Abstract Introduction/Rationale Pediatric tracheostomy patients frequently lack in-home nursing support, positioning caregivers as first responders during airway or cardiopulmonary emergencies. Early, high-quality cardiopulmonary resuscitation (CPR) improves outcomes, yet caregivers without healthcare backgrounds may struggle with effective compressions and ventilations. At Children’s Wisconsin, all tracheostomy-dependent children are discharged to home with two trained caregivers who complete comprehensive airway and emergency preparedness education. High-fidelity simulation is integrated to strengthen technique and confidence. This study evaluated caregiver CPR performance during simulated cardiac arrest. Methods This prospective quality-improvement study included caregivers of tracheostomy-dependent children who completed a standardized CPR curriculum: (1) instructional video, (2) hands-on practice with video reinforcement, and (3) high-fidelity simulation with real-time feedback on compression rate, depth, and ventilation. Facilitators provided coaching, prompting, or remediation as needed. Missing values were excluded. McNemar’s test assessed paired caregiver performance. Results A total of 102 caregivers had evaluable CPR performance data. Of included caregivers, 66% were female (n = 67) and 89% were parents (n = 91). Most caregivers effectively recognized the need to initiate CPR (95%, 63/66). Performances across CPR components demonstrated relative strength in ventilation but variability in compression quality. Specifically, 83% (85/102) delivered an appropriate ventilation rate, while 55% (56/102) achieved adequate compression depth and 49% (50/102) maintained an appropriate compression rate. Among dyads with paired data (n = 44), no statistically significant differences were observed between caregiver #1 and caregiver #2 across all CPR domains (p 0.63) (Table 1). Caregivers cited fear of causing harm and anxiety as barriers to effective compressions. Coaching offered immediate corrective feedback and improved technique during the session. Conclusions Caregivers reliably recognized cardiac arrest and generally performed ventilations accurately, while compression quality remained a relative challenge. Importantly, no significant differences were observed between paired caregivers, supporting equitable preparedness across household caregivers. These findings reinforce simulation as acritical element of discharge education for tracheostomy-dependent children. Simulation should be incorporated whenever possible in tracheostomy discharge teaching, with lower-fidelity options used to expand access when resources are limited. Future work will refine strategies to improve compression quality, assess longitudinal skill retention, and explore scalable approaches to ensure ongoing caregiver readiness. This abstract is funded by: None
Henningfeld et al. (Fri,) studied this question.