In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study

Abstract

BackgroundInterruption in chest compressions during cardiopulmonary resuscitation can be characterized as no flow ratio (NFR) and the importance of minimizing these pauses in chest compression has been highlighted recently. Further, documentation of resuscitation performance has been reported to be insufficient and there is a lack of identification of important issues where future efforts might be beneficial. By implementing in situ simulation we created a model to evaluate resuscitation performance. The aims of the study were to evaluate the feasibility of the applied method, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team.MethodsA prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty who responded to a cardiac arrest. We measured NFR and time to detection of initial rhythm on defibrillator and performed a comparison between the first responders and the cardiac arrest team.ResultsData from 13 out of 16 simulations was used to evaluate the ability of generating resuscitation performance data in simulated cardiac arrest. The defibrillator arrived after median 214 seconds (180-254) and detected initial rhythm after median 311 seconds (283-349). A significant difference in no flow ratio (NFR) was observed between the first responders, median NFR 38% (32-46), and the resuscitation teams, median NFR 25% (19-29), p < 0.001. The difference was significant even after adjusting for pulse and rhythm check and shock delivery.ConclusionThe main finding of this study was a significant difference between the first responders and the cardiac arrest team with the latter performing more adequate cardiopulmonary resuscitation with regards to NFR. Future research should focus on the educational potential for in-situ simulation in terms of improving skills of hospital staff and patient outcome.

Comparison of in-Hospital Cardiopulmonary Resuscitation Results Before and After the Introduction Code Blue

“…12,17,23,25 In the present study, the 24 hour survival rates of both groups were as high as those reported in the literature.…”

“…22 In several studies, the mean CPR starting time varied between 80 sec (1.3 min) and 341 sec (5.7 min). [23][24][25] In this study, the time for the arrival of the CBT to the arrest and the start of the CPR before and after the introduction of code blue was similar to the values presented in the literature. Our hospital is a four-floor building.…”

Mortality in Code Blue; can Apache II and PRISM scores be markers for prognostication?

“…[3,[15][16][17] In this study, the mortality rate in the CB procedures was found to be 62.61% and the survival rate was 38.07%.…”

Verification of changes in the time taken to initiate chest compressions according to modified basic life support guidelines

“…Furthermore, it has been reported by Roessler et al [2], Kobayashi et al [3], and Lubrano et al [5] that the time taken to initiate chest compressions can be shortened when the new guidelines were followed. Although the 2010 ERC guidelines and the 2010 AHA guidelines for BLS are different in terms of procedures for checking the victim for a response and the time taken to activate the emergency response system and initiate chest compressions, we showed that all subjects achieved a shorter chest compression initiation time after completing their re-education according to the new AHA guidelines [6][7][8][9][10][11][12][13][14]. At the time when 2005-BLS was developed, health care providers were considered not to have ventilation equipment for cardiopulmonary arrest, indicating that BLS may have actually been performed without rescue breathing.…”