Simulating Safe Airway Management Practice in Pediatric Cardiac ICU Patients with Covid Infection (1090-003765) (To be presented in the session entitled, Research Abstract Oral: COVID-19)
Start time: Friday, January 22, 2021, 2:00 PM End time: Friday, January 22, 2021, 3:00 PM Session Type: Research Abstracts (Completed Studies)
Patients in the pediatric cardiac intensive care unit (CICU) frequently have limited cardiorespiratory reserve and are particularly vulnerable to the sequelae of infection. In light of this, as Covid cases began to appear in pediatric ICUs nationally in March 2020, we elected to transiently replace our weekly in situ simulation exercises with a scenario involving the intubation of a patient with Covid infection. Our objectives were to instruct teams to perform a detailed pre-procedure huddle, ensure best practices regarding minimizing aerosol exposure among members, and foster proper use of available barriers to infection and personal protective equipment (PPE).
A scenario was written involving an infant with repaired congenital heart disease with impending respiratory failure who was en route to a CICU. Participants were instructed to assemble, decide which members would enter the room, discuss medications and equipment, and don PPE. After 5 minutes the team was informed that the patient was now in the room, at which point the designated team members entered, assessed the simulated patient and performed endotracheal intubation. A debrief ensued which focused on how well the team followed current best practices for this procedure (1). The discussion targeted the completeness of the pre-procedure huddle, proper use of PPE, and clarity of role assignments and responsibilities. Special attention was paid to appropriate use of aerosol barriers such as a video laryngoscope, high efficiency particulate air filter(s), a cuffed endotracheal tube, and minimizing bag-mask ventilation before and after intubation. Participant responses were collected.
Over a 7-week period, we conducted 10 simulations for a total of 51 participants comprising of 24 nurses, 17 physicians and 10 respiratory therapists. All exercises proceeded through patient intubation and participant responses were collected for each session using a Likert Scale with a score of 4 equating to “agree” and a score of 5 equating to “strongly agree”. Participants either agreed or strongly agreed that the sessions will change the way they practice (median 5, IQR 1), improved their confidence to perform their role during the actual intubation of patient with Covid infection (median 4, IQR 0), helped them demonstrate proper use of PPE (median 4, IQR 1), and helped them identify the proper personnel and equipment required for the procedure (median 4, IQR 1). During the debriefs, a number of latent safety threats were identified related to appropriate use of bag-mask ventilation, correct filter and adapter choice, and proper use of a video laryngoscope.
Tailoring simulation content to match the educational needs of patients and staff during the Covid era helped us provide airway management practice and instruction to a large number of CICU personnel. This effort illustrates the power and flexibility of in situ simulation when preparing staff to perform high-risk procedures on high-risk patients.