S108 Abstracts / Resuscitation 85S (2014) S15–S121

fessionals are training as a team. Team training have its pros andcons. One of the issues surfaced was the preferred sequence todebriefing the nurses as nurses possess different skill set fromphysicians. We tried four different sequences to debriefing: (1)debrief team together, (2) short team debrief followed by sep-arate debrief for physicians and nurses, (3) separate debrief forphysicians and nurses, (4) debrief team together and nurses hadan additional debriefing session with nursing educators at the endof training session. A survey was conducted. Five nursing educatorsand thirty nurses who had undergone team resuscitation trainingparticipated.

Results: Among the nursing educators, three chose Sequence(2) as the preferred sequence of debriefing. This is followed bySequence (4). For the nurses, 97% preferred Sequence (2), theremaining 3% chose Sequence (3). The 4 sequences each has theirown merit. In our culture, Sequence (1) did not work out becausethe debrief tend to be centred on the physicians, nurses took back-stage. The majority of nurses preferred Sequence (2) because theinitial debrief concentrate on team dynamics, e.g. team work andcommunications, and the second part of debrief discuss deeperdetails of individual skill competencies by the nursing educators.

Conclusions: We found that the preferred method of debrief-ing was that of a short combined debrief together to iron out themajor issues, followed by a separate debriefing by the nursing edu-cators to highlight details pertinent to the nursing skill set for theemergency nurses.

http://dx.doi.org/10.1016/j.resuscitation.2014.03.267

AP219

Association of glial cell line-derivedneurotrophic factor (GDNF) protein expressionwith the neuronal death in post-resuscitationperiod

Maria Avruschenko, Irina Ostrova ∗

V.A. Negovsky Research Institute of GeneralReanimatology Russian Academy of MedicalSciences, Moscow, Russia

Purpose of the study: To evaluate an expression level of GDNFprotein in hypoxia-sensitive neuronal population of Purkinje cellsand its relationship with the neuronal death in post-resuscitationperiod.

Materials and methods: 40 adult white rats both sexes under-went 10-min circulatory arrest evoked by intrathoracic clamping ofcardiac vascular bundle, followed by resuscitation. Total density ofPurkinje cells (PC) of the cerebellum was determined by morpho-metric analysis on the 1, 4, 7, and 14th days of post-resuscitativeperiod. The expression of GDNF was detected by immunohisto-chemistry.

Results: There were revealed the increasing of GDNF expres-sion in the PC population in males on the 1th day after cardiacarrest: the number of positive neurons increased by 70.0%, whilethe number of negative neurons decreased by 35.4%. The total num-ber of PC was not changed. On the 4th postoperative day GDNFexpression decreased: the number of positive neurons fell to thecontrol level and the number of negative neurons was reduced by32.3%. Reducing the GDNF expression accompanied by neuronaldeath (the total number of PC decreased by 16.6%). Subsequently(7, 14th days) GDNF expression was not changed, and the processof neuronal death did not enhanced. Thus the number of positiveneurons did not differ from controls, while the number of negativeneurons was reduced. There were found similar changes in females.

However the GDNF expression level shifts, as well as neuronal celldeath developed later than in males.

Conclusions: The results demonstrated association betweenchanges in the level of GDNF protein expression and develop-ment of neuronal death in the post-resuscitation period. Initialrise of GDNF expression in neuronal populations can prevent neu-ronal death. The decrease of GDNF expression accompanied bythe neuronal loss. The results indicate that the GDNF protein levelis an important factor for sustainability of neurons to ischemia-reperfusion.

http://dx.doi.org/10.1016/j.resuscitation.2014.03.268

AP220

Use of the “resuscitation team leaderevaluation” to evaluate the leaders in paediatricCPR simulations

Andres Gonzalez 1, Carlos Gonzalez 3,∗, InigoGorostiza 2, Pedro Gamboa 3, Joseba Rementeria 1,Uxoa jimenez 1, Frederic Samson 1, Ainhoalarrauri 1

1 Pediatric Emergency Section, Basurto UniversityHospital, Bilbao, Spain2 Investigation Unit, Basurto University Hospital,Bilbao, Spain3 Pediatric Allergy Uni, Basurto University Hospital,Bilbao, Spain

Introduction and objective: “Resuscitation Team Leader Eval-uation (RTLE) is an evaluation tool for the leaders of the CPRsimulation, developed and validated by Grant et al. It consists of26 items, 12 evaluate leadership and communication (LCS) and 14knowledge and skills (KCS).

Objective: To evaluate the “Resuscitation Team Leader Evalua-tion”.

Material and methods: Descriptive study from September 2013to January 2014. In our emergency service, CPR simulations werecarried out, the traditional simulation (Laerdal Resuci Baby® andResuci Junior®) and the advanced simulation (Laerdal Simbaby®),with the intervention as leaders of 3rd-year Paediatric Residents(R3) and 4th-year paediatric residents (R4), graduates in PaediatricCPR by the Spanish Group of Paediatric and neonatal CPR (GER-CPyN). Each leader was evaluated by two Paediatric CPR instructors(GERCPyN). The instructors completed the RTLE for each leader.Analysis realized with the SPSS® 21 software.

Results: Twenty-six leaders participated. On 14 occasions, R4,and on 12 occasions, R3. The number of evaluators was 5. The meanscore of the RTLE was 66.67 (SD = 3.81), of the LCS 63.89 (SD = 6.09),of the KCS 64.1 (SD = 5.99). For the R4, the mean score of the RTLEwas 70.21% (SD = 4.1) and for the R3 66.5% (SD = 3.7) (p = 0.025).The correlation coefficient between total scores and evaluators wasr = 0.846; p < 0.001. The weighted kappa was > 0.5 in 18 of the 24items of the RTLE. The worst item evaluated was “Order appropriateinvestigations” (� = 1.75 over 3, SD = 0.682), the best item evaluatedwas “Obtain full cardiorespiratory monitoring and full set of vitalspromptly” (� = 2.65 over 3, SD = 0.556). The Cronbach’s alpha forthe set of the RTLE was 0.167, due to the sample size.

Conclusion: RTLE can be used as an effective tool for the evalua-tion of the leaders in the CPR simulations. The validation to Spanishby an existing tool would be advisable.

http://dx.doi.org/10.1016/j.resuscitation.2014.03.269