Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial

Nancy J Sullivan; Jordan Duval-Arnould; Marida Twilley; Sarah P Smith; Deborah Aksamit; Pam Boone-Guercio; Pamela R Jeffries; Elizabeth A Hunt

doi:10.1016/j.resuscitation.2014.10.021

Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial

Resuscitation. 2015 Jan:86:6-13. doi: 10.1016/j.resuscitation.2014.10.021. Epub 2014 Nov 11.

Authors

Nancy J Sullivan¹, Jordan Duval-Arnould², Marida Twilley³, Sarah P Smith³, Deborah Aksamit⁴, Pam Boone-Guercio⁵, Pamela R Jeffries⁶, Elizabeth A Hunt⁷

Affiliations

¹ The Johns Hopkins University School of Nursing, 525N Wolfe St, Baltimore, MD, 21205, USA. Electronic address: nsulliv@jhmi.edu.
² Department of Anesthesiology and Critical Care Medicine, Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
³ The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.
⁴ The Johns Hopkins Hospital CPR Office, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.
⁵ Johns Hopkins Outpatient Center, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.
⁶ Johns Hopkins University, 3400N Charles Street, 265 Garland Hall, Baltimore, MD 21218, USA.
⁷ Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Division of Health Science Informatics, Johns Hopkins Medicine Simulation Center, 1800 Orleans St, Baltimore, MD 21287, USA.

PMID: 25447038
DOI: 10.1016/j.resuscitation.2014.10.021

Abstract

Background: Traditional American Heart Association (AHA) cardiopulmonary resuscitation (CPR) curriculum focuses on teams of two performing quality chest compressions with rescuers on their knees but does not include training specific to In-Hospital Cardiac Arrests (IHCA), i.e. patient in hospital bed with large resuscitation teams and sophisticated technology available.

Design: A randomized controlled trial was conducted with the primary goal of evaluating the effectiveness and ideal frequency of in-situ training on time elapsed from call for help to; (1) initiation of chest compressions and (2) successful defibrillation in IHCA.

Methods: Non-intensive care unit nurses were randomized into four groups: standard AHA training (C) and three groups that participated in 15 min in-situ IHCA training sessions every two (2M), three (3M) or six months (6M). Curriculum included specific choreography for teams to achieve immediate chest compressions, high chest compression fractions and rapid defibrillation while incorporating use of a backboard, stepstool.

Results: More frequent training was associated with decreased median (IQR) seconds to: starting compressions: [C: 33(25-40) vs. 6M: 21(15-26) vs. 3M: 14(10-20) vs. 2M: 13(9-20); p < 0.001]; and defibrillation: [C: 157(140-254) vs. 6M: 138(107-158) vs. 3M: 115(101-119) vs. 2M: 109(98-129); p < 0.001]. A composite outcome of key priorities, compressions within 20s, defibrillation within 180 s and use of a backboard, revealed improvement with more frequent training sessions: [C:5%(1/18) vs. 6M: 23%(4/17) vs. 3M: 56%(9/16) vs. 2M: 73%(11/15); p < 0.001].

Conclusion: Results revealed short in-situ training sessions conducted every 3 months are effective in improving timely initiation of chest compressions and defibrillation in IHCA.

Keywords: Cardiopulmonary resuscitation priorities; In-Hospital Cardiac Arrests; In-situ simulation training.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Aged
Cardiopulmonary Resuscitation / education*
Cardiopulmonary Resuscitation / methods*
Female
Heart Arrest / therapy*
Hospitalization
Humans
Male
Middle Aged
Quality Improvement
Simulation Training*
Single-Blind Method
United States
Young Adult