Abstract 268: From Advanced Cardiac Life Support (ACLS) to Airway-Circulation-Leadership-Support (A-C-L-S): A Novel Team Training Model for Resuscitation Teams

Abstract

INTRODUCTION The 2010 AHA Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care emphasize providers should coordinate and perform chest compressions and ventilations in a team-based approach. We developed a team training model called Airway-Circulation-Leadership-Support (A-C-L-S) to improve resuscitation performance, and presented our preliminary experience of A-C-L-S model in resuscitation team training for emergency department (ED) staff. METHODS CPR technical and non-technical tasks were prioritized and bundled into a mnemonic - ‘A-C-L-S’ which comprises 4 domains: Airway (A), Circulation (C), Leadership (L), and Support (S). A-team is assigned to manage airway, avoid hyperventilation, and monitor EtCO2. C-team focuses on rapid defibrillation and high-quality chest compression with feedback from an accelerometer. L-team assumes coordination and situation monitoring. S-team is responsible for intravenous access, drugs administration, time keeping, and recording. Each team training course consists of: (1) a video-assisted lecture on A-C-L-S model; (2) two high-fidelity simulation-based cardiac arrest scenarios before and after the lecture, each followed by (3) video-facilitated debriefing emphasizing the A-C-L-S model. A 10-item questionnaire using 5-point Likert scale was administered to evaluate perception of CPR teamwork before (i.e. prior clinical experiences) and after the course. RESULTS Seven A-C-L-S team training courses were delivered to 52 ED staff (17 residents and 35 nurses, all qualified ACLS providers) at a university teaching hospital from April to May 2011. Perception of CPR teamwork improved significantly in leadership (48.9% to 78.7%, p = 0.017), task assignment (34.1% to 74.5%, p = 0.002), role commitment (42.6% to 85.1%, p = 0.000), workload distribution (34.1% to 67.4%, p = 0.024), and shared goal (44.7% to 76.1%, p = 0.002) after the A-C-L-S team training. CONCLUSIONS Our novel A-C-L-S team training model can facilitate and reinforce the perception of CPR teamwork among ED staff. Application of this model in different scenarios and disciplines, and its impact on actual resuscitation performance and patient outcomes deserve further study.