Background: Advanced Cardiac Life Support (ACLS) and emergency resuscitation is a critical role for anesthesia providers. The application of a clinical ACLS simulation to a patient under anesthesia is important to provide educational review and determine if the knowledge and skill of managing emergency events deteriorates over time. Method: A surgical ACLS simulation training session was completed to test ACLS knowledge retention and provider skill. High-fidelity simulation was used with a pre-test and post-test design. Results: The data obtained demonstrated several knowledge gaps in ACLS fundamentals. Conclusions: The simulation demonstrated that key concepts and skills deteriorate when not utilized regularly. Simulation in nurse anesthesia continuing education can improve clinical skill and adequately prepare providers for emergency resuscitation.