Critical Cardiopulmonary Event Series: Four Simulations for Pediatric ICU Fellows, Critical Care Nurses, and Pediatric Residents

Abstract

Introduction: Critical cardiopulmonary events arising from congenital or acquired heart diseases are infrequent in some pediatric critical care units but can be associated with significant morbidity and mortality when encountered. We developed four simulation cases for interprofessional pediatric critical care teams (fellows, residents, and nurses) to provide participants with high-acuity cardiopulmonary scenarios in safe learning environments. The included cases were coarctation of the aorta, Kawasaki disease, myocarditis, and tetralogy of Fallot.

Methods: The simulations were typically 15 minutes in duration and took place within the pediatric intensive care unit. The scenarios began with handoff of the patient to the primary nurse, who recruited the assistance of resident physicians and ultimately a pediatric critical care medicine fellow as the scenario escalated. Upon completion, participants engaged in a structured, interactive debriefing session for 40 minutes. Afterward, they were asked to complete an anonymous feedback form that was collected and analyzed.

Results: Based on aggregate postsimulation survey responses from 114 learners, participants reported that these simulation exercises improved their knowledge and ability to manage acutely deteriorating cardiac patients. Additionally, learners rated the impact of the simulation on their practice highly (average score >4 for each group of participants on a 5-point Likert scale). Feedback was analyzed and categorized into three domains: (1) Pediatric Medicine Learning Objectives, (2) Teamwork Strategies, and (3) Opportunities for Simulation Improvements.

Discussion: This series advances self-reported learner knowledge and skills surrounding management of cardiopulmonary events while also providing opportunities to enhance teamwork and communication skills.

Keywords: Aortic Coarctation; Cardiopulmonary; Case-Based Learning; Clinical Teaching/Bedside Teaching; Clinical/Procedural Skills Training; Communication; Critical Care; Interprofessional; Kawasaki Disease; Mucocutaneous Lymph Node Syndrome; Myocarditis; Pediatric Critical Care Medicine; Program Evaluation; Self-Assessment; Simulation; Teamwork; Tetralogy of Fallot.