Cardiopulmonary Arrest and Resuscitation in the Prone Patient: An Adult Simulation Case for Internal Medicine Residents

Abstract

Introduction Acute respiratory distress syndrome (ARDS) is present in approximately 10% of ICU admissions and is associated with great morbidity and mortality. Prone ventilation has been shown to improve refractory hypoxemia and mortality in patients with ARDS. Methods In this simulation, a 70-year-old male had been transferred to the ICU for ARDS and was undergoing scheduled prone ventilation as part of his care when he experienced a cardiopulmonary arrest secondary to a tension pneumothorax. Learners demonstrated how to manage cardiac arrest in a prone patient and subsequently identified and treated the tension pneumothorax that was the cause of his initial arrest. This single-session simulation for internal medicine residents (PGY 1-PGY 4) utilized a prone mannequin connected to a ventilator in a high-fidelity simulation center. Following the simulation, facilitators led a team debriefing and reviewed key learning objectives. Results A total of 103 internal medicine residents participated in this simulation. Of those, 43 responded to a postsimulation survey. Forty-two of 43 agreed or strongly agreed that all learning objectives were met, that the simulation was appropriate for their level of training, and that their participation would be useful for their future practice. Discussion We designed this simulation to improve learners' familiarity with prone cardiopulmonary resuscitation and to enhance overall comfort with cardiac arrest management. Postsimulation survey results and debriefings revealed that the simulation was a valuable education opportunity, and learners felt that their participation in this simulation would be helpful in their future practice.

The Effect of the Knowledge, Skills, and Attitudes from Nurse Training Using In Situ Simulation in an Intensive Care Unit

“…Our study involved three weeks of training with repeat practice and role-play simulation patients in turn. The application of situational simulation training in clinical training can improve trainees' clinical knowledge, nursing skills, and communication skills [8], thereby improving the quality of clinical care and patient safety [9]. Our study showed similar findings with effectiveness in knowledge (Table 1) and skills (Table 2).…”

Airborne Isolation Cardiac Arrest: A Simulation Program for Interdisciplinary Code Blue Team Training

“…Our learner-reported improvements are similar to those seen in prior cardiac arrest simulation literature, 26,27 and they add to a growing body of evidence supporting the utility of simulation programs to prepare for COVID-19 cardiac arrest and other rare resuscitation events. [13][14][15][16][17][18][19][20]28 Unlike previous work, however, our talk-through walk-through structure and scripted simulation is far simpler to implement in time-, personnel-, and resourceconstrained settings such as those with current outbreaks due to low vaccination rates. While we cannot directly compare our outcomes to a traditional high-fidelity simulation structure, some of our highest-risk communities are less likely to have a dedicated simulation lab.…”

“…Simulation is a well-established and effective means of education for code blue training, 13 particularly in preparing for situational variations with which health care teams may have less experience. [14][15][16][17] At the start of the COVID-19 pandemic, several groups successfully used high-fidelity simulation to train staff for airborne isolation code blue. [18][19][20] Unfortunately, this method of simulation requires significant resources, including personnel, time, and expensive equipment, that are limited in many institutions.…”

Advances in the Use of Prone Cardiopulmonary Resuscitation During Spinal Surgery in the Prone Position

“…In addition, a study of conventional CPR and prone CPR in six dying patients found that prone CPR was effective in increasing systolic BP even when the patients experienced vasodilatation and severe hypovolemia. It has also been shown that prone CPR was performed on 22 patients undergoing posterior spinal surgery, and 10 patients were successfully resuscitated [15] . Prone CPR uniformly elevates the patient's intrathoracic pressure, thereby restoring their body circulation.…”