Randomised controlled trial of simulation-based education for mechanical cardiopulmonary resuscitation training

Abstract

IntroductionMechanical cardiopulmonary resuscitation (M-CPR) is increasingly used in the management of cardiac arrest. There are no previously reported randomised studies investigating M-CPR training. This study of newly trained M-CPR providers hypothesised that a brief simulation-based intervention after 4 months would improve M-CPR performance at 6 months.MethodsThis study used a simulated ‘in situ’ cardiac arrest model. The M-CPR device used was a proprietary Lund University Cardiac Assist System 3 machine (Physio Control, Redmond, Washington, USA). Standardised baseline training was provided to all participants. Following training, baseline performance was assessed. The primary outcome measure was the time taken to initiate M-CPR and the secondary outcome was performance against a checklist of errors. Participants were then randomised to intervention group (simulation training) or control group (routine clinical use of M-CPR). After 6 months the outcome measures were reassessed. Comparative statistical tests used an intention-to-treat analysis.Results112 participants were enrolled. The intervention group (n=60) and control group (n=52) had similar demographic characteristics. At the 6-month assessment, median time to M-CPR initiation was 27.0 s (IQR 22.0–31.0) in the intervention group and 31.0 s (IQR 25.6–46.0) in the control group (p=0.003). The intervention group demonstrated fewer errors compared with controls at 6 months (p<0.001)ConclusionIn this randomised study of approaches to M-CPR training, providers receiving additional simulation-based training had higher retention levels of M-CPR skills. Therefore, when resuscitation skills are newly learnt, provision follow-up training should be an important consideration.

GENESISS 2—Generating Standards for In-Situ Simulation project: a systematic mapping review

“…Ten studies were Pre / Post observational studies which included ISS interventions, two were prospective cohort studies, two RCTs, one observational study with a control and one multicomponent quality improvement project. Studies were conducted in emergency and resuscitation teams and departments [ 79 – 86 ], paediatric and neonatal care settings [ 87 – 89 ], in-patient ward settings [ 90 – 92 ], coronary care [ 93 ], an obstetric unit [ 94 ] and a mental healthcare setting [ 2 ]. Where reported, ISS interventions frequency varied from single training sessions delivered over one day to repeat ISS training lasting 18 months.…”

“…Incidence of septic shock 2. Incidence of respiratory failure Prospective observational Quality assessment: good (3e) Coggins 2019 [ 86 ] (Australia) Improve mechanical CPR performance ( n = 112) 1. CPR performance scores RCT Risk of bias: moderate (1c) Generoso 2016 [ 91 ] (US) Improve nurses' responses in the first 5 min of in-hospital emergencies ( n = 147) 1.…”

“…Knight et al [ 84 ] conducted 16 paediatric ISS sessions over 18 months and reported that survival rates had improved when compared to historical controls. Other studies reporting favourable outcomes for regular ISS training included anaphylaxis management [ 79 ], sepsis management [ 90 ] response times to hospital emergencies [ 91 ], detection of arrhythmias [ 81 ], management of medical deterioration [ 2 , 89 ] and CPR performance [ 83 , 86 ].…”

Desenvolvimento de protótipo de reanimação cardiopulmonar para educação em saúde [Development of a cardiopulmonary resuscitation prototype for health education] [Desarrollo de un prototipo de reanimación cardiopulmonar para la educación en salud]

“…Corrobora com essa perspectiva, estudo brasileiro objetivando a criação de um aplicativo digital de instrução educacional para suporte avançado de vida cardiovascular, demonstrando que formas de tecnologias podem contribuir para melhoria do ensino/aprendizado, ajudando a preencher lacunas na avaliação e gestão de parada cardíaca e acidente vascular cerebral. O uso da tecnologia certamente seria mais uma alternativa e traria incremento ao protótipo, por esta razão os pesquisadores entendem que ferramentas tecnológicas podem ser utilizadas posteriormente, mas para isso ocorrer, seria necessária novas parcerias 19 .…”

“…A intervenção em RCP foi possível graças ao baixo custo do manequim e a disposição de uma pequena quantidade de tempo dos instrutores no processo de validação, assim, é possível inferir que o uso eficiente do corpo docente é especialmente importante em ambientes educacionais, mesmo que as oportunidades de treinamento sejam limitadas temporalmente. Além de que, as necessidades de aprendizado dos estudantes, como habilidades de comunicação e correção de erros, podem ser tratadas individualmente com feedback imediato sobre o desempenho 17,[19][20][21] . Para o treinamento regular nas universidades, muitas vezes visto como proibitivamente caro a partir do uso de simuladores de alta fidelidade, a intervenção descrita pode ser realizada pelos educadores motivados em aprimorar a qualidade do ensino.…”