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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
51
Type of resuscitation team
Children's of Alabama at Birmingham
Birmingham, Alabama, United States
No flow fraction
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)
Time frame: From start time of compression until 60 seconds have elapsed
Temperature regulation
Infant placed in polyethylene wrap with warming mattress and hat placed on head.
Time frame: From baseline to 30 seconds
Time of first heart rate check (seconds)
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.
Time frame: From baseline until heart rate check up to 5 minutes
Heart rate check compliance
HR was checked within 60 seconds after birth.
Time frame: From baseline to 60 seconds up to 5 minutes
Time of bag mask ventilation (seconds)
The number of seconds elapsed at the time the mask was first applied to the infant's face.
Time frame: From baseline to bag mask placement up to 5 minutes
Bag mask ventilation compliance
Mask was applied to the infant's face at 60 seconds after birth.
Time frame: From baseline to 60 seconds
Time of sat probe placement (seconds)
The number of seconds elapsed at the time the oxygen saturation probe was placed.
Time frame: From baseline to probe placement up to 5 minutes
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Sat probe placement compliance
Sat probe placed at 60 seconds after birth.
Time frame: From baseline to 60 seconds
Time of increase in FiO2 (seconds)
The number of seconds elapsed at the time the amount of oxygen administered was increased.
Time frame: From simulation start to time of FiO2 increase up to 5 minutes
MR SOPA Performance: Mask adjustment
Mask was adjusted on the infant's face
Time frame: From start of bag mask ventilation to 2 minutes
MR SOPA Performance: Reposition airway
infant's neck was adjusted
Time frame: From start of bag mask ventilation to 2 minutes
MR SOPA Performance: Suction mouth
infant's mouth was suctioned
Time frame: From start of bag mask ventilation to 2 minutes
MR SOPA Performance: Open mouth
infant's mouth was opened
Time frame: From start of bag mask ventilation to 2 minutes
MR SOPA Performance: Increased pressure
pressure on bag mask was increased
Time frame: From start of bag mask ventilation to 2 minutes
MR SOPA Performance: Placed advanced airway
endotracheal tube was placed
Time frame: From start of bag mask ventilation to 2 minutes
MR SOPA performed in correct sequence
corrective measures were performed in this sequence
Time frame: From start of bag mask ventilation to 2 minutes
MR SOPA measures all performed
each corrective measure was performed
Time frame: From start of bag mask ventilation to 2 minutes
Number of steps correctly performed
The number of steps correctly performed during the resuscitation
Time frame: From start of bag mask ventilation to 2 minutes
Time to effective ventilation (seconds)
The number of seconds elapsed at the time the mannequin had visible chest rise
Time frame: From time of bag mask placement until chest rise up to 5 minutes
Time to first compression (seconds)
The number of seconds elapsed at the time the first chest compression was performed
Time frame: From baseline until first compression up to 5 minutes
Correct hand position
Hands positioned with either two fingers on the mannequin's sternum or thumbs over the sternum with hands encircling the chest
Time frame: From baseline until first compression up to 5 minutes
Compression depth compliance
Compressions given at 1/3 of the infant's chest depth
Time frame: From baseline until first compression up to 5 minutes
Compression synchronization compliance
Synchronization with bag mask ventilation with a rate of 3 compressions: 1 ventilation
Time frame: From start time of compression until 60 seconds have elapsed
Compression rate per minute
Number of compressions within 10 seconds multiplied by 6
Time frame: From start time of compression until 10 seconds have elapsed
No blow fraction
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)
Time frame: From baseline to 10 minutes
Time to effective ventilation (seconds)
The number of seconds elapsed at the time the mannequin is intubated and ventilated
Time frame: From baseline to time of first ventilated breath with an endotracheal tube up to 10 minutes