilation errors.

Keywords: AAP, American Academy of Pediatrics; AHA, American Heart Association; Adverse Safety Events; BVM, Bag valve mask; CPR, Cardiopulmonary Resuscitation; CTS™, Clinical Teamwork Scale; Cardiac arrest; Clinical Teamwork Scale; EMS, Emergency Medical Services; EMT, Emergency Medical Technician; Emergency medical services; ILCOR, International Liaison Committee of Resuscitation.; NRP, Neonatal Resuscitation Program; Neonatal Resuscitation Program.