In Situ Simulation Comparing In-Hospital First Responder Sudden Cardiac Arrest Resuscitation Using Semiautomated Defibrillators and Automated External Defibrillators

Abstract

Multifaceted approaches using simulation and human factors methods may optimize in-hospital sudden cardiac arrest (SCA) response. The Arrhythmia Simulation/Cardiac Event Nursing Training-Automated External Defibrillator phase (ASCENT-AED) study used in situ medical simulation to compare traditional and AED-supplemented SCA first-responder models. The study was conducted at an academic 719-bed hospital with institutional review board approval. Two simulation scenarios were developed and featured either respiratory arrest with perfusing bradycardia or ventricular fibrillation (VF) arrest. Study floors were equipped with either a semiautomated defibrillator (SD) only (control) or with both SD and AED (experimental); subjects functioned as solitary first responders and did not receive resuscitation training. Fifty nurses were enrolled on control (n=25) and experimental (n=25) floors. The groups' nonblinded performances exhibited the following differences during VF scenario: slower calls for help by the control group [mean time to completion of 25+/-17 seconds versus 18+/-11 seconds for the experimental group (P<0.05)] and fewer subjects in the control group performing chest compressions [44.0% versus experimental group's 95.8% (P<0.001)]. Eighty-eight percent of the control group defibrillated the manikin at an average of 155+/-59 seconds, with 32.0% of those subjects using semiautomated rhythm analysis; 100% (not significant [NS]) of experimental group defibrillated at 154+/-72 seconds (NS) with 100% AED analysis (P<0.001). Fewer control group subjects (28.0%) were observed during the bradycardia scenarios to perform inappropriate chest compressions than the AED-supplemented subjects [69.6% (P=0.01)]; nonindicated defibrillation was delivered during these scenarios by a single subject in the control group. Twenty-eight percent and 72% of VF scenarios were managed appropriately by control and experimental groups, respectively; bradycardia scenarios were managed without severe adverse event by 64% of control group and 28% of experimental group. In situ simulation can provide useful information, both anticipated and unexpected, to guide decisions about proposed defibrillation technologies and SCA response models for in-hospital resuscitation system design and education before implementation.