Nicole Yamada

All Publications

• Implementation of a multi-site neonatal simulation improvement program: a cost analysis. BMC health services research Xu, X., Yao, J., Bohnert, J., Yamada, N., Lee, H. C. 2024; 24 (1): 623

  Abstract

  BACKGROUND: To improve patient outcomes and provider team practice, the California Perinatal Quality Care Collaborative (CPQCC) created the Simulating Success quality improvement program to assist hospitals in implementing a neonatal resuscitation training curriculum. This study aimed to examine the costs associated with the design and implementation of the Simulating Success program.METHODS: From 2017-2020, a total of 14 sites participated in the Simulating Success program and 4 of them systematically collected resource utilization data. Using a micro-costing approach, we examined costs for the design and implementation of the program occurring at CPQCC and the 4 study sites. Data collection forms were used to track personnel time, equipment/supplies, space use, and travel (including transportation, food, and lodging). Cost analysis was conducted from the healthcare sector perspective. Costs incurred by CPQCC were allocated to participant sites and then combined with site-specific costs to estimate the mean cost per site, along with its 95% confidence interval (CI). Cost estimates were inflation-adjusted to 2022 U.S. dollars.RESULTS: Designing and implementing the Simulating Success program cost $228,148.36 at CPQCC, with personnel cost accounting for the largest share (92.2%), followed by program-related travel (6.1%), equipment/supplies (1.5%), and space use (0.2%). Allocating these costs across participant sites and accounting for site-specific resource utilizations resulted in a mean cost of $39,210.69 per participant site (95% CI: $34,094.52-$44,326.86). In sensitivity analysis varying several study assumptions (e.g., number of participant sites, exclusion of design costs, and useful life span of manikins), the mean cost per site changed from $35,645.22 to$39,935.73. At all four sites, monthly cost of other neonatal resuscitation training was lower during the program implementation period (mean=$1,112.52 per site) than pre-implementation period (mean=$2,504.01 per site). In the 3months after the Simulating Success program ended, monthly cost of neonatal resuscitation training was also lower than the pre-implementation period at two of the four sites.CONCLUSIONS: Establishing a multi-site neonatal in situ simulation program requires investment of sufficient resources. However, such programs may have financial and non-financial benefits in the long run by offsetting the need for other neonatal resuscitation training and improving practice.

  View details for DOI 10.1186/s12913-024-11075-z

  View details for PubMedID 38741098

• 2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care CIRCULATION Yamada, N. K., Szyld, E., Strand, M. L., Finan, E., Illuzzi, J. L., Kamath-Rayne, B. D., Kapadia, V. S., Niermeyer, S., Schmoelzer, G. M., Williams, A., Weiner, G. M., Wyckoff, M. H., Lee, H. C., Amer Heart Assoc Amer Acad Pediat 2024; 149 (1): e157-e166

  Abstract

  This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.

  View details for DOI 10.1161/CIR.0000000000001181

  View details for Web of Science ID 001149820500012

  View details for PubMedID 37970724

• The difficult neonatal airway. Seminars in fetal & neonatal medicine Sawyer, T., Yamada, N., Umoren, R. 2023: 101484

  Abstract

  Airway management is one of the most crucial aspects of neonatal care. The occurrence of a difficult airway is more common in neonates than in any other age group, and any neonatal intubation can develop into a difficult airway scenario. Understanding the intricacies of the difficult neonatal airway is paramount for healthcare professionals involved in the care of newborns. This chapter explores the multifaceted aspects of the difficult neonatal airway. We begin with a review of the definition and incidence of difficult airway in the neonate. Then, we explore factors contributing to a difficult neonatal airway. We next examine diagnostic considerations specific to the difficult neonatal airway, including prenatal imaging. Finally, we review management strategies. The importance of a multidisciplinary team approach and the role of communication and collaboration in achieving optimal outcomes are emphasized.

  View details for DOI 10.1016/j.siny.2023.101484

  View details for PubMedID 38000927

• 2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics Yamada, N. K., Szyld, E., Strand, M. L., Finan, E., Illuzzi, J. L., Kamath-Rayne, B. D., Kapadia, V. S., Niermeyer, S., Schmölzer, G. M., Williams, A., Weiner, G. M., Wyckoff, M. H., Lee, H. C. 2023

  Abstract

  This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.

  View details for DOI 10.1542/peds.2023-065030

  View details for PubMedID 37970665

• Novel umbilical catheter securement and protection device for umbilical line securement during laparotomy. American journal of perinatology Salimi Jazi, F., Wood, L., Rafeeqi, T., Yamada, N. K., Fuerch, J. H., Wall, J. K. 2023

  Abstract

  Umbilical catheter malposition rate is high. We compared a Novel Umbilical Securement Device (NUSD) to standard methodologies for NICU patients undergoing laparotomy.Retrospective study was performed on infants undergoing laparotomy from April 2019 to January 2023. Two neonatologists compared position of UAC/UVC on perioperative CXRs in patients with or without NUSD.18 patients underwent laparotomy. 8 patients had NUSD (9 lines), and 10 patients didn't (14 lines). In NUSD group, mean gestational age was 374 weeks and mean birth weight was 2.30.9 kg compared to 318 weeks and 2.11.4 kg in non-NUSD group. The mean age at surgery was 57 and 53 days respectively. No malposition was seen in NUSD group, while 57% of UVCs (28% of lines) were malpositioned post-operatively in non-NUSD group (p: 0.048).NUSD is an umbilical catheter securement device with low malposition rate, specifically during perioperative period with heightened risk for dislodgement.

  View details for DOI 10.1055/a-2182-4221

  View details for PubMedID 37758205

• In Situ Simulation and Clinical Outcomes in Infants Born Preterm. The Journal of pediatrics Chitkara, R., Bennett, M., Bohnert, J., Yamada, N., Fuerch, J., Halamek, L. P., Quinn, J., Padua, K., Gould, J., Profit, J., Xu, X., Lee, H. C. 2023: 113715

  Abstract

  To evaluate impact of a multi-hospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm.Twelve neonatal intensive care units (NICUs) were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Very low birthweight (VLBW) infants born between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room (DR), DR continuous positive airway pressure (CPAP), hypothermia (<36ºC) upon NICU admission, severe intraventricular hemorrhage, and mortality prior to hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect.Between March 2017 and December 2020, a total of 2,626 eligible VLBW births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in Mar-Aug2017 and 76.0% in Jul-Dec 2020 (RR 1.03 [0.94,1.12]; no significant improvement occurred during the study period for both participating and non-participating sites. The effect of in situ simulation on all secondary outcomes was stable.Implementation of a multi-hospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.

  View details for DOI 10.1016/j.jpeds.2023.113715

  View details for PubMedID 37659586

• Neonatal Healthcare Professionals' Experiences When Implementing a Simulation and Debriefing Program in Neonatal Intensive Care Settings: A Qualitative Analysis. Advances in neonatal care : official journal of the National Association of Neonatal Nurses Quinn, J., Quinn, M., Lieu, B., Bohnert, J., Halamek, L. P., Profit, J., Fuerch, J. H., Chitkara, R., Yamada, N. K., Gould, J., Lee, H. C. 2023

  Abstract

  BACKGROUND: Simulation-based training (SBT) and debriefing have increased in healthcare as a method to conduct interprofessional team training in a realistic environment.PURPOSE: This qualitative study aimed to describe the experiences of neonatal healthcare professionals when implementing a patient safety simulation and debriefing program in a neonatal intensive care unit (NICU).METHODS: Fourteen NICUs in California and Oregon participated in a 15-month quality improvement collaborative with the California Perinatal Quality Care Collaborative. Participating sites completed 3 months of preimplementation work, followed by 12 months of active implementation of the simulation and debriefing program. Focus group interviews were conducted with each site 2 times during the collaborative. Content analysis found emerging implementation themes.RESULTS: There were 234 participants in the 2 focus group interviews. Six implementation themes emerged: (1) receptive context; (2) leadership support; (3) culture change; (4) simulation scenarios; (5) debriefing methodology; and (6) sustainability. Primary barriers and facilitators with implementation of SBT centered around having a receptive context at the unit level (eg, availability of resources and time) and multidisciplinary leadership support.IMPLICATIONS FOR PRACTICE AND RESEARCH: NICUs have varying environmental (context) factors and consideration of unit-level context factors and support from leadership are integral aspects of enhancing the successful implementation of a simulation and debriefing program for neonatal resuscitation. Additional research regarding implementation methods for overcoming barriers for both leaders and participants, as well as determining the optimal frequency of SBT for clinicians, is needed. A knowledge gap remains regarding improvements in patient outcomes with SBT.

  View details for DOI 10.1097/ANC.0000000000001085

  View details for PubMedID 37399571

• The Evolution of Neonatal Patient Safety. Clinics in perinatology Yamada, N. K., Halamek, L. P. 2023; 50 (2): 421-434

  Abstract

  Human factors science teaches us that patient safety is achieved not by disciplining individual health care professionals for mistakes, but rather by designing systems that acknowledge human limitations and optimize the work environment for them. Incorporating human factors principles into simulation, debriefing, and quality improvement initiatives will strengthen the quality and resilience of the process improvements and systems changes that are developed. The future of patient safety in neonatology will require continued efforts to engineer and re-engineer systems that support the humans who are at the interface of delivering safe patient care.

  View details for DOI 10.1016/j.clp.2023.01.005

  View details for PubMedID 37201989

• A Novel Method for Administering Epinephrine During Neonatal Resuscitation. American journal of perinatology Gu, H., Perl, J., Rhine, W., Yamada, N. K., Sherman, J., McMillin, A., Halamek, L., Wall, J. K., Fuerch, J. H. 2023

  Abstract

  To determine if prefilled epinephrine syringes will reduce time to epinephrine administration compared to conventional epinephrine during standardized simulated neonatal resuscitation.Timely and accurate epinephrine administration during neonatal resuscitation is lifesaving in bradycardic infants. Current epinephrine preparation is inefficient and error-prone. For other emergency use drugs, prefilled medication syringes have decreased error and administration time.Twenty-one neonatal intensive care unit (NICU) nurses were enrolled. Each subject engaged in four simulated neonatal resuscitation scenarios involving term or preterm manikins using conventional epinephrine or novel prefilled epinephrine syringes specified for patient weight and administration route. All scenarios were video-recorded. Two investigators analyzed video-recordings for time to epinephrine preparation and administration. Differences between conventional and novel techniques were evaluated using Wilcoxon Signed Rank Tests.Twenty-one subjects completed 42 scenarios with conventional epinephrine and 42 scenarios with novel prefilled syringes. Epinephrine preparation was faster using novel prefilled epinephrine syringes (median = 17.0 sec, IQR 13.3 - 22.8) compared to conventional epinephrine (median = 48.0 sec, IQR 40.5 - 54.9), n = 42, z = 5.64, p < 0.001. Epinephrine administration was also faster using novel prefilled epinephrine syringes (median = 26.9 sec, IQR 22.1 - 33.2) compared to conventional epinephrine (median 57.6 sec, IQR 48.8 - 66.8), n = 42, z = 5.63, p < 0.001. In a post-study survey, all subjects supported the clinical adoption of prefilled epinephrine syringes.During simulated neonatal resuscitation, epinephrine preparation and administration are faster using novel prefilled epinephrine syringes, which may hasten return of spontaneous circulation and be lifesaving for bradycardic neonates in clinical practice.

  View details for DOI 10.1055/a-2082-4729

  View details for PubMedID 37105225

• Implementation of Video Laryngoscope Assisted Coaching Reduces Adverse Tracheal Intubation Associated Events in the PICU. Critical care medicine Giuliano, J. J., Krishna, A., Napolitano, N., Panisello, J., Shenoi, A., Sanders, R. C., Rehder, K., Al-Subu, A., Brown, C. 3., Edwards, L., Wright, L., Pinto, M., Harwayne-Gidansky, I., Parsons, S., Romer, A., Laverriere, E., Shults, J., Yamada, N. K., Walsh, C. M., Nadkarni, V., Nishisaki, A., National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network 2023

  Abstract

  OBJECTIVES: To evaluate implementation of a video laryngoscope (VL) as a coaching device to reduce adverse tracheal intubation associated events (TIAEs).DESIGN: Prospective multicenter interventional quality improvement study.SETTING: Ten PICUs in North America.PATIENTS: Patients undergoing tracheal intubation in the PICU.INTERVENTIONS: VLs were implemented as coaching devices with standardized coaching language between 2016 and 2020. Laryngoscopists were encouraged to perform direct laryngoscopy with video images only available in real-time for experienced supervising clinician-coaches.MEASUREMENTS AND MAIN RESULTS: The primary outcome was TIAEs. Secondary outcomes included severe TIAEs, severe hypoxemia (oxygen saturation < 80%), and first attempt success. Of 5,060 tracheal intubations, a VL was used in 3,580 (71%). VL use increased from baseline (29.7%) to implementation phase (89.4%; p < 0.001). VL use was associated with lower TIAEs (VL 336/3,580 [9.4%] vs standard laryngoscope [SL] 215/1,480 [14.5%]; absolute difference, 5.1%; 95% CI, 3.1-7.2%; p < 0.001). VL use was associated with lower severe TIAE rate (VL 3.9% vs SL 5.3%; p = 0.024), but not associated with a reduction in severe hypoxemia (VL 15.7% vs SL 16.4%; p = 0.58). VL use was associated with higher first attempt success (VL 71.8% vs SL 66.6%; p < 0.001). In the primary analysis after adjusting for site clustering, VL use was associated with lower adverse TIAEs (odds ratio [OR], 0.61; 95% CI, 0.46-0.81; p = 0.001). In secondary analyses, VL use was not significantly associated with severe TIAEs (OR, 0.72; 95% CI, 0.44-1.19; p = 0.20), severe hypoxemia (OR, 0.95; 95% CI, 0.73-1.25; p = 0.734), or first attempt success (OR, 1.28; 95% CI, 0.98-1.67; p = 0.073). After further controlling for patient and provider characteristics, VL use was independently associated with a lower TIAE rate (adjusted OR, 0.65; 95% CI, 0.49-0.86; p = 0.003).CONCLUSIONS: Implementation of VL assisted coaching achieved a high level of adherence across the PICUs. VL use was associated with reduced adverse TIAEs.

  View details for DOI 10.1097/CCM.0000000000005847

  View details for PubMedID 37058348

• The Debriefing Assessment in Real Time (DART) tool for simulation-based medical education. Advances in simulation (London, England) Baliga, K., Halamek, L. P., Warburton, S., Mathias, D., Yamada, N. K., Fuerch, J. H., Coggins, A. 2023; 8 (1): 9

  Abstract

  BACKGROUND: Debriefing is crucial for enhancing learning following healthcare simulation. Various validated tools have been shown to have contextual value for assessing debriefers. The Debriefing Assessment in Real Time (DART) tool may offer an alternative or additional assessment of conversational dynamics during debriefings.METHODS: This is a multi-method international study investigating reliability and validity. Enrolled raters (n = 12) were active simulation educators. Following tool training, the raters were asked to score a mixed sample of debriefings. Descriptive statistics are recorded, with coefficient of variation (CV%) and Cronbach's alpha used to estimate reliability. Raters returned a detailed reflective survey following their contribution. Kane's framework was used to construct validity arguments.RESULTS: The 8 debriefings (mu = 15.4 min (SD 2.7)) included 45 interdisciplinary learners at various levels of training. Reliability (mean CV%) for key components was as follows: instructor questions mu = 14.7%, instructor statements mu = 34.1%, and trainee responses mu = 29.0%. Cronbach alpha ranged from 0.852 to 0.978 across the debriefings. Post-experience responses suggested that DARTs can highlight suboptimal practices including unqualified lecturing by debriefers.CONCLUSION: The DART demonstrated acceptable reliability and may have a limited role in assessment of healthcare simulation debriefing. Inherent complexity and emergent properties of debriefing practice should be accounted for when using this tool.

  View details for DOI 10.1186/s41077-023-00248-1

  View details for PubMedID 36918946

• 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces CIRCULATION Wyckoff, M. H., Greif, R., Morley, P. T., Ng, K., Olasveengen, T. M., Singletary, E. M., Soar, J., Cheng, A., Drennan, I. R., Liley, H. G., Scholefield, B. R., Smyth, M. A., Welsford, M., Zideman, D. A., Acworth, J., Aickin, R., Andersen, L. W., Atkins, D., Berry, D. C., Bhanji, F., Bierens, J., Borra, V., Bottiger, B. W., Bradley, R. N., Bray, J. E., Breckwoldt, J., Callaway, C. W., Carlson, J. N., Cassan, P., Castren, M., Chang, W., Charlton, N. P., Chung, S., Considine, J., Costa-Nobre, D. T., Couper, K., Couto, T., Dainty, K. N., Davis, P. G., de Almeida, M., de Caen, A. R., Deakin, C. D., Djarv, T., Donnino, M. W., Douma, M. J., Duff, J. P., Dunne, C. L., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Finn, J., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A., Guinsburg, R., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M., Kim, H., Kleinman, M., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y., Lockey, A. S., Maconochie, I. K., Madar, R., Hansen, C., Masterson, S., Matsuyama, T., McKinlay, C. D., Meyran, D., Morgan, P., Morrison, L. J., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., O'Neill, B. J., Ong, Y., Orkin, A. M., Paiva, E. F., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Rudiger, M., Sakamoto, T., Sandroni, C., Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Sugiura, T., Tijssen, J. A., Trevisanuto, D., Van de Voorde, P., Wang, T., Weiner, G. M., Wyllie, J. P., Yang, C., Yeung, J., Nolan, J. P., Berg, K. M. 2022; 146 (25): E483-E557

  Abstract

  This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

  View details for DOI 10.1161/CIR.0000000000001095

  View details for Web of Science ID 000928164500001

  View details for PubMedID 36325905

• 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces RESUSCITATION Wyckoff, M. H., Greif, R., Morley, P. T., Ng, K., Olasveengen, T. M., Singletary, E. M., Soar, J., Cheng, A., Drennan, I. R., Liley, H. G., Scholefield, B. R., Smyth, M. A., Welsford, M., Zideman, D. A., Acworth, J., Aickin, R., Andersen, L. W., Atkins, D., Berry, D. C., Bhanji, F., Bierens, J., Borra, V., Boettiger, B. W., Bradley, R. N., Bray, J. E., Breckwoldt, J., Callaway, C. W., Carlson, J. N., Cassan, P., Castren, M., Chang, W., Charlton, N. P., Chung, S., Considine, J., Costa-Nobre, D. T., Couper, K., Couto, T., Dainty, K. N., Davis, P. G., de Almeida, M., de Caen, A. R., Deakin, C. D., Djarv, T., Donnino, M. W., Douma, M. J., Duff, J. P., Dunne, C. L., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Finn, J., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A., Guinsburg, R., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M., Kim, H., Kleinman, M., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y., Lockey, A. S., Maconochie, I. K., Madar, R., Hansen, C., Masterson, S., Matsuyama, T., McKinlay, C. D., Meyran, D., Morgan, P., Morrison, L. J., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., O'Neill, B. J., Ong, Y., Orkin, A. M., Paiva, E. F., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Ruediger, M., Sakamoto, T., Sandroni, C., Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Sugiura, T., Tijssen, J. A., Trevisanuto, D., Van de Voorde, P., Wang, T., Weiner, G. M., Wyllie, J. P., Yang, C., Yeung, J., Nolan, J. P., Berg, K. M. 2022; 181: 208-288

  Abstract

  This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

  View details for DOI 10.1016/j.resuscitation.2022.10.005

  View details for Web of Science ID 001072601200001

  View details for PubMedID 36336195

• Pilot study of the DART tool - an objective healthcare simulation debriefing assessment instrument. BMC medical education Baliga, K., Coggins, A., Warburton, S., Mathias, D., Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2022; 22 (1): 636

  Abstract

  BACKGROUND: Various rating tools aim to assess simulation debriefing quality, but their use may be limited by complexity and subjectivity. The Debriefing Assessment in Real Time (DART) tool represents an alternative debriefing aid that uses quantitative measures to estimate quality and requires minimal training to use. The DART isuses a cumulative tally of instructor questions (IQ), instructor statements (IS) and trainee responses (TR). Ratios for IQ:IS and TR:[IQ+IS] may estimate the level of debriefer inclusivity and participant engagement.METHODS: Experienced faculty from four geographically disparate university-affiliated simulation centers rated video-based debriefings and a transcript using the DART. The primary endpoint was an assessment of the estimated reliability of the tool. The small sample size confined analysis to descriptive statistics and coefficient of variations (CV%) as an estimate of reliability.RESULTS: Ratings for Video A (n=7), Video B (n=6), and Transcript A (n=6) demonstrated mean CV% for IQ (27.8%), IS (39.5%), TR (34.8%), IQ:IS (40.8%), and TR:[IQ+IS] (28.0%). Higher CV% observed in IS and TR may be attributable to rater characterizations of longer contributions as either lumped or split. Lower variances in IQ and TR:[IQ+IS] suggest overall consistency regardless of scores being lumped or split.CONCLUSION: The DART tool appears to be reliable for the recording of data which may be useful for informing feedback to debriefers. Future studies should assess reliability in a wider pool of debriefings and examine potential uses in faculty development.

  View details for DOI 10.1186/s12909-022-03697-w

  View details for PubMedID 35989331

• Supraglottic Airways Compared With Face Masks for Neonatal Resuscitation: A Systematic Review. Pediatrics Yamada, N. K., McKinlay, C. J., Quek, B. H., Schmolzer, G. M., Wyckoff, M. H., Liley, H. G., Rabi, Y., Weiner, G. M. 2022

  Abstract

  BACKGROUND AND OBJECTIVES: Positive pressure ventilation (PPV) is the most important component of neonatal resuscitation, but face mask ventilation can be difficult. Compare supraglottic airway devices (SA) with face masks for term and late preterm infants receiving PPV immediately after birth.METHODS: Data sources include Medline, Embase, Cochrane Databases, Database of Abstracts of Reviews of Effects, and Cumulative Index to Nursing and Allied Health Literature. Study selections include randomized, quasi-randomized, interrupted time series, controlled before-after, and cohort studies with English abstracts. Two authors independently extracted data and assessed risk of bias and certainty of evidence. The primary outcome was failure to improve with positive pressure ventilation. When appropriate, data were pooled using fixed effect models.RESULTS: Meta-analysis of 6 randomized controlled trials (1823 newborn infants) showed that use of an SA decreased the probability of failure to improve with PPV (relative risk 0.24; 95% confidence interval 0.17 to 0.36; P <.001, moderate certainty) and endotracheal intubation (4 randomized controlled trials, 1689 newborn infants) in the delivery room (relative risk 0.34, 95% confidence interval 0.20 to 0.56; P <.001, low certainty). The duration of PPV and time until heart rate >100 beats per minute was shorter with the SA. There was no difference in the use of chest compressions or epinephrine during resuscitation. Certainty of evidence was low or very low for most outcomes.CONCLUSIONS: Among late preterm and term infants who require resuscitation after birth, ventilation may be more effective if delivered by SA rather than face mask and may reduce the need for endotracheal intubation.

  View details for DOI 10.1542/peds.2022-056568

  View details for PubMedID 35948789

• A prospective observational study of video laryngoscopy guided coaching in the PICU. Paediatric anaesthesia Laverriere, E., Fiadjoe, J. E., McGowan, N., Bruins, B. B., Napolitano, N., Watanabe, I., Yamada, N. K., Walsh, C. M., Berg, R. A., Nadkarni, V. M., Nishisaki, A. 2022

  Abstract

  BACKGROUND: There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room.AIM: Our primary aim is to evaluate whether implementation of video laryngoscopy guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events.METHODS: This is a pre-post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single-center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation-associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured.RESULTS: Among 580 tracheal intubations, 284 (49%) were performed during the pre-implementation phase, and 296 (51%) post-implementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% post-implementation) and sustained. There were no statistically significant differences in adverse tracheal intubation-associated events between the two phases (pre- 9% vs. post- 5%, absolute difference -3%, CI95 : -8% to 1%, p =0.11), oxygen desaturations <80% (pre- 13% vs. post- 13%, absolute difference 1%, CI95 -6% to 5%, p =0.75), or first attempt success (pre- 73% vs. post- 76%, absolute difference 4%, CI95 -3% to 11%, p =0.29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI95 23% to 51%, p <0.001).CONCLUSIONS: Implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.

  View details for DOI 10.1111/pan.14505

  View details for PubMedID 35656910

• Impact of bed height on the biomechanics of healthcare professionals during chest compressions on the neonate: a descriptive pilot study. BMJ open Parent-Nichols, J., Perez, J., Witherell, B., McWilliam, P., Halamek, L. P., Kent, N., Varnum, W., Yamada, N. K. 2021; 11 (9): e047666

  Abstract

  OBJECTIVES: The biomechanics of the healthcare professionals (HCPs) performing the life-saving intervention of chest compressions in the neonatal population is poorly understood. The aim of this pilot study was to describe the variations in body position at a self-selected and a predetermined bed height during neonatal chest compressions. Measures of joint angles, time to postural sway and number of postural adjustments were chosen as indices for the stability of the HCP's position.SETTING: Data were collected at a simulation-based research centre in which the patient care environment was replicated.PARTICIPANTS: HCPs with varying roles working in the neonatal intensive care unit and holding a current Neonatal Resuscitation Program Provider certification were recruited for this study.INTERVENTIONS: Fifteen HCPs performed two trials of chest compressions, each lasting 2min, at a predetermined bed height and a self-selected bed height. Trials were video recorded, capturing upper and lower body movements. Videos were analysed for time to postural sway and number of postural adjustments. Joint angles were measured at the start and end of each trial.RESULTS: A statistically significant difference was found between the two bed height conditions for number of postural adjustments (p=0.02). While not statistically significant, time postural sway was increased in the choice bed height condition (85s) compared with the predetermined bed height (45s). After 30s of chest compressions, mean shoulder and knee angles were smaller for choice bed height (p=0.03, 95%CI Lower=-12.14, Upper=-0.68and p=0.05, 95%CI Lower=3.43, Upper=0.01, respectively). After 1min and 45s of chest compressions, mean wrist angles were smaller in the choice bed height condition (p=0.01, 95%CI Lower=-9.20, Upper=-1.22), stride length decreased between the 30s and 1min 45s marks of the chest compressions in the predetermined height condition (p=0.02).

  View details for DOI 10.1136/bmjopen-2020-047666

  View details for PubMedID 34531209

• Use of briefing and debriefing in neonatal resuscitation, a scoping review. Resuscitation plus Fawke, J., Stave, C., Yamada, N. 2021; 5: 100059

  Abstract

  Aim: To review the literature on briefing and debriefing in neonatal resuscitation using International Liaison Committee on Resuscitation (ILCOR) methodology to see if a formal systematic review is justified.Methods: This scoping review was undertaken by an ILCOR Newborn Life Support scoping review team and guided by the ILCOR methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were peer-reviewed, compared briefing/debriefing of healthcare professionals who had completed a neonatal resuscitation or simulated resuscitation and reported outcomes for infants, families or staff. PubMed, Embase, Cochrane, and Web of Science databases were searched.Results: This review included four studies that reported on three briefing/debriefing interventions: video debriefing, the use of checklists with a briefing/debriefing component and rapid cycle deliberate practice. Video debriefing was associated with improvements in the process of care and adherence to resuscitation guidelines. Use of checklists was associated with improvements in short term clinical outcomes and a reduction in communication problems. Rapid cycle deliberate practice may lead to short but not sustained improvements in algorithm compliance and timely completion of resuscitation steps.Conclusion: This scoping review did not identify sufficient new evidence to justify conducting new systematic reviews or review of current resuscitation guidelines. Improvements in the process of care, short term clinical outcomes and reduction in communication problems were associated with briefing/debriefing supported by video, checklists or rapid, cycle deliberate practice. It highlights knowledge gaps, including the need to consider briefing/debriefing separately from other interventions, the effect of briefing/debriefing on short- and long-term clinical outcomes and the effect of rapid cycle deliberate practice on resuscitation training.

  View details for DOI 10.1016/j.resplu.2020.100059

  View details for PubMedID 34223331

• Lessons Learned from a Collaborative to Develop a Sustainable Simulation-Based Training Program in Neonatal Resuscitation: Simulating Success. Children (Basel, Switzerland) Arul, N. n., Ahmad, I. n., Hamilton, J. n., Sey, R. n., Tillson, P. n., Hutson, S. n., Narang, R. n., Norgaard, J. n., Lee, H. C., Bergin, J. n., Quinn, J. n., Halamek, L. P., Yamada, N. K., Fuerch, J. n., Chitkara, R. n. 2021; 8 (1)

  Abstract

  Newborn resuscitation requires a multidisciplinary team effort to deliver safe, effective and efficient care. California Perinatal Quality Care Collaborative's Simulating Success program was designed to help hospitals implement on-site simulation-based neonatal resuscitation training programs. Partnering with the Center for Advanced Pediatric and Perinatal Education at Stanford, Simulating Success engaged hospitals over a 15 month period, including three months of preparatory training and 12 months of implementation. The experience of the first cohort (Children's Hospital of Orange County (CHOC), Sharp Mary Birch Hospital for Women and Newborns (SMB) and Valley Children's Hospital (VCH)), with their site-specific needs and aims, showed that a multidisciplinary approach with a sound understanding of simulation methodology can lead to a dynamic simulation program. All sites increased staff participation. CHOC reduced latent safety threats measured during team exercises from 4.5 to two per simulation while improving debriefing skills. SMB achieved 100% staff participation by identifying unit-specific hurdles within in situ simulation. VCH improved staff confidence level in responding to neonatal codes and proved feasibility of expanding simulation across their hospital system. A multidisciplinary approach to quality improvement in neonatal resuscitation fosters engagement, enables focus on patient safety rather than individual performance, and leads to identification of system issues.

  View details for DOI 10.3390/children8010039

  View details for PubMedID 33445638

• Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery. PloS one Sotto, K. T., Hedli, L. C., Sie, L., Padua, K., Yamada, N., Lee, H., Halamek, L., Daniels, K., Nathan-Roberts, D., Austin, N. S. 2021; 16 (6): e0252888

  Abstract

  OBJECTIVE: This study aimed to begin to address this gap using validated techniques in human factors to perform a participatory user-centered analysis of physical space during emergency Cesarean.METHODS: This study employed a mixed-methods design. Focus group interviews and surveys were administered to a convenience sample (n = 34) of multidisciplinary obstetric teams. Data collected from focus group interviews were used to perform a task and equipment analysis. Survey data were coded and mapped by specialty to identify reported areas of congestion and time spent, and to identify themes related to physical space of the OR and labor and delivery unit.RESULTS: Task analysis revealed complex interdependencies between specialties. Thirty task groupings requiring over 20 pieces of equipment were identified. Perceived areas of congestion and areas of time spent in the OR varied by clinical specialty. The following categories emerged as main challenges encountered during an emergency Cesarean: 1) size of physical space and equipment, 2) layout and orientation, and 3) patient transport.CONCLUSION: User insights on physical space and workflow processes during emergency Cesarean section at the institution studied revealed challenges related to getting the patients into the OR expediently and having space to perform tasks without crowding or staff injury. By utilizing human factors techniques, other institutions may build upon our findings to improve safety during emergency situations on labor and delivery.

  View details for DOI 10.1371/journal.pone.0252888

  View details for PubMedID 34111177

• A Neonatal Intensive Care Unit's Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative. Children (Basel, Switzerland) Eckels, M. n., Zeilinger, T. n., Lee, H. C., Bergin, J. n., Halamek, L. P., Yamada, N. n., Fuerch, J. n., Chitkara, R. n., Quinn, J. n. 2020; 7 (11)

  Abstract

  Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality. In Simulating Success, a 15-month quality improvement (QI) project, the Center for Advanced Pediatric and Perinatal Education (CAPE) and California Perinatal Quality Care Collaborative (CPQCC) provided outreach and training on neonatal simulation and debriefing fundamentals to individual teams, including community hospital settings, and assisted in implementing a sustainable program at each site. The primary Aim was to conduct two simulations a month, with a goal of 80% neonatal intensive care unit (NICU) staff participation in two simulations during the implementation phase. While the primary Aim was not achieved, in-situ simulations led to the identification of latent safety threats and improvement in system processes. This paper describes one unit's QI collaborative experience implementing an in-situ neonatal simulation and debriefing program.

  View details for DOI 10.3390/children7110202

  View details for PubMedID 33137897

• Validation of an Instrument for Real-Time Assessment of Neonatal Intubation Skills: A Randomized Controlled Simulation Study. American journal of perinatology Kuijpers, L. J., Binkhorst, M. n., Yamada, N. K., Bouwmeester, R. N., van Heijst, A. F., Halamek, L. P., Hogeveen, M. n. 2020

  Abstract

   This study aimed to evaluate the construct validity and reliability of real-time assessment of a previously developed neonatal intubation scoring instrument (NISI). We performed a randomized controlled simulation study at a simulation-based research and training facility. Twenty-four clinicians experienced in neonatal intubation ("experts") and 11 medical students ("novices") performed two identical elective intubations on a neonatal patient simulator. Subjects were randomly assigned to either the intervention group, receiving predefined feedback between the two intubations, or the control group, receiving no feedback. Using the previously developed NISI, all intubations were assessed, both in real time and remotely on video. Construct validity was evaluated by (1) comparing the intubation performances, expressed as percentage scores, with and without feedback, and (2) correlating the intubation performances with the subjects' level of experience. The intrarater reliability, expressed as intraclass correlation coefficient (ICC), of real-time assessment compared with video-based assessment was determined. The intervention group contained 18 subjects, the control group 17. Background characteristics and baseline intubation scores were comparable in both groups. The median (IQR) change in percentage scores between the first and second intubation was significantly different between the intervention and control group (11.6% [4.7-22.8%] vs. 1.4% [0.0-5.7%], respectively; p = 0.013). The 95% CI for this 10.2% difference was 2.2 to 21.4%. The subjects' experience level correlated significantly with their percentage scores (Spearman's R = 0.70; p <0.01). ICC's were 0.95 (95% CI: 0.89-0.97) and 0.94 (95% CI: 0.89-0.97) for the first and second intubation, respectively. Our NISI has construct validity and is reliable for real-time assessment.· Our neonatal intubation scoring instrument has construct validity.. · Our instrument can be reliably employed to assess neonatal intubation skills directly in real time.. · It is suitable for formative assessment, i.e., providing direct feedback during procedural training..

  View details for DOI 10.1055/s-0040-1715530

  View details for PubMedID 32898921

• 2019 American Heart Association Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics Escobedo, M. B., Aziz, K., Kapadia, V. S., Lee, H. C., Niermeyer, S., Schmölzer, G. M., Szyld, E., Weiner, G. M., Wyckoff, M. H., Yamada, N. K., Zaichkin, J. G. 2019

  Abstract

  This 2019 focused update to the American Heart Association neonatal resuscitation guidelines is based on 2 evidence reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. The International Liaison Committee on Resuscitation Expert Systematic Reviewer and content experts performed comprehensive reviews of the scientific literature on the appropriate initial oxygen concentration for use during neonatal resuscitation in 2 groups: term and late-preterm newborns (≥35 weeks of gestation) and preterm newborns (<35 weeks of gestation). This article summarizes those evidence reviews and presents recommendations. The recommendations for neonatal resuscitation are as follows: In term and late-preterm newborns (≥35 weeks of gestation) receiving respiratory support at birth, the initial use of 21% oxygen is reasonable. One hundred percent oxygen should not be used to initiate resuscitation because it is associated with excess mortality. In preterm newborns (<35 weeks of gestation) receiving respiratory support at birth, it may be reasonable to begin with 21% to 30% oxygen and to base subsequent oxygen titration on oxygen saturation targets. These guidelines require no change in the Neonatal Resuscitation Algorithm-2015 Update.

  View details for DOI 10.1542/peds.2019-1362

  View details for PubMedID 31727863

• Appraisal of a scoring instrument for training and testing neonatal intubation skills ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION Bouwmeester, R. N., Binkhorst, M., Yamada, N. K., Geurtzen, R., van Heijst, A. J., Halamek, L. P., Draaisma, J. T., Hogeveen, M. 2019; 104 (5): F521–F527

  View details for DOI 10.1136/archdischild-2018-315221

  View details for Web of Science ID 000501744900012

• The role of human factors in neonatal patient safety. Seminars in perinatology Yamada, N. K., Catchpole, K., Salas, E. 2019: 151174

  Abstract

  The relationship between the fields of human factors and patient safety is relatively nascent but represents a powerful interaction that has developed in only the last twenty years. Application of human factors principles, techniques, and science can facilitate the development of healthcare systems, protocols, and technology that leverage the enormous and adaptable capacity of human performance while acknowledging human vulnerability and decreasing the risk of error during patient care. This chapter will review these concepts and employ case studies from neonatal care to demonstrate how an understanding of human factors can be applied to improve patient safety.

  View details for DOI 10.1053/j.semperi.2019.08.003

  View details for PubMedID 31477264

• Ergonomic Challenges Inherent in Neonatal Resuscitation. Children (Basel, Switzerland) Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2019; 6 (6)

  Abstract

  Neonatal resuscitation demands that healthcare professionals perform cognitive and technical tasks while working under time pressure as a team in order to provide efficient and effective care. Neonatal resuscitation teams simultaneously process and act upon multiple data streams, perform ergonomically challenging technical procedures, and coordinate their actions within a small physical space. An understanding and application of human factors and ergonomics science broadens the areas of need in resuscitation research, and will lead to enhanced technologies, systems, and work environments that support human limitations and maximize human performance during neonatal resuscitation.

  View details for DOI 10.3390/children6060074

  View details for PubMedID 31163596

• 2019 American Heart Association Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation Escobedo, M. B., Aziz, K. n., Kapadia, V. S., Lee, H. C., Niermeyer, S. n., Schmölzer, G. M., Szyld, E. n., Weiner, G. M., Wyckoff, M. H., Yamada, N. K., Zaichkin, J. G. 2019: CIR0000000000000729

  Abstract

  This 2019 focused update to the American Heart Association neonatal resuscitation guidelines is based on 2 evidence reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. The International Liaison Committee on Resuscitation Expert Systematic Reviewer and content experts performed comprehensive reviews of the scientific literature on the appropriate initial oxygen concentration for use during neonatal resuscitation in 2 groups: term and late-preterm newborns (≥35 weeks of gestation) and preterm newborns (<35 weeks of gestation). This article summarizes those evidence reviews and presents recommendations. The recommendations for neonatal resuscitation are as follows: In term and late-preterm newborns (≥35 weeks of gestation) receiving respiratory support at birth, the initial use of 21% oxygen is reasonable. One hundred percent oxygen should not be used to initiate resuscitation because it is associated with excess mortality. In preterm newborns (<35 weeks of gestation) receiving respiratory support at birth, it may be reasonable to begin with 21% to 30% oxygen and to base subsequent oxygen titration on oxygen saturation targets. These guidelines require no change in the Neonatal Resuscitation Algorithm-2015 Update.

  View details for DOI 10.1161/CIR.0000000000000729

  View details for PubMedID 31724451

• Appraisal of a scoring instrument for training and testing neonatal intubation skills. Archives of disease in childhood. Fetal and neonatal edition Bouwmeester, R. N., Binkhorst, M., Yamada, N. K., Geurtzen, R., van Heijst, A. F., Halamek, L. P., Draaisma, J. M., Hogeveen, M. 2018

  Abstract

  OBJECTIVE: To determine the validity, reliability, feasibility and applicability of a neonatal intubation scoring instrument.DESIGN: Prospective observational study.SETTING: Simulation-based research and training centre (Center for Advanced Pediatric and Perinatal Education), California, USA.SUBJECTS: Forty clinicians qualified for neonatal intubation.INTERVENTIONS: Videotaped elective intubations on a neonatal patient simulator were scored by two independent raters. One rater scored the intubations twice. We scored the preparation of equipment and premedication, intubation performance, tube position/fixation, communication, number of attempts, duration and successfulness of the procedure.MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICC) were calculated for intrarater and inter-rater reliability. Kappa coefficients for individual items and mean kappa coefficients for all items combined were calculated. Construct validity was assessed with one-way analysis of variance using the hypothesis that experienced clinicians score higher than less experienced clinicians. The approximate time to score one intubation and the instrument's applicability in another setting were evaluated.RESULTS: ICCs for intrarater and inter-rater reliability were 0.99 (95% CI 0.98 to 0.99) and 0.89 (95% CI 0.35 to 0.96), and mean kappa coefficients were 0.93 (95% CI 0.85 to 1.01) and 0.71 (95% CI 0.56 to 0.92), respectively. There were no differences between the more and less experienced clinicians regarding preparation, performance, communication and total scores. The experienced group scored higher only on tube position/fixation (p=0.02). Scoring one intubation took approximately 15min. Our instrument, developed in The Netherlands, could be readily applied in the USA.CONCLUSIONS: Our scoring instrument for simulated neonatal intubations appears to be reliable, feasible and applicable in another centre. Construct validity could not be established.

  View details for PubMedID 30504442

• Perspectives on periviability counselling and decision-making differed between neonatologists in the United States and the Netherlands ACTA PAEDIATRICA Schrijvers, N. M., Geurtzen, R., Draaisma, J. T., Halamek, L. P., Yamada, N. K., Hogeveen, M. 2018; 107 (10): 1710–15

  Abstract

  American guidelines suggest that neonatal resuscitation be considered at 23 weeks of gestation, one week earlier than in the Netherlands, but how counselling practices differ at the threshold of viability is unknown. This pilot study compared prenatal periviability counselling in the two countries.In 2013, a cross-sectional survey was sent to 121 Dutch neonatologists as part of a nationwide evaluation of prenatal counselling. In this pilot study, the same survey was sent to a convenience sample of 31 American neonatologists in 2014. The results were used to compare the organisation, content and decision-making processes in prenatal counselling at 24 weeks of gestation between the two countries.The survey was completed by 17 (55%) American and 77 (64%) Dutch neonatologists. American neonatologists preferred to meet with parents more frequently, for longer periods of time, and to discuss more intensive care topics, including long-term complications, than Dutch neonatologists. Neonatologists from both countries preferred shared decision-making when deciding whether to initiate intensive care.Neonatologists in the United States and the Netherlands differed in their approach to prenatal counselling at 24 weeks of gestation. Cross-cultural differences may play a role.

  View details for PubMedID 29603788

• Optimal human and system performance during neonatal resuscitation. Seminars in fetal & neonatal medicine Yamada, N. K., Kamlin, C. O., Halamek, L. P. 2018

  Abstract

  Performance in the delivery of care to sick neonates in need of resuscitation has long been defined primarily in terms of the extent of the knowledge possessed and hands-on skill demonstrated by physicians and other healthcare professionals. This definition of performance in neonatal resuscitation is limited by its focus solely on the human beings delivering care and a perceived set of the requisite skills to do so. This manuscript will expand the definition of performance to include all of the skill sets that humans must use to resuscitate newborns as well as the often complex systems in which those humans operate while delivering that care. It will also highlight how the principles of human factors and ergonomics can be used to enhance human and system performance during patient care. Finally, it will describe the role of simulation and debriefing in the assessment of human and system performance.

  View details for DOI 10.1016/j.siny.2018.03.006

  View details for PubMedID 29571705

• Simulation-Based Patient-Specific Multidisciplinary Team Training in Preparation for the Resuscitation and Stabilization of Conjoined Twins AMERICAN JOURNAL OF PERINATOLOGY Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2017; 34 (6): 621-626

  Abstract

  The resuscitation of conjoined twins is a rare and complex clinical challenge. We detail how patient-specific, in situ simulation can be used to prepare a large, multidisciplinary team of health care professionals (HCPs) to deliver safe, efficient, and effective care to such patients. In this case, in situ simulation allowed an 18-person team to address the clinical and ergonomic challenges anticipated for this neonatal resuscitation. The HCPs trained together as an intact team in the actual delivery room environment to probe for human and system weaknesses prior to this unique delivery, and optimized communication, teamwork, and other behavioral skills as they prepared for the simultaneous resuscitation of two patients who were physically joined to one another.

  View details for DOI 10.1055/s-0036-1593808

  View details for Web of Science ID 000400074500016

• Impact of Standardized Communication Techniques on Errors during Simulated Neonatal Resuscitation. American journal of perinatology Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2016; 33 (4): 385-392

  Abstract

  Aim Current patterns of communication in high-risk clinical situations, such as resuscitation, are imprecise and prone to error. We hypothesized that the use of standardized communication techniques would decrease the errors committed by resuscitation teams during neonatal resuscitation. Methods In a prospective, single-blinded, matched pairs design with block randomization, 13 subjects performed as a lead resuscitator in two simulated complex neonatal resuscitations. Two nurses assisted each subject during the simulated resuscitation scenarios. In one scenario, the nurses used nonstandard communication; in the other, they used standardized communication techniques. The performance of the subjects was scored to determine errors committed (defined relative to the Neonatal Resuscitation Program algorithm), time to initiation of positive pressure ventilation (PPV), and time to initiation of chest compressions (CC). Results In scenarios in which subjects were exposed to standardized communication techniques, there was a trend toward decreased error rate, time to initiation of PPV, and time to initiation of CC. While not statistically significant, there was a 1.7-second improvement in time to initiation of PPV and a 7.9-second improvement in time to initiation of CC. Conclusions Should these improvements in human performance be replicated in the care of real newborn infants, they could improve patient outcomes and enhance patient safety.

  View details for DOI 10.1055/s-0035-1565997

  View details for PubMedID 26485251

• Modification of the Neonatal Resuscitation Program Algorithm for Resuscitation of Conjoined Twins. American journal of perinatology Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2016; 33 (4): 420-424

  Abstract

  There are no national or international guidelines for the resuscitation of conjoined twins. We have described how the U.S. Neonatal Resuscitation Program algorithm can be modified for delivery room resuscitation of omphaloischiopagus conjoined twins. In planning for the delivery and resuscitation of these patients, we considered the challenges of providing cardiopulmonary support to preterm conjoined twins in face-to-face orientation and with shared circulation via a fused liver and single umbilical cord. We also demonstrate how in situ simulation can be used to prepare a large, multidisciplinary team of health care professionals to deliver safe, efficient, and effective care to such patients.

  View details for DOI 10.1055/s-0035-1563713

  View details for PubMedID 26461924

• Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants. Journal of perinatology Wallenstein, M. B., Birnie, K. L., Arain, Y. H., Yang, W., Yamada, N. K., Huffman, L. C., Palma, J. P., Chock, V. Y., Shaw, G. M., Stevenson, D. K. 2016; 36 (2): 112-115

  Abstract

  To quantify the importance of successful endotracheal intubation on the first attempt among extremely low birth weight (ELBW) infants who require resuscitation after delivery.A retrospective chart review was conducted for all ELBW infants ⩽1000 g born between January 2007 and May 2014 at a level IV neonatal intensive care unit. Infants were included if intubation was attempted during the first 5 min of life or if intubation was attempted during the first 10 min of life with heart rate <100. The primary outcome was death or neurodevelopmental impairment. The association between successful intubation on the first attempt and the primary outcome was assessed using multivariable logistic regression with adjustment for birth weight, gestational age, gender and antenatal steroids.The study sample included 88 ELBW infants. Forty percent were intubated on the first attempt and 60% required multiple intubation attempts. Death or neurodevelopmental impairment occurred in 29% of infants intubated on the first attempt, compared with 53% of infants that required multiple attempts, adjusted odds ratio 0.4 (95% confidence interval 0.1 to 1.0), P<0.05.Successful intubation on the first attempt is associated with improved neurodevelopmental outcomes among ELBW infants. This study confirms the importance of rapid establishment of a stable airway in ELBW infants requiring resuscitation after birth and has implications for personnel selection and role assignment in the delivery room.Journal of Perinatology advance online publication, 5 November 2015; doi:10.1038/jp.2015.158.

  View details for DOI 10.1038/jp.2015.158

  View details for PubMedID 26540244

• Simulation in Paediatrics Manual of Simulation in Healthcare Yamada, N. K., Fuerch, J. H., Halamek, L. P. edited by Riley, R. Oxford University Press. 2016; 2nd: 383–396
• Analysis and classification of errors made by teams during neonatal resuscitation RESUSCITATION Yamada, N. K., Yaeger, K. A., Halamek, L. P. 2015; 96: 109-113

  Abstract

  The Neonatal Resuscitation Program (NRP) algorithm serves as a guide to healthcare professionals caring for neonates transitioning to extrauterine life. Despite this, adherence to the algorithm is challenging, and errors are frequent. Information-dense, high-risk fields such as air traffic control have proven that formal classification of errors facilitates recognition and remediation. This study was performed to determine and characterize common deviations from the NRP algorithm during neonatal resuscitation.Audiovisual recordings of 250 real neonatal resuscitations were obtained between April 2003 and May 2004. Of these, 23 complex resuscitations were analyzed for adherence to the contemporaneous NRP algorithm and scored using a novel classification tool based on the validated NRP Megacode Checklist.Seven hundred eighty algorithm-driven tasks were observed. One hundred ninety-four tasks were completed incorrectly, for an average error rate of 23%. Forty-two were errors of omission (28% of all errors) and 107 were errors of commission (72% of all errors). Many errors were repetitive and potentially clinically significant: failure to assess heart rate and/or breath sounds, improper rate of positive pressure ventilation, inadequate peak inspiratory and end expiratory pressures during ventilation, improper chest compression technique, and asynchronous PPV and CC.Errors of commission, especially when performing advanced life support interventions such as positive pressure ventilation, intubation, and chest compressions, are common during neonatal resuscitation and are sources of potential harm. The adoption of error reduction strategies capable of decreasing cognitive and technical load and standardizing communication - strategies common in other industries - should be considered in healthcare.

  View details for DOI 10.1016/j.resuscitation.2015.07.048

  View details for Web of Science ID 000366584500026

• Analysis and classification of errors made by teams during neonatal resuscitation. Resuscitation Yamada, N. K., Yaeger, K. A., Halamek, L. P. 2015; 96: 109-13

  Abstract

  The Neonatal Resuscitation Program (NRP) algorithm serves as a guide to healthcare professionals caring for neonates transitioning to extrauterine life. Despite this, adherence to the algorithm is challenging, and errors are frequent. Information-dense, high-risk fields such as air traffic control have proven that formal classification of errors facilitates recognition and remediation. This study was performed to determine and characterize common deviations from the NRP algorithm during neonatal resuscitation.Audiovisual recordings of 250 real neonatal resuscitations were obtained between April 2003 and May 2004. Of these, 23 complex resuscitations were analyzed for adherence to the contemporaneous NRP algorithm and scored using a novel classification tool based on the validated NRP Megacode Checklist.Seven hundred eighty algorithm-driven tasks were observed. One hundred ninety-four tasks were completed incorrectly, for an average error rate of 23%. Forty-two were errors of omission (28% of all errors) and 107 were errors of commission (72% of all errors). Many errors were repetitive and potentially clinically significant: failure to assess heart rate and/or breath sounds, improper rate of positive pressure ventilation, inadequate peak inspiratory and end expiratory pressures during ventilation, improper chest compression technique, and asynchronous PPV and CC.Errors of commission, especially when performing advanced life support interventions such as positive pressure ventilation, intubation, and chest compressions, are common during neonatal resuscitation and are sources of potential harm. The adoption of error reduction strategies capable of decreasing cognitive and technical load and standardizing communication - strategies common in other industries - should be considered in healthcare.

  View details for DOI 10.1016/j.resuscitation.2015.07.048

  View details for PubMedID 26282500

• Impact of a novel decision support tool on adherence to Neonatal Resuscitation Program algorithm RESUSCITATION Fuerch, J. H., Yamada, N. K., Coelho, P. R., Lee, H. C., Halamek, L. P. 2015; 88: 52-56

  Abstract

  Studies have shown that healthcare professionals (HCPs) display a 16-55% error rate in adherence to the Neonatal Resuscitation Program (NRP) algorithm. The aim of this study was to evaluate adherence to the Neonatal Resuscitation Program algorithm by subjects working from memory as compared to subjects using a decision support tool that provides auditory and visual prompts to guide implementation of the Neonatal Resuscitation Program algorithm during simulated neonatal resuscitation.Healthcare professionals (physicians, nurse practitioners, obstetrical/neonatal nurses) with a current NRP card were randomized to the control or intervention group and performed three simulated neonatal resuscitations. The scenarios were evaluated for the initiation and cessation of positive pressure ventilation (PPV) and chest compressions (CC), as well as the frequency of FiO2 adjustment. The Wilcoxon rank sum test was used to compare a score measuring the adherence of the control and intervention groups to the Neonatal Resuscitation Program algorithm.Sixty-five healthcare professionals were recruited and randomized to the control or intervention group. Positive pressure ventilation was performed correctly 55-80% of the time in the control group vs. 94-95% in the intervention group across all three scenarios (p<0.0001). Chest compressions were performed correctly 71-81% of the time in the control group vs. 82-93% in the intervention group in the two scenarios in which they were indicated (p<0.0001). FiO2 was addressed three times more frequently in the intervention group compared to the control group (p<0.001).Healthcare professionals using a decision support tool exhibit significantly fewer deviations from the Neonatal Resuscitation Program algorithm compared to those working from memory alone during simulated neonatal resuscitation.

  View details for DOI 10.1016/j.resuscitation.2014.12.016

  View details for PubMedID 25555358

• On the need for precise, concise communication during resuscitation: a proposed solution. journal of pediatrics Yamada, N. K., Halamek, L. P. 2015; 166 (1): 184-187

  View details for DOI 10.1016/j.jpeds.2014.09.027

  View details for PubMedID 25444016

• The Role of a Fetal Center in Preparing for a Conjoined Twin Delivery NeoReviews Fuerch, J. H., Yamada, N. K., Kobayashi, D., Hartman, G. E., Blumenfeld, Y. J., Hintz, S. R., Chock, V. Y. 2015; 16 (11): e617-623
• Communication during resuscitation: Time for a change? RESUSCITATION Yamada, N. K., Halamek, L. P. 2014; 85 (12): E191-E192

  View details for DOI 10.1016/j.resuscitation.2014.08.034

  View details for PubMedID 25277341

• The Neonatal Resuscitation Program: Current Recommendations and a Look at the Future INDIAN JOURNAL OF PEDIATRICS Kumar, P., Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2014; 81 (5): 473-480

  Abstract

  The Neonatal Resuscitation Program (NRP) consists of an algorithm and curriculum to train healthcare professionals to facilitate newborn infants' transition to extrauterine life and to provide a standardized approach to the care of infants who require more invasive support and resuscitation. This review discusses the most recent update of the NRP algorithm and recommended guidelines for the care of newly born infants. Current challenges in training and assessment as well as the importance of ergonomics in the optimization of human performance are discussed. Finally, it is recommended that in order to ensure high-performing resuscitation teams, members should be selected and retained based on objective performance criteria and frequent participation in realistic simulated clinical scenarios.

  View details for DOI 10.1007/s12098-013-1332-0

  View details for Web of Science ID 000335739000011

  View details for PubMedID 24652267

• When operating is considered futile: Difficult decisions in the neonatal intensive care unit SURGERY Yamada, N. V., Kodner, I. J., Brown, D. E. 2009; 146 (1): 122-125

  View details for DOI 10.1016/j.surg.2009.03.029

  View details for Web of Science ID 000267498600015

  View details for PubMedID 19548365