Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association

Abstract

The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.

Training interval in cardiopulmonary resuscitation

“…With spaced training, learners have guided practice spread across several training sessions. Studies support that spaced CPR training improves performance and retention of skills [1,12,15,[17][18][19].…”

“…The association between high quality cardiopulmonary resuscitation (CPR) and patient survival has been well documented over the years. High quality CPR that meets the guidelines of the American Heart Association (AHA) and European Resuscitation Council improves patient outcomes and chances of survival following a cardiac arrest [1][2][3][4][5][6][7]. Many health care providers, however, are unable to perform high quality CPR even though they satisfied CPR training requirements [1,[8][9][10][11].…”

“…Research has repeatedly documented a significant decay in CPR skills within weeks to months after training [1,[11][12][13][14][15][16]. Thus, CPR training that is completed in a 1-or 2-day course may confirm providers' acquisition of knowledge and skills at that moment, but those skills deteriorate rapidly without continued practice.…”

“…Thus, CPR training that is completed in a 1-or 2-day course may confirm providers' acquisition of knowledge and skills at that moment, but those skills deteriorate rapidly without continued practice. Based on a review of studies on resuscitation education, investigators concluded that increasing the frequency of training would improve training efficacy, prevent skill deterioration, and improve CPR skill performance [1].…”

“…For CPR training, provider performance is bolstered when accurate and detailed information on performance quality is provided in real time. Automated feedback devices leveraging objective performance measures provide real-time audio and visual feedback about performance and lead to improved CPR quality [1,9,12,14,15,19,22]. This feedback increases CPR quality in both training and during actual performance of CPR [12,23,24].…”