Acute Hypoxemia in Infants With Cyanotic Complex Cardiac Anatomy: Simulation Cases for Pediatric Fellows

Abstract

Introduction Cardiopulmonary compromises are infrequent but high-acuity events that occur at pediatric hospitals. Simulation is a powerful modality to teach fellows in pediatric critical care, cardiology, and neonatology important clinical skills in managing complex cardiorespiratory pathophysiology in infants with cyanotic heart disease. Methods We developed three simulation cases of hypoxemia involving differing complex cardiorespiratory pathophysiology in neonates/infants with cyanotic heart disease. Through teamwork, the participants were expected to recognize hypoxemia, work through a differential diagnosis, and implement the medical intervention needed to temporize while awaiting further procedures. Assessment of the participants' performance was via direct observation during the simulated activity. Debriefing occurred immediately using a formal debriefing framework. Results In 10 years, these three cases have been utilized approximately 48 times. Participants subjectively increased their confidence in managing cardiopulmonary events and improved their teamwork and communication skills in similar high-stress events. Discussion This unique module advanced learners' knowledge by building on their Pediatric Advanced Life Support and Neonatal Resuscitation Program foundation, identified management deficits in the care of patients with complex cardiorespiratory pathophysiology, and taught effective teamwork with role assignment and closed-loop communication.

Keywords

• Hypoxemia
• Hypoxia
• Hypoplastic Left Heart Syndrome
• Tetralogy of Fallot
• Transposition of Great Vessels
• Transposition of Great Arteries