Mock CPR drills in kids show many residents fail in key skills, Hopkins stu...( Research from the Johns Hopkins Chil...),Health

Research from the Johns Hopkins Children's Center exposes alarming gaps in training hospital residents in "first response" emergency treatment of staged cardiorespiratory arrests in children, while at the same time offering a potent recipe for fixing the problem.

The research was conducted just before the release of the 2005 American Heart Association's practice guidelines focusing on strengthening first-response skills, which suggests that at least some of the findings in the study may paint a grimmer picture than current reality, researchers say. And changes already made to the Hopkins resident training program beginning in 2005 have resulted significant improvement, they add.

The Hopkins study, now available online and to be published in the July print issue of the journal Resuscitation, revealed critical mistakes during life-saving maneuvers like chest compressions and defibrillations in children undergoing arrests or "codes," as they are medically known.

Staging mock cardio-pulmonary arrests with life-size dummies, researchers observed that of the 70 residents participating in the drills, one-third (24) never started chest compressions, while two-thirds (46) did so with a delay of over one minute, the critical cutoff time to initiate compressions in a child without a pulse. Nearly half of the residents (46 percent) failed to restore heart rhythm using a defibrillator within the recommended three minutes. Timely resuscitation of a child whose breathing or heart beat has stopped is, of course, critical to prevent permanent brain damage and death.

Because most arrests in children are caused by respiratory rather than cardiac problems, pediatric life-support training in most teaching hospitals traditionally has emphasized airway rather than heart maneuvers to resuscitate a lifeless child. But in a patient without a pulse, airway maneuvers will only work if used together with chest compressions to circulate the bl
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