O2063: Impact of Delivery Room-Specific Critical Congenital Heart Disease Learning Modules on Knowledge and Technical Performance - A Multi-Center Educational Intervention and Simulation Study from LEARN-CHD

Background: Neonates with critical congenital heart disease (CCHD) require physiology-specific delivery room (DR) management. While a neonate with complete congenital heart block (CHB) requires prioritizing chronotropy over chest compressions and epinephrine, neonates with Transposition of Great Arteries with intact ventricular septum (TGA-IVS) and hypoplastic left heart syndrome (HLHS) require different approaches for hypoxia and hemodynamic instability. Such adaptations unique to physiology are not discussed in traditional DR resuscitation training, leading to knowledge gaps. We aimed to evaluate CCHD DR management eLearning modules through acceptance surveys, pre/post-knowledge tests, and simulation performance.

Methods: We performed a prospective multi-center study through the DeveLopment of EducationAl Modules for Resuscitation of Neonates in the Delivery Room with Congenital Heart Disease (LEARN-CHD) where neonatal healthcare providers (HCPs) were randomized to receive either journal articles or eLearning modules and then underwent the same simulation scenarios. All participants submitted pre- and post-intervention knowledge tests before team simulations where technical performance on baseline neonatal resuscitation (abruption) and specific CCHD scenarios were assessed. Scenarios included HLHS, TGA-IVS with restrictive atrial septum, and unstable CHB. Simulations were video-recorded and scored by two pairs of raters blinded to allocation using scenario-specific performance checklists. Performance of critical interventions was compared between groups.

Results: 32 teams from 9 centers participated (n=102). 87% of Modules group HCPs felt the modules were more effective than traditional educational methods.(Figure 1A). Modules group HCPs demonstrated improvement in knowledge test scores post-intervention (mean change 6.6+/-12.1%), compared with no improvement (-0.1+/-10.6%) in the Articles group (p=0.008) (Figure 1B). In simulations, there was no difference between groups in teams technical performance checklist scores in abruption, TGA-IVS, or CHB scenarios (Table 1). Teams in the Modules group had lower checklist scores for HLHS, as more teams chose to intubate rather than optimize mask ventilation when the infant developed apnea secondary to Prostin. Critical actions that need further education include prioritizing chronotropic interventions in CHB, avoiding excess oxygen in HLHS, and interventions to decrease metabolic demand and increase mixing in TGA-IVS.

Conclusion: Delivery room-specific CCHD learning modules were well-accepted by HCPs and resulted in improved post-intervention knowledge scores. Simulation performance in TGA-IVS and CHB management was similar, while HLHS performance was lower in the Modules group due to differences in approach to mask ventilation vs intubation. Video reviews highlighted key areas of focus for ongoing education to improve DR management of CCHD infants, as both standard neonatal resuscitation steps (i.e., mask ventilation) and CCHD-specific steps are important to successful neonatal transition.