Analysis of the Performance of Positive Pressure Ventilation by In-hospital Physicians as Measured on High Quality Simulators (1090-004338) (Research Abstract Oral: Resuscitation)
Start time: Monday, January 25, 2021, 3:30 PM End time: Monday, January 25, 2021, 4:30 PM Session Type: Research Abstracts (Completed Studies)
The recent outbreak of Coronavirus (Covid-19) highlights the need for healthcare professionals to be able to perform airway skills to a high level of accuracy. The most basic of such skills is how to correctly deliver positive pressure ventilation through use of a non-invasive bag valve mask. This study examines how well in-hospital physicians perform non-invasive ventilation.
Full time practicing physicians with various specializations working in hospitals were encouraged to stop by and hone their ventilation skills utilizing a BVM on SmartMan feedback manikins (adult or infant depending on specialization). 113 doctors stopped by (26 pediatrics; 87 non-pediatrics). All physicians were briefed on the real time feedback provided by the simulator. In order to control for the ability to attain a perfect seal and correct head position, all physicians were asked whether they would like an assistant to perform this for them. Almost all took advantage of this, although a few individuals opted out of the assistance. All physicians were asked to perform rescue breathing for 1 to 1.25 minutes and were allowed more attempts if they chose. A review of the correct performance for volume and rate was provided verbally to each participant with reference to the onscreen performance results review.
Pediatrician's first performance score was 21.97% and rose to 45.97%. Non-pediatrician's performance was 30.80% and rose to 50.21%. Pediatricians made more attempts to attain a higher score (2.31 attempts) than non-pediatricians (1.92 attempts). The differences in first attempt between the two groups was not significant (t(111)=1.7156, p=0.0890) and was not significant in best attempt (t(111)=1.0013, p=0.3188). The difference in improvement for pediatricians compared to non-pediatricians was significant; pediatrician p<0.0001; non-pediatrician: p<0.0001. Further analyzing pediatrician’s first performance: 67.98% tidal volume, 27.80% tidal flow rate, and 35.95% of the interval pause between ventilations which improved to 83.35% tidal volume, 51.35% tidal flow rate, and 62.38% for interval. Non-pediatrician’s first performance: 71.22% tidal volume, 38.30% tidal flow rate, and 22.34% of the interval which improved to 84.59% tidal volume, 56.84% tidal flow rate, and 40.43% for interval.
The general ability to perform positive pressure ventilation is low among both pediatric and non-pediatric physicians. Most physicians can easily provide the right tidal volume, but often times have trouble with the right tidal flow rate, and interval pause between ventilations. With an accurate feedback simulator, physicians quickly improved. However, even with that improvement, performance levels were still below desirable level for in an In-Hospital respiratory emergency. This highlights the fact that physicians require additional specific and focused training for improving ventilation performance and they should train on high quality feedback simulators to improve their ability to provide positive pressure ventilation.