Simulated Cardiac Arrest Scenario Research Articles

Teaching Cardiopulmonary Resuscitation to Later Elementary School Students

Bystander cardiopulmonary resuscitation (CPR) rates remain low in the United States. Training children is a proposed method to increase this rate, but data on the compression efficacy of US elementary school-aged children are scarce. We hypothesized that fourth and fifth graders could learn how to respond to cardiac arrests and provide effective chest compressions. We conducted a nonrandomized before-and-after study with fourth- and fifth-grade elementary students. Two 2-hour CPR educational sessions were held. Two weeks later, skills were assessed using a de novo checklist, and manikin-analyzed compression effectiveness (dichotomized at 50% efficacy) was analyzed using Chi-squared tests. We used paired t tests to evaluate knowledge change on identical pre- and post-tests. Secondary analysis evaluated associations between compression effectiveness and grade, age, sex, and body mass index (BMI) using Chi-squared tests. Three hundred fifty-six students completed the study. The mean change in test scores measuring CPR knowledge increased from 8.2 to 9.3 (1.1, 95% confidence interval [CI] 0.9 to 1.2). Self-reported adequate CPR knowledge increased from 44% to 97% (odds ratio [OR] 44.17, 95% CI 12.62 to 154.62). Seventy-two percent of students completed >7/11 predefined resuscitation steps, and 76% delivered ≥50% effective compressions. Grade was significantly associated with achieving ≥50% effective compression (OR 2.02, 95% CI, 1.19 to 3.43). Age, BMI, and sex were not significantly associated with greater compression efficacy. Most students were able to learn hands-only CPR, apply their knowledge during a simulated cardiac arrest scenario, and deliver effective chest compressions. Students' confidence and willingness to perform CPR increased after the intervention.

Who is the real team leader? Comparing leadership performance of the team leader and CPR Coach during simulated cardiac arrest

PurposeTo describe the leadership performance of team leaders and CPR Coaches, and to determine if there is a correlation between leadership scores and CPR performance during management of simulated pediatric cardiac arrest events. MethodsThis is a secondary analysis of data from a prior randomized controlled trial. We observed the performance of both team leaders and CPR coaches during the management of an 18-minute simulated cardiac arrest scenario which was run for 20 resuscitation teams comprised of CPR-certified professionals from four pediatric tertiary care centers. CPR Coaches were responsible for providing real-time verbal feedback of CPR performance to compressors. Two raters were trained to use the Behavioral Assessment Tool (BAT) to assess leadership performance of the team leader and CPR Coach. BAT scores of team leaders and CPR coaches were compared and linked with objective CPR performance. ResultsThere was no significant difference between the BAT scores of team leaders and CPR coaches (median score 27/40 vs 28.8/40, p = 0.16). Higher BAT scores of team leaders were significantly associated with higher percentage of excellent CPR (r = 0.52, p = 0.02), while higher BAT scores of CPR coaches were significantly associated with higher chest compression fraction (r = 0.48, p = 0.03). ConclusionsBoth team leaders and CPR coaches have similarly high leadership performance during the management of simulated cardiac arrest. Leadership behaviors were associated with quality of CPR performance.Clinical Trial Registration: Registration ID: NCT02539238; https://www.clinicaltrials.gov.

A study of validity and usability evidence for non-technical skills assessment tools in simulated adult resuscitation scenarios

BackgroundNon-technical skills (NTS) assessment tools are widely used to provide formative and summative assessment for healthcare professionals and there are now many of them. This study has examined three different tools designed for similar settings and gathered evidence to test their validity and usability.MethodsThree NTS assessment tools designed for use in the UK were used by three experienced faculty to review standardized videos of simulated cardiac arrest scenarios: ANTS (Anesthetists’ Non-Technical Skills), Oxford NOTECHS (Oxford NOn-TECHnical Skills) and OSCAR (Observational Skill based Clinical Assessment tool for Resuscitation). Internal consistency, interrater reliability and quantitative and qualitative analysis of usability were analyzed for each tool.ResultsInternal consistency and interrater reliability (IRR) varied considerably for the three tools across NTS categories and elements. Intraclass correlation scores of three expert raters ranged from poor (task management in ANTS [0.26] and situation awareness (SA) in Oxford NOTECHS [0.34]) to very good (problem solving in Oxford NOTECHS [0.81] and cooperation [0.84] and SA [0.87] in OSCAR). Furthermore, different statistical tests of IRR produced different results for each tool. Quantitative and qualitative examination of usability also revealed challenges in using each tool.ConclusionsThe lack of standardization of NTS assessment tools and training in their use is unhelpful for healthcare educators and students. Educators require ongoing support in the use of NTS assessment tools for the evaluation of individual healthcare professionals or healthcare teams. Summative or high-stakes examinations using NTS assessment tools should be undertaken with at least two assessors to provide consensus scoring. In light of the renewed focus on simulation as an educational tool to support and enhance training recovery in the aftermath of COVID-19, it is even more important that assessment of these vital skills is standardized, simplified and supported with adequate training.

Improve Cardiac Emergency Preparedness by Building a Team-Based Cardiopulmonary Resuscitation Educational Plan.

ObjectiveTo design an innovative team-based cardiopulmonary resuscitation (CPR) educational plan for multiple bystanders and evaluate whether it was associated with better teamwork and higher quality of resuscitation.MethodsThe team-based CPR plan defined the process for a three-person team, emphasize task allocation, leadership, and closed-loop communication. Participants qualified for single-rescuer CPR skills were randomized into teams of 3. The teamwork performance and CPR operation skills were evaluated in one simulated cardiac arrest scenario before and after training on the team-based CPR plan. The primary outcomes were measured by the Team Emergency Assessment Measure (TEAM) scale and chest compression fraction (CCF).ResultsForty-three teams were included in the analysis. The team-based CPR plan significantly improved the team performance (global rating 6.7 ± 1.3 vs. 9.0 ± 0.7, corrected p < 0.001 after Bonferroni's correction). After implementing the team-based CPR plan, CCF increased [median 59 (IQR 48–69) vs. 64 (IQR 57–71%)%, corrected p = 0.002], while hands-off time decreased [median 233.2 (IQR 181.0–264.0) vs. 207 (IQR 174–222.9) s, corrected p = 0.02]. We found the average compression depth was significantly improved through the team-based CPR training [median 5.1 (IQR 4.7–5.6) vs. 5.3 (IQR 4.9–5.5) cm, p = 0.03] but no more significantly after applying the Bonferroni's correction (corrected p = 0.35). The compression depths were significantly improved by collaborating and exchanging the role of compression among the participants after the 6th min.ConclusionThe team-based CPR plan is feasible for improving bystanders teamwork performance and effective for improving resuscitation quality in prearrival care. We suggest a wide application of the team-based CPR plan in the educational program for better resuscitation performance in real rescue events.

A Multicenter, Prospective Study Comparing Subxiphoid and Parasternal Views During Brief Echocardiography: Effect on Image Quality, Acquisition Time, and Visualized Anatomy

BackgroundRecent literature has suggested echocardiography (echo) may prolong pauses in chest compressions during cardiac arrest. ObjectvesWe sought to determine the impact of the sonographic approach (subxiphoid [SX] vs. parasternal long [PSL]) on time to image completion, image quality, and visualization of cardiac anatomy during echo, as performed during Advanced Cardiac Life Support. MethodsThis was a multicenter, randomized controlled trial conducted at 29 emergency departments (EDs) assessing the time to image acquisition and image quality between SX and PSL views for echo. Patients were enrolled in the ED and imaged in a simulated cardiac arrest scenario. Clinicians experienced in echo performed both SX and PSL views, first view in random order. Image quality and time to image acquisition were recorded. Echos were evaluated for identification of cardiac landmarks. Data are presented as percentages or medians with interquartile ranges (IQRs). ResultsWe obtained 6247 echo images, comprising 3124 SX views and 3123 PSL. Overall time to image acquisition was 9.0 s (IQR 6.7–14.1 s). Image acquisition was shorter using PSL (8.8 s, IQR 6.5–13.5 s) compared with SX (9.3 s, IQR 6.7–15.0 s). The image quality was better with the PSL view (3.86 vs. 3.54; p < 0.0001), twice as many SX images scoring in the worst quality category compared with PSL (8.6% vs. 3.7%). Imaging of the pericardium, cardiac chambers, and other anatomic landmarks was superior with PSL imaging. ConclusionsEcho was performed in < 10 s in > 50% of patients using either imaging technique. Imaging using PSL demonstrated improved image quality and improved identification of cardiac landmarks.

Guiding Attention via a Cognitive Aid During a Simulated In-Hospital Cardiac Arrest Scenario: A Salience Effort Expectancy Value Model Analysis.

To investigate the effect of a cognitive aid on the visual attention distribution of the operator using the Salience Effort Expectancy Value (SEEV) model. Cognitive aids aim to support an operator during the execution of a task. The effect of cognitive aids on performance is frequently evaluated but whether a cognitive aid improved, for example, attention distribution has not been considered. We built the Expectancy Value (EV) model version which can be considered to indicate optimal attention distribution for a given event. We analyzed the eye tracking data of emergency physicians while using a cognitive aid application versus no application during a simulated in-hospital cardiac arrest scenario. The EV model could fit the attention distribution in such a simulated emergency situation. Partially supporting our hypothesis, the cognitive aid application group showed a significantly better EV model fit than the no application group in the first phases of the event, but a worse fit in the last phase. We demonstrated that a cognitive aid affected attention distribution and that the SEEV model provides the means of capturing these effects. We suggest that the aid supported and improved visual attention distribution in the stressful first phases of a cardiopulmonary resuscitation but may have focused attention on objects that are relevant for lower priority goals in the last phase. The SEEV model can provide insights into expected and unexpected effects of cognitive aids on visual attention distribution and may help to design better artifacts.

84 Using the Team Tool in High-Fidelity Immersive Simulation for Internal Medicine Trainees: Assessing Leadership of Cardiac Arrest Scenarios

Non-technical skills (NTS) play a crucial role in cardiac arrest resuscitation performance, both in simulated and clinical environments This observational pilot study aimed to explore the leadership and team-working behaviours of IMT1 doctors in a simulated cardiac arrest scenario, to identify strengths and areas for improvement to focus future training.The Scottish national IMT1 boot camp involves a variety of high-fidelity immersive simulation scenarios across the 3-day course. Trainees are in groups of six with one IMT taking a lead role in each scenario. This study assessed a scenario of shockable rhythm cardiac arrest. All group participants are involved as the cardiac arrest team, with the original ‘hot seat’ participant expected to take the role of team leader, unless otherwise agreed by the team. The scenario is followed by a facilitated debrief around leadership in cardiac arrest.Following ethical approval from NHS Education for Scotland and written participant consent, videos of the cardiac arrest scenario were observed by the research team. Leadership and team behaviours were scored using the validated Team Emergency Assessment Measure (TEAM) Seventeen videos involving 102 trainees were reviewed and scored using the TEAM tool. The average overall TEAM score was 6.19/10. Scores for each of the 11 NTS domains ranged from 2.13/4 to 3.25/4. IMT1s scored highly on adapting to changing situations and monitoring and reassessing, but poorly on team leader displaying direction and command and leader maintaining a global perspective. When leadership scores were high, overall team performance was also high. General observations from field notes found the team often did not allocate a leader until cardiac arrest occurred. The leader often struggled to remain hands-off with a lack of assertiveness and poor communication between the leader and team. One hundred and fourteen IMT1s completed a pre- and post-course questionnaire. Average pre-course confidence in cardiac arrest team leadership was 3.8/7, and among the lowest of all situations rated. This improved to 5.35/7 post-course, but compared with other situations, remained low.This pilot study found leadership to be a key component in managing cardiac arrest for IMT1s, influencing overall team performance. Particular areas for improvement include hands-off leadership, leader assertiveness and whole team communication, which could be the focus of future educational interventions. Scenario participation and facilitated debrief improved overall confidence, but further focussed leadership and team training is required as IMT1s transition into the leadership role.

Bystander performance using the 2010 vs 2015 ERC guidelines: A post-hoc analysis of two randomised simulation trials

BackgroundThe European Resuscitation Council (ERC) basic life support (BLS) 2015 guidelines were simplified compared to the 2010 guidelines. We aimed to compare BLS/automated external defibrillator (AED) skill performance and skill retention following training with the 2010 or 2015 BLS/AED guidelines. MethodsPost-hoc analysis of two randomised simulation trials including videorecordings of laypersons skill-tested after ERC BLS/AED training using either the 2010 (n=70) or 2015 (n=70) BLS guidelines. Outcomes: (a) correct sequence of the BLS/AED algorithm, (b) correct sequence of the BLS/AED algorithm with all skills performed correctly, and (c) time to EMS call, first chest compression and shock delivery immediately after training and three months later. Groups were compared using multivariate logistic regression. ResultsMean age (±standard deviation) was 40 (±11) vs. 44 (±11) years and 70% vs. 50% were females for the 2010 and 2015 groups, respectively. Correct sequence of the BLS/AED algorithm for the 2010 vs. 2015 group was 84% vs. 91%, P=0.08 immediately after training and 16% vs. 41%, adjusted odds ratio (aOR): 5.6 (95% CI: 2.3–14.0, P<0.001) after three months. Correct sequence with all skills performed correctly was 56% vs. 47%, P=0.31 immediately after training and 5% vs. 16%, aOR: 4.8 (95% CI: 1.2–19.2), P=0.03 after three months. Time to EMS call was shorter in the 2015 group immediately after training (P=0.008) but all other time points did not differ. ConclusionThe simplified 2015 BLS guidelines was associated with better adherence to the sequence of the BLS/AED algorithm when compared to the 2010 BLS guidelines three months after training in a simulated cardiac arrest scenario, without significantly improving skill performance immediately after training.

Staff perceptions of military chemical-biological-radiological-nuclear (CBRN) air-purifying masks during a simulated clinical task in the context of SARS-CoV-2.

Air-purifying full-face masks, such as military chemical-biological-radiological-nuclear masks, might offer superior protection against severe acute respiratory syndrome coronavirus 2 compared to disposable polypropylene P2 or N95 masks. In addition, disposable masks are in short supply, while military chemical-biological-radiological-nuclear masks can be disinfected then reused. It is unknown whether such masks might be appropriate for civilians with minimal training in their use. Accordingly, we compared the Australian Defence Force in-service chemical-biological-radiological-nuclear Low Burden Mask (AirBoss Defense, Newmarket, Canada) with polypropylene N95 masks and non-occlusive glasses worn during simulated tasks performed by civilian clinicians in an Australian tertiary referral hospital intensive care unit. After brief training in the use of the Low Burden Mask, participants undertook a simulated cardiac arrest scenario. Previous training with polypropylene N95 masks had been provided. Evaluation of 10 characteristics of each mask type were recorded, and time to mask application was assessed. Thirty-three participants tested the Low Burden Mask, and 28 evaluated polypropylene N95 masks and glasses. The Low Burden Mask was donned more quickly: mean time 7.0 (standard deviation 2.1) versus 18.3 (standard deviation 6.7) seconds; P = 0.0076. The Low Burden Mask was rated significantly higher in eight of the 10 assessed criteria, including ease of donning, comfort (initially and over a prolonged period), fogging, seal, safety while removing, confidence in protection, and overall. Visibility and communication ability were rated equally highly for both systems. We conclude that this air-purifying full-face mask is acceptable to clinicians in a civilian intensive care unit. It enhances staff confidence, reduces waste, and is likely to be a lower logistical burden during a prolonged pandemic. Formal testing of effectiveness is warranted.

Change in Cardiopulmonary Resuscitation Performance Over Time During Simulated Pediatric Cardiac Arrest and the Effect of Just-in-Time Training and Feedback.

Effective cardiopulmonary resuscitation (CPR) is critical to ensure optimal outcomes from cardiac arrest, yet trained health care providers consistently struggle to provide guideline-compliant CPR. Rescuer fatigue can impact chest compression (CC) quality during a cardiac arrest event, although it is unknown if visual feedback or just-in-time training influences change of CC quality over time. In this study, we attempt to describe the changes in CC quality over a 12-minute simulated resuscitation and examine the influence of just-in-time training and visual feedback on CC quality over time. We conducted secondary analysis of data collected from the CPRCARES study, a multicenter randomized trial in which CPR-certified health care providers from 10 different pediatric tertiary care centers were randomized to receive visual feedback, just-in-time CPR training, or no intervention. They participated in a simulated cardiac arrest scenario with 2 team members providing CCs. We compared the quality of CCs delivered (depth and rate) at the beginning (0-4 minutes), middle (4-8 minutes), and end (8-12 minutes) of the resuscitation. There was no significant change in depth over the 3 time intervals in any of the arms. There was a significant increase in rate (128 to 133 CC/min) in the no intervention arm over the scenario duration (P < 0.05). There was no significant drop in CC depth over a 12-minute cardiac arrest scenario with 2 team members providing compressions.

Echocardiography does not prolong peri-shock pause in cardiopulmonary resuscitation using the COACH-RED protocol with non-expert sonographers in simulated cardiac arrest

ObjectiveFocused echocardiography during peri-shock pause (PSP) can prognosticate and detect reversible causes in cardiac arrest but minimising interruptions to chest compressions improves outcome. The COACH-RED protocol was adapted from the COACHED protocol to systematically incorporate echocardiography into rhythm check without prolonging PSP beyond the recommended 10s. The primary objective of this study was to test the feasibility of emergency nurses learning to perform all roles in the COACH-RED protocol. PSP duration and change in participant confidence were secondary outcomes. MethodsAfter an initial two-hour workshop, five ALS-trained nurses were assessed for the correct use of COACH-RED protocol, without critical error, in three simulated cardiac arrest scenarios of four cycles each. Assessments were repeated on days 7 and 35. On day 35, three COACHED scenarios were also assessed for comparison. Participant roles per scenario and cardiac rhythm per cycle were randomised. Participants completed questionnaires on their confidence levels. Sessions were videotaped for accurate measurement of PSP duration and results tabulated for simple comparison. Statistical analysis was not performed due to small sample size. ResultsThere were no critical errors, two minor team-leading errors and two minor echosonography errors. Minor errors occurred in separate scenarios resulting in a 100% pass rate overall by predetermined criteria. Echocardiographic recordings were 100% adequate. Overall median PSP was 9.35s for COACH-RED and 6.94s for COACHED. Sub-group analysis of COACH-RED revealed median PSP 10.80s in shockable rhythms and 8.74s (∼2s less) in non-shockable rhythms. Mean participant confidence in performing COACH-RED improved from 1.6 to 4.6, on a 5-point scale. ConclusionThe COACH-RED protocol can be effectively performed by ALS-trained nurses, in all roles of this protocol, including echocardiography, in a simulated environment, after a single training session. Using this protocol, focused echocardiography does not prolong PSP beyond 10s.

Influence of Cardiopulmonary Resuscitation Coaching on Interruptions in Chest Compressions During Simulated Pediatric Cardiac Arrest.

To determine the impact of a cardiopulmonary resuscitation coach on the frequency and duration of pauses during simulated pediatric cardiac arrest. This is a secondary analysis of video data collected from a prospective multicenter trial. Forty simulated pediatric cardiac arrest scenarios (20 noncoach and 20 coach teams), each lasting 18 minutes in duration, were reviewed by three clinical experts to document events surrounding each pause in chest compressions. Four pediatric academic medical centers from Canada and the United States. Two-hundred healthcare providers in five-member interprofessional resuscitation teams that included either a cardiopulmonary resuscitation coach or a noncoach clinical provider. Teams were randomized to include either a trained cardiopulmonary resuscitation coach or an additional noncoach clinical provider. The frequency, duration, and associated factors with each interruption in chest compressions were recorded and compared between the groups with and without a cardiopulmonary resuscitation coach, using t tests, Wilcoxon rank-sum tests, or chi-squared tests, depending on the distribution and types of outcome variables. Mixed-effect linear models were used to explore the effect of cardiopulmonary resuscitation coaching on pause durations, accounting for multiple measures of pause duration within teams. A total of 655 pauses were identified (noncoach n = 304 and coach n = 351). Cardiopulmonary resuscitation-coached teams had decreased total mean pause duration (98.6 vs 120.85 s, p = 0.04), decreased intubation pause duration (median 4.0 vs 15.5 s, p = 0.002), and similar mean frequency of pauses (17.6 vs 15.2, p = 0.33) when compared with noncoach teams. Teams with cardiopulmonary resuscitation coaches are more likely to verbalize the need for pause (86.5% vs 73.7%, p < 0.001) and coordinate change of the compressors, rhythm check, and pulse check (31.7% vs 23.2%, p = 0.05). Teams with cardiopulmonary resuscitation coach have a shorter pause duration than non-coach teams, adjusting for number and types of tasks performed during the pause. When compared with teams without a cardiopulmonary resuscitation coach, the inclusion of a trained cardiopulmonary resuscitation coach leads to improved verbalization before pauses, decreased pause duration, shorter pauses during intubation, and better coordination of key tasks during chest compression pauses.

Promoting hot debriefing in an emergency department

IntroductionDebriefing is a process of communication that takes place between a team following a clinical case. Debriefing facilitates discussion of individual and team level performance and identifies points of excellence...

Manual ventilation quality is improved with a real-time visual feedback system during simulated resuscitation

IntroductionManual ventilations during cardiac arrest are frequently performed outside of recommended guidelines. Real-time feedback has been shown to improve chest compression quality, but the use of feedback to guide ventilation volume and rate has not been studied. The purpose of this study was to determine whether the use of a real-time visual feedback system for ventilation volume and rate improves manual ventilation quality during simulated cardiac arrest.MethodsTeams of 2 emergency medical technicians (EMTs) performed two 8-min rounds of cardiopulmonary resuscitation (CPR) on a manikin during a simulated cardiac arrest scenario with one EMT performing ventilations while the other performed compressions. The EMTs switched roles every 2 min. During the first round of CPR, ventilation and chest compression feedback was disabled on a monitor/defibrillator. Following a 20-min rest period and a brief session to familiarize the EMTs with the feedback technology, the trial was repeated with feedback enabled. The primary outcome variables for the study were ventilations and chest compressions within target. Ventilation rate (target, 8–10 breaths/minute) and tidal volume (target, 425–575 ml) were measured using a novel differential pressure-based flow sensor. Data were analyzed using paired t tests.ResultsTen teams of 2 EMTs completed the study. Mean percentages of ventilations performed in target for rate (41% vs. 71%, p < 0.01), for volume (31% vs. 79%, p < 0.01), and for rate and volume together (10% vs. 63%, p < 0.01) were significantly greater with feedback.ConclusionThe use of a novel visual feedback system for ventilation quality increased the percentage of ventilations in target for rate and volume during simulated CPR. Real-time feedback to perform ventilations within recommended guidelines during cardiac arrest should be further investigated in human resuscitation.

The general public��s ability to operate automated external defibrillator: A controlled simulation study

Automated external defibrillators (AEDs) enable laypeople to provide early defibrillations to patients undergoing cardiac arrest, but scant information is available on the general public's ability to use AEDs. This study assessed the ability of laypeople to operate AEDs, the effect of a 15-minute training, and whether skills differed by age. From May 1 to December 31, 2018, a prospective simulation study was conducted with 94 laypeople aged 18-65 years (32 aged 18-24 years, 34 aged 25-54 years, and 28 aged 55-65 years) with no prior AED training. The participants' AED skills were assessed individually pre-training, post-training, and at a three-month follow-up using a simulated cardiac arrest scenario. The critical actions and time intervals were evaluated during the AED operating process. Only 14 (14.9%) participants (eight aged 18-24 years, four aged 25-54 years, and two aged 55-65 years) successfully delivered defibrillations before training. AED operation errors were more likely to occur among the participants aged 55-65 years than among other age groups. After training, the proportion of successful defibrillations increased significantly (18-24 years old: 25.0% vs. 71.9%, P<0.01; 25-54 years old: 11.8% vs. 70.6%, P<0.01; 55-65 years old: 7.1% vs. 67.9%, P<0.01). After three months, 26.1% of the participants aged 55-65 years successfully delivered defibrillations, which was significantly lower than that of participants aged 18-24 years (54.8%) and 25-54 years (64.3%) (P=0.02). There were no differences in time measures among three age groups in each test. The majority of untrained laypeople cannot effectively operate AEDs. More frequent training and refresher courses are crucial to improve AED skills.

Basic life support training using shared mental models improves team performance of first responders on normal wards: A randomised controlled simulation trial

IntroductionSurvival of in-hospital cardiac arrest (IHCA) depends on fast and effective action of the first responding team. Not only technical skills, but professional teamwork is required. Observational studies and theoretical models suggest that shared mental models of members improve teamwork. This study investigated if a training on shared mental models, improves team performance in simulated in-hospital cardiac arrest. MethodsOn the background of an introduction of mandatory Basic Life Support (BLS) training for clinical staff a randomized controlled trial was performed to compare two training methods. Staff from clinical departments was randomised to receive either a conventional instructor led training (control group) or an interventional training (intervention group). The interventional training was based on self-directed learning of the group in order to develop shared mental models. Primary outcome were mean scores of the team assessment scale (TAS) and the hands-off time. Secondary outcome were mean scores for quality of BLS. ResultsPerformance of 75 teams of the interventional and 66 of the control group was analysed. The hands-off time was significantly lower in the interventional group (5.42% vs. 8.85%, p = 0.029). Scores of the TAS and the overall BLS score were high and not significantly different between the groups. Hands-off time correlated significantly negative with all TAS items. ConclusionBLS training for clinical staff which creates shared mental models reduces hands-off time in a simulated cardiac arrest scenario. Training methods establishing shared mental models of team members can be considered for effective team trainings without adding additional training time.

The use of dispatcher assistance in improving the quality of cardiopulmonary resuscitation: A randomised controlled trial

AimsThe introduction of dispatcher assistance (DA) services has led to increased bystander cardiopulmonary resuscitation (CPR) participation rates. However, the extent to which DA improves CPR quality remains unclear. This study aimed to evaluate the efficacy of DA in improving CPR quality among healthcare professionals and laypersons within a multi-ethnic Southeast Asian population. MethodsA parallel, randomised controlled, open label trial was performed. Four hundred and twelve participants were recruited via convenience sampling in a public location. In a simulated cardiac-arrest scenario, the participants were randomised to perform CPR with DA over the phone (DA+) or CPR without DA (DA-). The ratio of participant assignment to DA+ and DA- was 1:1. The primary outcomes were CPR compression depth, compression rate, no-flow time, complete release of pressure between compressions, and hand location. The assessment involved CPR manikins and human assessors. ResultsA larger proportion of participants in DA + achieved the correct compression rate (34.3% vs 18.1%, p < 0.001). There was no difference in the other primary outcomes.A subgroup analysis revealed that healthcare professionals in DA+ had a higher proportion of correct hand location compared to those in DA- (82.1% vs. 53.5%, p < 0.05). There was no significant difference in CPR quality among laypersons with valid CPR certification regardless of whether they received DA. ConclusionDA should be provided to laypersons without valid CPR certification, as well as healthcare professionals. The identification of gaps in the current DA protocol highlights areas where specific changes can be made to improve CPR quality.

Simulation training enables emergency medicine providers to rapidly and safely initiate extracorporeal cardiopulmonary resuscitation (ECPR) in a simulated cardiac arrest scenario

BackgroundExtracorporeal cardiopulmonaryresuscitation (ECPR) is emerging as a viable rescue strategy for refractory out-of-hospital cardiac arrest. In the U.S., limited training of emergency medicine providers is a barrier to widespread implementation. AimsTest the hypothesis that emergency medicine physicians and nurses can acquire and retain the skills to rapidly and safely initiate ECPR using high-fidelity simulation. Study designProspective interventional study. SettingU.S. tertiary academic medical center. SubjectsEmergency medicine physicians and nurses with no prior ECPR/ECMO experience. MethodsTeams of three physicians and three nurses underwent a two-day ECPR training course including didactics, hands-on training, and simulation. Teams were videotaped initiating ECPR in a high-fidelity simulation scenario before and after simulation training. The primary outcome was the proportion of simulations in which full ECPR support was achieved within 30 min of patient arrival. ResultsFive teams completed the entire study. Full ECPR support was achieved within 30 min of patient arrival in 11/15, 15/15, and 15/15 attempts at baseline (B), post-testing (PT) and 3-month post-testing (3-PT), respectively (p = 0.06). Intervals (mean ± sd) required to achieve full ECPR support at B, PT, and 3-PT were 25.8±5.3, 17.2±4.6, and 19.2±1.9 min respectively (p < 0.05 for B vs. PT and 3-PT). ConclusionHigh fidelity simulation training is effective in preparing emergency medicine physicians and nurses to rapidly and safely initiate ECPR in a simulated cardiac arrest scenario, and should be considered when implementing an ED-based ECPR program.

Does electronic decision support influence advanced life support in simulated cardiac arrest?

Introduction: In-hospital cardiac arrest is common but survival rates vary considerably. The reasons for this may relate to human factors. Decision support systems and tools have been suggested as a means of reducing human errors and improving outcomes. Methods: This study aimed to: investigate if an electronic decision support system (eDSS) influenced advanced life support (ALS) in a simulated in-hospital cardiac arrest scenario; and explore practitioners' views of their performance with and without the eDSS. Teams of nurses and student nurses managed two scenarios with and without using an eDSS, and their adherence to an ALS protocol was assessed. Teams then took part in group interviews. Results: Teams using the eDSS were more likely to adhere to the drug and shock administration elements of the ALS protocol but were less safe in doing so, which may have been because they were unfamiliar with it. The interviews yielded one overarching theme—team working—and three subthemes of team performance and dynamics, team leader performance and areas for development. Some considered the eDSS as a source of reassurance that supported organisation and communication, while others found it a distraction; reduced situational awareness was observed when it was used. Conclusion: While an eDSS can support practitioners managing a simulated cardiac arrest, it is important to test prototypes in extensive simulation-based situations before they are used in clinical practice.

Randomized Controlled Trial of Simulation vs. Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation.

IntroductionMost medical schools teach cardiopulmonary resuscitation (CPR) during the final year in course curriculum to prepare students to manage the first minutes of clinical emergencies. Little is known regarding the optimal method of instruction for this critical skill. Simulation has been shown in similar settings to enhance performance and knowledge. We evaluated the comparative effectiveness of high-fidelity simulation training vs. standard manikin training for teaching medical students the American Heart Association (AHA) guidelines for high-quality CPR.MethodsThis was a prospective, randomized, parallel-arm study of 70 fourth-year medical students to either simulation (SIM) or standard training (STD) over an eight-month period. SIM group learned the AHA guidelines for high-quality CPR via an hour session that included a PowerPoint lecture with training on a high-fidelity simulator. STD group learned identical content using a low-fidelity Resusci Anne® CPR manikin. All students managed a simulated cardiac arrest scenario with primary outcome based on the AHA guidelines definition of high-quality CPR (specifies metrics for compression rate, depth, recoil, and compression fraction). Secondary outcome was time to emergency medical services (EMS) activation. We analyzed data via Kruskal-Wallis rank sum test. Outcomes were performed on a simulated cardiac arrest case adapted from the AHA Advanced Cardiac Life Support (ACLS) SimMan® Scenario manual.ResultsStudents in the SIM group performed CPR that more closely adhered to the AHA guidelines of compression depth and compression fraction. Mean compression depth was 4.57 centimeters (cm) (95% confidence interval [CI] [4.30–4.82]) for SIM and 3.89 cm (95% CI [3.50–4.27]) for STD, p=0.02. Mean compression fraction was 0.724 (95% CI [0.699–0.751]) for SIM group and 0.679 (95% CI [0.655–0.702]) for STD, p=0.01. There was no difference for compression rate or recoil between groups. Time to EMS activation was 24.7 seconds (s) (95% CI [15.7–40.8]) for SIM group and 79.5 s (95% CI [44.8–119.6]) for STD group, p=0.007.ConclusionHigh-fidelity simulation training is superior to low-fidelity CPR manikin training for teaching fourth-year medical students implementation of high-quality CPR for chest compression depth and compression fraction.