Performance of advanced resuscitation skills by pediatric housestaff

Objective: To describe pediatric housestaff resuscitation experience and th eir ability to perform key resuscitation skills. Design: Cohort study of 63 pediatric residents in a university-based traini ng program. Participants and Methods: Investigators observed, scored, and timed residen t performance on 4 key resuscitation skills. Cognitive ability was tested w ith 4 written scenarios. Housestaff provided self-reports of the number of months since their last American Heart Association Pediatric Advanced Life Support course, number of mock and actual codes attended, number of times s kills were performed, and self-confidence with respect to resuscitation. Results: A total of 45 pediatric residents (71%) participated. Median cogni tive score was 5 (range, 1-5). Of all residents, 44 (97%) successfully bag mask-ventilated the mannequin; 24 (53%) and 36 (80%) used the correct bag a nd mask size, respectively. Thirty-nine residents (87%) placed a tube in th e mannequin trachea, 12(27%) checked that suction was working prior to intu bation, and 30 (67%) those the correct endotracheal tube size. Forty reside nts (89%) discharged the defibrillator, and 25 (56%) and 32 (71%) correctly chose asynchronous mode and infant paddles, respectively. Thirty-eight res idents (84%) inserted an intraosseous line; 35 (78%) had correct placement. Median times for successful skill completion were 83 seconds for bag mask ventilation, 136 seconds for intubation, 149 seconds for defibrillation, an d 68 seconds for intraosseous line placement. Conclusion: Pediatric housestaff previously trained in pediatric advanced l ife support were generally able to reach the end point of 4 key resuscitati on skills but less frequently performed the specific subcomponents of each skill. This poor performance and the prolonged time to skill completion sug gest the need for greater attention to detail during training.