In Situ Simulation Based Development and Training of an Emergency Airway Management Protocol for use in the Pediatric Population during the COVID-19 Pandemic (1090-003994) (Research Abstract Professor Rounds: Group 3)
Start time: Thursday, January 28, 2021, 11:30 AM End time: Thursday, January 28, 2021, 12:30 PM Session Type: Research Abstracts (Completed Studies)
The evolution of the COVID-19 pandemic across the United States has been a rapidly changing learning curve for all medical providers. Critically ill children with COVID-19 are less common than adults, yet not absent from the illness' demographics [1,2,3,4,5]. Additionally, higher rates of asymptomatic infectious states in children have been reported . We recognized a need to adjust our process for emergency airway management to reduce risk of aerosolization and contamination [6,7]. The COVID-19 airway process developed by our adult emergency medicine colleagues needed to be tailored to address pediatric-specific physiology, as well as differences in our space, team structure and equipment needs. Using a collaborative, team-based approach we formulated an emergency provider based airway management algorithm for the pediatric population. We postulated that in-situ simulation would be an effective tool to develop, revise and implement our new airway protocol.
A cohort of pediatric emergency medicine (PEM) faculty volunteered to lead our workgroup that included nursing leadership, respiratory therapy, and pharmacy. We performed a literature review of available pediatric COVID-19 publications, which was limited in general by the rapidity of the pandemic evolution. We also discussed available anecdotal evidence from collaborative PEM listservs and from personal communications with colleagues at other institutions. Prior to implementation, in situ simulation was used to assess and iteratively improve the protocol through identification of potential process and system issues. After this preliminary development stage, a simulation-based training utilizing a case scenario was employed to educate and train providers. Pre- and post- training surveys were completed to determine how our developed airway process and simulation training had impacted provider comfort and safety.
PEM faculty and fellows were surveyed at the onset of the COVID-19 pandemic prior to process implementation. They then received the same set of questions after in-situ simulation implementation for post-intervention evaluation, approximately two months after project origination. We had an 100% (n=27) survey response rate. There was a clinically significant improvement in provider's level of comfort in performing emergency airway management, with only 18.5% (n=5) reporting feeling at least somewhat comfortable pre intervention vs 88.8% (n=24) reporting feeling at least somewhat comfortable post-intervention. Furthermore, 96.2% (n=26) of respondents reported feeling at least somewhat confident in their ability to keep team members protected from infectious exposure following implementation and simulation based training, up from the 44.4% (n=12) prior to our intervention.
There is limited available data to guide pediatric airway management during the COVID-19 pandemic. Through the use of in-situ simulation for process development and training, our workgroup was able to tailor an airway management algorithm to address the inherently unique needs of the pediatric population during the COVID-19 pandemic. Changes were based on issues noted during in-situ simulations and were related to either refining procedural workflow, appropriate personal protective equipment (PPE) utilization, and discussions around pediatric anatomic and physiologic differences that necessitated adjustments. Most importantly, our simulation-based educational intervention greatly improved provider comfort and perceived safety in performing emergency airway management during this time of unprecedented risk. We hope our work will support our emergency medicine colleagues in the clinical care, workflow, and decision-making that pertains specifically to the pediatric population.