PURPOSE: The purpose of this blinded, randomized pilot study would be to determine whether standardized advanced cardiac life support (ACLS) simulation training improves educational and clinical outcomes when compared with standard training.
METHODS: 103 second and third-year internal medicine residents were randomized into two groups. The 1st group underwent usual experiental learning of ACLS. The second group underwent two 2.5-hour sessions of standardized simulation ACLS teaching. The groups were evaluated through the entire academic year for their performance during in-hospital monthly mock codes, in addition to real codes at three large academic hospitals,to be concluded in June. Primary outcomes were the perfect time to first epinephrine, time to first defibrillation and adherence to American Heart Association (AHA) guidelines.
RESULTS: At the time of April 2011, 14 mock codes are actually conducted among the three hospitals. Data can be found for 89 real codes. There is absolutely no difference between the groups in real code and mock code performance with time to first epinephrine, time for you to defibrillation, or adherence to AHA guidelines. As predicted, adherence to AHA guidelines did correlate with survival, though never to a statistically significant extent (p=0.059). The most common errors in codes with shockable rythms were administering medication and defibrillation within the wrong sequence. Within the mock codes, the most frequent errors were misidentifying the intial rhythm and delivering inappropriate defibrillation.
CONCLUSIONS: This blinded, randomized pilot study could be the largest study to knowledge analyzing how standardized resident simulation training correlates with real patient outcomes in ACLS performance. We found out that resident ACLS simulation training did not have any meaningful impact on medical outcome.
CLINICAL IMPLICATIONS: This study suggests that resident ACLS simulation training mightn’t have any meaningful influence on clinical outcomes. We theorize that providing bedside simulation education, using in-hospital mock codes accompanied by an immediate debrief, is likely an effective method of improving physician, nursing, respiratory therapy and pharmacy performance in codes, that can have a greater affect clinical outcomes.
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Author: JanicMOconnel
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