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Use of the “resuscitation team leader evaluation” to evaluate the leaders in paediatric CPR simulations
S108
Abstracts / Resuscitation 85S (2014) S15–S121
fessionals are training as a team. Team training have its pros and cons. One of the issues surfaced was the preferred sequence to debriefing the nurses as nurses possess different skill set from physicians. We tried four different sequences to debriefing: (1) debrief team together, (2) short team debrief followed by separate debrief for physicians and nurses, (3) separate debrief for physicians and nurses, (4) debrief team together and nurses had an additional debriefing session with nursing educators at the end of training session. A survey was conducted. Five nursing educators and thirty nurses who had undergone team resuscitation training participated. Results: Among the nursing educators, three chose Sequence (2) as the preferred sequence of debriefing. This is followed by Sequence (4). For the nurses, 97% preferred Sequence (2), the remaining 3% chose Sequence (3). The 4 sequences each has their own merit. In our culture, Sequence (1) did not work out because the debrief tend to be centred on the physicians, nurses took backstage. The majority of nurses preferred Sequence (2) because the initial debrief concentrate on team dynamics, e.g. team work and communications, and the second part of debrief discuss deeper details of individual skill competencies by the nursing educators. Conclusions: We found that the preferred method of debriefing was that of a short combined debrief together to iron out the major issues, followed by a separate debriefing by the nursing educators to highlight details pertinent to the nursing skill set for the emergency nurses. http://dx.doi.org/10.1016/j.resuscitation.2014.03.267 AP219 Association of glial cell line-derived neurotrophic factor (GDNF) protein expression with the neuronal death in post-resuscitation period Maria Avruschenko, Irina Ostrova ∗ V.A. Negovsky Research Institute of General Reanimatology Russian Academy of Medical Sciences, Moscow, Russia Purpose of the study: To evaluate an expression level of GDNF protein in hypoxia-sensitive neuronal population of Purkinje cells and its relationship with the neuronal death in post-resuscitation period. Materials and methods: 40 adult white rats both sexes underwent 10-min circulatory arrest evoked by intrathoracic clamping of cardiac vascular bundle, followed by resuscitation. Total density of Purkinje cells (PC) of the cerebellum was determined by morphometric analysis on the 1, 4, 7, and 14th days of post-resuscitative period. The expression of GDNF was detected by immunohistochemistry. Results: There were revealed the increasing of GDNF expression in the PC population in males on the 1th day after cardiac arrest: the number of positive neurons increased by 70.0%, while the number of negative neurons decreased by 35.4%. The total number of PC was not changed. On the 4th postoperative day GDNF expression decreased: the number of positive neurons fell to the control level and the number of negative neurons was reduced by 32.3%. Reducing the GDNF expression accompanied by neuronal death (the total number of PC decreased by 16.6%). Subsequently (7, 14th days) GDNF expression was not changed, and the process of neuronal death did not enhanced. Thus the number of positive neurons did not differ from controls, while the number of negative neurons was reduced. There were found similar changes in females.
However the GDNF expression level shifts, as well as neuronal cell death developed later than in males. Conclusions: The results demonstrated association between changes in the level of GDNF protein expression and development of neuronal death in the post-resuscitation period. Initial rise of GDNF expression in neuronal populations can prevent neuronal death. The decrease of GDNF expression accompanied by the neuronal loss. The results indicate that the GDNF protein level is an important factor for sustainability of neurons to ischemiareperfusion. http://dx.doi.org/10.1016/j.resuscitation.2014.03.268 AP220 Use of the “resuscitation team leader evaluation” to evaluate the leaders in paediatric CPR simulations ˜ Andres Gonzalez 1 , Carlos Gonzalez 3,∗ , Inigo Gorostiza 2 , Pedro Gamboa 3 , Joseba Rementeria 1 , Uxoa jimenez 1 , Frederic Samson 1 , Ainhoa larrauri 1 1 Pediatric Emergency Section, Basurto University Hospital, Bilbao, Spain 2 Investigation Unit, Basurto University Hospital, Bilbao, Spain 3 Pediatric Allergy Uni, Basurto University Hospital, Bilbao, Spain
Introduction and objective: “Resuscitation Team Leader Evaluation (RTLE) is an evaluation tool for the leaders of the CPR simulation, developed and validated by Grant et al. It consists of 26 items, 12 evaluate leadership and communication (LCS) and 14 knowledge and skills (KCS). Objective: To evaluate the “Resuscitation Team Leader Evaluation”. Material and methods: Descriptive study from September 2013 to January 2014. In our emergency service, CPR simulations were carried out, the traditional simulation (Laerdal Resuci Baby® and Resuci Junior® ) and the advanced simulation (Laerdal Simbaby® ), with the intervention as leaders of 3rd-year Paediatric Residents (R3) and 4th-year paediatric residents (R4), graduates in Paediatric CPR by the Spanish Group of Paediatric and neonatal CPR (GERCPyN). Each leader was evaluated by two Paediatric CPR instructors (GERCPyN). The instructors completed the RTLE for each leader. Analysis realized with the SPSS® 21 software. Results: Twenty-six leaders participated. On 14 occasions, R4, and on 12 occasions, R3. The number of evaluators was 5. The mean score of the RTLE was 66.67 (SD = 3.81), of the LCS 63.89 (SD = 6.09), of the KCS 64.1 (SD = 5.99). For the R4, the mean score of the RTLE was 70.21% (SD = 4.1) and for the R3 66.5% (SD = 3.7) (p = 0.025). The correlation coefficient between total scores and evaluators was r = 0.846; p < 0.001. The weighted kappa was > 0.5 in 18 of the 24 items of the RTLE. The worst item evaluated was “Order appropriate investigations” ( = 1.75 over 3, SD = 0.682), the best item evaluated was “Obtain full cardiorespiratory monitoring and full set of vitals promptly” ( = 2.65 over 3, SD = 0.556). The Cronbach’s alpha for the set of the RTLE was 0.167, due to the sample size. Conclusion: RTLE can be used as an effective tool for the evaluation of the leaders in the CPR simulations. The validation to Spanish by an existing tool would be advisable. http://dx.doi.org/10.1016/j.resuscitation.2014.03.269
Abstracts / Resuscitation 85S (2014) S15–S121
fessionals are training as a team. Team training have its pros and cons. One of the issues surfaced was the preferred sequence to debriefing the nurses as nurses possess different skill set from physicians. We tried four different sequences to debriefing: (1) debrief team together, (2) short team debrief followed by separate debrief for physicians and nurses, (3) separate debrief for physicians and nurses, (4) debrief team together and nurses had an additional debriefing session with nursing educators at the end of training session. A survey was conducted. Five nursing educators and thirty nurses who had undergone team resuscitation training participated. Results: Among the nursing educators, three chose Sequence (2) as the preferred sequence of debriefing. This is followed by Sequence (4). For the nurses, 97% preferred Sequence (2), the remaining 3% chose Sequence (3). The 4 sequences each has their own merit. In our culture, Sequence (1) did not work out because the debrief tend to be centred on the physicians, nurses took backstage. The majority of nurses preferred Sequence (2) because the initial debrief concentrate on team dynamics, e.g. team work and communications, and the second part of debrief discuss deeper details of individual skill competencies by the nursing educators. Conclusions: We found that the preferred method of debriefing was that of a short combined debrief together to iron out the major issues, followed by a separate debriefing by the nursing educators to highlight details pertinent to the nursing skill set for the emergency nurses. http://dx.doi.org/10.1016/j.resuscitation.2014.03.267 AP219 Association of glial cell line-derived neurotrophic factor (GDNF) protein expression with the neuronal death in post-resuscitation period Maria Avruschenko, Irina Ostrova ∗ V.A. Negovsky Research Institute of General Reanimatology Russian Academy of Medical Sciences, Moscow, Russia Purpose of the study: To evaluate an expression level of GDNF protein in hypoxia-sensitive neuronal population of Purkinje cells and its relationship with the neuronal death in post-resuscitation period. Materials and methods: 40 adult white rats both sexes underwent 10-min circulatory arrest evoked by intrathoracic clamping of cardiac vascular bundle, followed by resuscitation. Total density of Purkinje cells (PC) of the cerebellum was determined by morphometric analysis on the 1, 4, 7, and 14th days of post-resuscitative period. The expression of GDNF was detected by immunohistochemistry. Results: There were revealed the increasing of GDNF expression in the PC population in males on the 1th day after cardiac arrest: the number of positive neurons increased by 70.0%, while the number of negative neurons decreased by 35.4%. The total number of PC was not changed. On the 4th postoperative day GDNF expression decreased: the number of positive neurons fell to the control level and the number of negative neurons was reduced by 32.3%. Reducing the GDNF expression accompanied by neuronal death (the total number of PC decreased by 16.6%). Subsequently (7, 14th days) GDNF expression was not changed, and the process of neuronal death did not enhanced. Thus the number of positive neurons did not differ from controls, while the number of negative neurons was reduced. There were found similar changes in females.
However the GDNF expression level shifts, as well as neuronal cell death developed later than in males. Conclusions: The results demonstrated association between changes in the level of GDNF protein expression and development of neuronal death in the post-resuscitation period. Initial rise of GDNF expression in neuronal populations can prevent neuronal death. The decrease of GDNF expression accompanied by the neuronal loss. The results indicate that the GDNF protein level is an important factor for sustainability of neurons to ischemiareperfusion. http://dx.doi.org/10.1016/j.resuscitation.2014.03.268 AP220 Use of the “resuscitation team leader evaluation” to evaluate the leaders in paediatric CPR simulations ˜ Andres Gonzalez 1 , Carlos Gonzalez 3,∗ , Inigo Gorostiza 2 , Pedro Gamboa 3 , Joseba Rementeria 1 , Uxoa jimenez 1 , Frederic Samson 1 , Ainhoa larrauri 1 1 Pediatric Emergency Section, Basurto University Hospital, Bilbao, Spain 2 Investigation Unit, Basurto University Hospital, Bilbao, Spain 3 Pediatric Allergy Uni, Basurto University Hospital, Bilbao, Spain
Introduction and objective: “Resuscitation Team Leader Evaluation (RTLE) is an evaluation tool for the leaders of the CPR simulation, developed and validated by Grant et al. It consists of 26 items, 12 evaluate leadership and communication (LCS) and 14 knowledge and skills (KCS). Objective: To evaluate the “Resuscitation Team Leader Evaluation”. Material and methods: Descriptive study from September 2013 to January 2014. In our emergency service, CPR simulations were carried out, the traditional simulation (Laerdal Resuci Baby® and Resuci Junior® ) and the advanced simulation (Laerdal Simbaby® ), with the intervention as leaders of 3rd-year Paediatric Residents (R3) and 4th-year paediatric residents (R4), graduates in Paediatric CPR by the Spanish Group of Paediatric and neonatal CPR (GERCPyN). Each leader was evaluated by two Paediatric CPR instructors (GERCPyN). The instructors completed the RTLE for each leader. Analysis realized with the SPSS® 21 software. Results: Twenty-six leaders participated. On 14 occasions, R4, and on 12 occasions, R3. The number of evaluators was 5. The mean score of the RTLE was 66.67 (SD = 3.81), of the LCS 63.89 (SD = 6.09), of the KCS 64.1 (SD = 5.99). For the R4, the mean score of the RTLE was 70.21% (SD = 4.1) and for the R3 66.5% (SD = 3.7) (p = 0.025). The correlation coefficient between total scores and evaluators was r = 0.846; p < 0.001. The weighted kappa was > 0.5 in 18 of the 24 items of the RTLE. The worst item evaluated was “Order appropriate investigations” ( = 1.75 over 3, SD = 0.682), the best item evaluated was “Obtain full cardiorespiratory monitoring and full set of vitals promptly” ( = 2.65 over 3, SD = 0.556). The Cronbach’s alpha for the set of the RTLE was 0.167, due to the sample size. Conclusion: RTLE can be used as an effective tool for the evaluation of the leaders in the CPR simulations. The validation to Spanish by an existing tool would be advisable. http://dx.doi.org/10.1016/j.resuscitation.2014.03.269