Simulation in Neonatal Resuscitation

The use of RFM during simulated neonatal resuscitation is a useful tool to provide quantitative and qualitative assessment of the trainee’s resuscitation technique, identifying correct mask hold and positioning technique. 

Dempsey and Garvey review the current evidence on simulation based learning for neonatal resuscitation training and its effectiveness in the attainment and maintenance of high quality skills along with the development of new interventions and technologies in neonatal resuscitation. Looking at innovative ways to improve technical skills, the authors mention intermittent positive pressure ventilation (IPPV), intubation, chest compressions and administration of medication. 

When elaborating on the provision of IPPV, the use of Respiratory Function Monitors (RFM) as a way to measure adequate ventilation with estimate of leak and tidal volume, can be considered as useful in ascertaining proficiency. As demonstrated by Roehr in 2011, a RFM can provide quantitative and qualitative assessment of the trainee’s resuscitation technique, identifying correct mask hold and positioning techniques. 

RFMs have been shown to almost halve the incidence of leak during facemask ventilation and when used as part of Newborn Resuscitation Program (NRP) training, the use of an RFM improved the effectiveness of newborn ventilation. They have been used in the clinical environment in one randomized trial which showed that using an RFM was associated with significantly less mask leak, more mask adjustments, and a lower rate of excessive V(T). 

With regards to non-technical skills, several studies have shown the benefit of team training as part of the resuscitation course. Standardized precise communication as well as role assignment are other important aspects. Retention of skills remains a concern considering that studies show a significant decay in skills as early as 2 months after NRP. ILCOR guidelines highlight the necessity to ensure neonatal task training occure more frequently than every 2 years. 

The authors conclude that….’Simulation allows for regular refrehsers, deliberate practice and instant feedback where the learner is priority without the risk of jeopardizing patient safety.’