Abstract 10739: Simulation Based Assessment of Trainee’s Performance in Post-Cardiac Arrest Resuscitation

Abstract

Up to 22% of patients survive to hospital admission following out-of-hospital cardiac arrest (OHCA). Post cardiac arrest is complex and requires a multidisciplinary approach. Our aim is to assess trainee’s performance in managing post-cardiac arrest care using a high-fidelity manikin-based simulation. We also sought to obtain evidence regarding the validity of our findings. Methods: In this prospective, observational, simulation based study, participants ranging from sub interns to attending physicians evaluated and managed a post cardiac arrest patient, complicated by refractory status epilepticus. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society’s Emergency Neurological Life Support protocols. The primary outcome measure was the critical action item sum score. We sought validity evidence to support our findings by comparing trainees’ performance across four levels of training. Results: Forty-nine participants completed the simulation. The mean sum of critical actions completed by participants was 10/21(49%). Eleven(22%) participants verbalized a differential diagnosis for the arrest. Thirty-two(65%) recognized the abnormal electrocardiography, and consulted cardiology. Forty trainees(81%) independently decided to start target temperature management (TTM), but only 20(41%) insisted on TTM when asked to reconsider. There was an effect of level of training on critical action checklist sum scores (novice mean score [standard deviation (SD)] = 4.8 (1.8) vs. intermediate mean score (SD) = 10.4 (2.1) vs. advanced mean score (SD) = 11.6 (3.0) vs. expert mean score (SD) = 14.7 (2.2) Conclusions: High-fidelity manikin-based simulation holds promise as an assessment tool in the performance of post-cardiac arrest care. Areas for further educational initiatives to improve performance include diagnostic work-up of OHCA and implementation of TTM.