Basic cardiopulmonary resuscitation graduates’training with pediatric manikins

Abstract

Approved national pediatric cardiopulmonary resuscitation (CPR) recommendations are not still available in Ukraine, nevertheless CPR history starts since 1740, when the Paris Academy of Sciences offi cially recommended mouthto-mouth resuscitation for drowning victims. In 1960 modern CPR was developed. In 2005 American Heart Association (AHA) developed a revolutionary product that allowed anyone to learn the core skills of basic CPR, use of automated external defi brillators (AED) and choking relief in just 20 minutes. In 2015 some Pediatric basic life support (PBLS) guideline changes have been made both by European Resuscitation Council and AHA with slight differences in approaches. CPR practical skill with peculiarities in childhood is a stage of a fi nal practically oriented exam in Pediatrics. We have chosen AHA PBLS guidelines for graduates’ training in 2017-2018 as a stage in preparing to the fi nal exam in Pediatrics. The aim of the CPR training was to recognize need of CPR and master basic CPR skills in children of two age groups (up to 1 year old and 1-8 years old) except neonates. In order to achieve this aim the following components were included in the course: high-quality CPR for children and infants; the chain of survival, specifi cally the BLS components; use of an AED; effective ventilations using a barrier device; importance of teams in multirescuer resuscitation and performance as an effective team member during multirescuer CPR; relief of foreign-body airway obstruction (choking) for infants and elder children. Two low-fi delity and one mid-fi delity manikins (two infants, one toddler) were used to master CPR skills. Training class was incorporated within module 5 for Ukrainian speaking 6 year students (medical faculty ¹2, groups ¹23-31, medical faculty ¹4, groups ¹1-4, specialty “Pediatrics”, “Medical Psychology”) and modules 5/6 for English speaking groups ¹41-51, medical faculty ¹2, totally 25 groups, 19 of which already have passed the training course. The place of course was a modernly equipped class based on the Chernivtsi Hospital for Emergency Care. The course duration was 1,5 hours. Finally course was divided in 7 stages: (1) initial paper testing – 10 min; (2) instructor’s introduction – 5 min; (3) demonstration of 6 short training videos – 25 min; (4) comments and discussion – 5 min; (5) students’ practice with manikins – 30 min; (6) cross-exam and debriefi ng – 5 min; (7) fi nal paper testing – 10 min. Testing (stages 1 and 7) was approved since spring semester. Teachers previously were trained by certifi ed instructor working in the Intensive Care Unit of the Municipal Medical Institution “Regional Children’s Clinical Hospital”. Totally 6 trained teachers played a role of instructors. Students (groups of 5 up to 15) were working with the teacher/instructor to complete BLS skills practice and skills testing. Students also complete a written initial and fi nal testing. Youtube video-based course with real scenarios was demonstrated via big smart board. Instructor-led, hands-on practical class training format reinforced skills profi ciency. Emphasis is done on high-quality CPR including a team dynamics classroom activity especially in stages 4-6. In the instructor-led course, students participated in simulated clinical scenarios and learning stations. Recommended by AHA duration for full BLS provider course is approximately 4.5 hours to complete, and for BLS renewal course is approximately 3 hours to complete, including skills practice and testing, which means that our training was at least twice shorter as compared to minimal recommended by AHA such course duration. Shortening may be explained by the need of mastering only pediatric peculiarities of BLS. One more discussed issue was the availability of the AED use in Ukraine, especially for the pediatric patients. Nevertheless students have passed some CPR training on another departments, initially they demonstrated some skills loss, especially due to recent frequent CPR updates. Conclusions. Pediatric basic CPR training course allowed to master the basics of child CPR with breaths, child choking relief and general awareness of AED. The BLS course trained students to promptly recognize several life-threatening emergencies, give high-quality chest compressions, deliver appropriate ventilations and provide early use of an AED. Recommendations of diminishing number of students up to 6 in a group, increase of the course duration up to 3 hours and questionable duration of validity of the completed basic CPR training are to be discussed.