Key result
Pediatric resuscitation simulation shows no significant delay to cardioversion versus adult simulation.
Why the study?
The performance of emergency medical service providers in resuscitating pediatric versus adult patients with unstable supraventricular tachycardia using high-fidelity simulation was unclear.
Does pediatric simulation compared to adult simulation affect time to cardioversion by EMS providers managing unstable SVT?
RCT (n=37)
Single-blind
randomized
Does pediatric simulation compared to adult simulation affect time to cardioversion by EMS providers managing unstable SVT?
EMS providers demonstrated similar time to cardioversion and dosing accuracy in both pediatric and adult simulated unstable SVT scenarios.
Answers are grounded in this paper and cite their sources.
No performance gap found in simulation; leaves open whether pediatric SVT care differs in practice and requires real-world validation.
OBJECTIVE: The aim of the study was to compare emergency medical service resuscitation of pediatric and adult high-fidelity manikins in unstable supraventricular tachycardia. The primary objective was time to cardioversion. The secondary objective was to assess if the cardioversion was synchronized at the correct dosage for the manikin's weight. METHODS: Emergency medical service providers were voluntarily enrolled as part of an emergency medical service training program. Participants were randomized to either a pediatric or adult resuscitation as their study scenario. They then completed the second resuscitation as part of the training program. Participants completed presurvey and postsurvey. Resuscitations were videotaped and analyzed by a blinded reviewer. The study was powered to detect a 60-second difference in performance between pediatric and adult scenarios with a β of 0.8 and 2-tailed α of 0.05 using an independent-samples t test. RESULTS: A total of 37 participants were enrolled. Participants in the pediatric arm had a longer mean time to cardioversion, but the difference was not statistically significant. The mean delay to cardioversion in the pediatric scenario was 34 seconds (197 vs 163 seconds; difference 95% confidence interval [CI], -5 to 73 seconds; P = 0.09). There was no significant difference in the percentage of participants who administered a correct dose (32% vs 50%; difference 95% CI, -50% to 13%; P = 0.75) or regarding synchronization of cardioversion (74% vs 83%; difference 95% CI, -36% to 17%; P = 0.42). CONCLUSIONS: Emergency medical service providers did not have a significant difference in time to cardioversion between pediatric and adult unstable supraventricular tachycardia simulations.
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Khalil et al. (2019) conducted an RCT in unstable supraventricular tachycardia (n=37). Pediatric resuscitation simulation vs. Adult resuscitation simulation was evaluated on time to cardioversion (MD 34 seconds, 95% CI -5 to 73, p=0.09). Pediatric resuscitation simulation by emergency medical service providers resulted in a non-significant 34-second mean delay to cardioversion compared to adult simulation (197 vs 163 seconds; P=0.09).
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