Newborn Morbidity
Conditions
Keywords
telemedicine, simulation, neonatal resuscitation
Brief summary
Teleneonatology, the use of audio-video communication to facilitate neonatal-perinatal care, may bridge the resuscitation quality gap by connecting centers with lower level care to experienced care providers. Using randomized trial design, this investigation will compare teleneonatal resuscitation facilitated by a neonatologist to standard resuscitation within a simulated environment.
Detailed description
Multiple studies have evaluated telemedicine using simulation, but the level of evidence for the use of telemedicine to improve neonatal resuscitation is low. In this investigation and within a simulated environment, pediatric interns and residents will resuscitate a simulated 25 week infant at delivery assisted by a simulated nurse and respiratory therapist. Participants will be randomized to resuscitation performed either with or without telemedicine facilitated by a neonatologist. The primary outcome will be time to effective ventilation with other secondary outcomes including metrics derived from the American Academy of Pediatrics Neonatal Resuscitation Program.
Interventions
OTHERResuscitation Personnel
Type of resuscitation team
Sponsors
University of Alabama at Birmingham
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcome assessors will be masked to group allocation.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
* Inclusion criteria for experienced providers include at least 3 years of pediatric and/or neonatal training, having previously performed \>10 endotracheal intubations, and may include neonatologists, pediatric fellows, and neonatal nurse practitioners. Inclusion criteria for trainees: previous exposure to NRP, an interval of \> 3 months elapsing between previous NRP applications, and may include pediatric residents, family medicine residents, nurses, respiratory therapists, neonatal fellows, and neonatal attendings.
Exclusion criteria
* Does not meet inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| No flow fraction | From start time of compression until 60 seconds have elapsed | The proportion of time for which the mannequin received no effective compression (the number of seconds without effective chest compressions divided by the total number of seconds) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time of first heart rate check (seconds) | From baseline until heart rate check up to 5 minutes | The number of seconds elapsed at the time the heart rate was first checked either by stethoscope, palpation of umbilical stump, or by EKG lead. |
| Heart rate check compliance | From baseline to 60 seconds up to 5 minutes | HR was checked within 60 seconds after birth. |
| Time of bag mask ventilation (seconds) | From baseline to bag mask placement up to 5 minutes | The number of seconds elapsed at the time the mask was first applied to the infant's face. |
| Bag mask ventilation compliance | From baseline to 60 seconds | Mask was applied to the infant's face at 60 seconds after birth. |
| Time of sat probe placement (seconds) | From baseline to probe placement up to 5 minutes | The number of seconds elapsed at the time the oxygen saturation probe was placed. |
| Sat probe placement compliance | From baseline to 60 seconds | Sat probe placed at 60 seconds after birth. |
| Time of increase in FiO2 (seconds) | From simulation start to time of FiO2 increase up to 5 minutes | The number of seconds elapsed at the time the amount of oxygen administered was increased. |
| MR SOPA Performance: Mask adjustment | From start of bag mask ventilation to 2 minutes | Mask was adjusted on the infant's face |
| MR SOPA Performance: Reposition airway | From start of bag mask ventilation to 2 minutes | infant's neck was adjusted |
| MR SOPA Performance: Suction mouth | From start of bag mask ventilation to 2 minutes | infant's mouth was suctioned |
| MR SOPA Performance: Open mouth | From start of bag mask ventilation to 2 minutes | infant's mouth was opened |
| Temperature regulation | From baseline to 30 seconds | Infant placed in polyethylene wrap with warming mattress and hat placed on head. |
| MR SOPA Performance: Placed advanced airway | From start of bag mask ventilation to 2 minutes | endotracheal tube was placed |
| MR SOPA performed in correct sequence | From start of bag mask ventilation to 2 minutes | corrective measures were performed in this sequence |
| MR SOPA measures all performed | From start of bag mask ventilation to 2 minutes | each corrective measure was performed |
| Number of steps correctly performed | From start of bag mask ventilation to 2 minutes | The number of steps correctly performed during the resuscitation |
| Time to effective ventilation (seconds) | From time of bag mask placement until chest rise up to 5 minutes | The number of seconds elapsed at the time the mannequin had visible chest rise |
| Time to first compression (seconds) | From baseline until first compression up to 5 minutes | The number of seconds elapsed at the time the first chest compression was performed |
| Correct hand position | From baseline until first compression up to 5 minutes | Hands positioned with either two fingers on the mannequin's sternum or thumbs over the sternum with hands encircling the chest |
| Compression depth compliance | From baseline until first compression up to 5 minutes | Compressions given at 1/3 of the infant's chest depth |
| Compression synchronization compliance | From start time of compression until 60 seconds have elapsed | Synchronization with bag mask ventilation with a rate of 3 compressions: 1 ventilation |
| Compression rate per minute | From start time of compression until 10 seconds have elapsed | Number of compressions within 10 seconds multiplied by 6 |
| No blow fraction | From baseline to 10 minutes | The proportion of time for which the mannequin received no effective ventilation (the number of seconds without effective ventilation divided by the total number of seconds) |
| MR SOPA Performance: Increased pressure | From start of bag mask ventilation to 2 minutes | pressure on bag mask was increased |
Countries
United States
Outcome results
None listed