Anesthesiology Residents' Performance of Pediatric Resuscitation during a Simulated Hyperkalemic Cardiac Arrest

• Published in: Anesthesiology (Philadelphia) Vol. 112; no. 4; pp. 993 - 997
• Main Authors: HOWARD-QUIJANO, Kimberly J, STIEGLER, Marjorie A, YUE MING HUANG, CANALES, Cecilia, STEADMAN, Randolph H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-04-2010
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology - education; Biological and medical sciences; Cardiopulmonary Resuscitation; Checklist; Child; Clinical Competence; Electroencephalography; Epinephrine - administration & dosage; Epinephrine - therapeutic use; Heart Arrest - therapy; Humans; Hyperkalemia - complications; Infant; Internship and Residency; Male; Medical sciences; Patient Simulation; Resuscitation; Vasoconstrictor Agents - administration & dosage; Vasoconstrictor Agents - therapeutic use; Human; Pediatrics; Cardiocirculatory arrest; Cardiovascular disease; Anesthesia; Child; Resuscitation
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0b013e3181d31fbe

Anesthesiologists are responsible for the management of perioperative cardiopulmonary arrest in children. This study used simulation to assess the pediatric resuscitation skills of experienced anesthesia residents.
Nineteen anesthesia residents were evaluated using a pediatric pulseless electrical activity scenario. The authors used a standardized checklist to evaluate the residents' diagnostic and therapeutic interventions.
After the onset of pulseless electrical activity, 79% of residents initiated cardiopulmonary resuscitation within 1 min. Approximately one third (31%) performed chest compressions at the recommended rate. Epinephrine was administered by 95% of residents, but only one third used the correct pediatric dose. All residents administered fluid boluses, but only 16% administered the recommended volume. Only one fourth of the residents considered hyperkalemia as a cause of pulseless electrical activity. None of the residents asked for dosing aids.
During this simulated pediatric emergency, anesthesia residents demonstrated an acceptable knowledge of general resuscitation maneuvers. However, a subset of resuscitation skills was incorrectly performed, mostly related to age or weight. Importantly, many residents did not consider the full differential diagnosis of pulseless electrical activity. Anesthesia residents may benefit from additional pediatric resuscitation training and practice using cognitive aids to access dosages and complicated diagnostic algorithms.