Evaluating Simulation-Based ACLS Education on Patient Outcomes: A Randomized, Controlled Pilot Study

Abstract

Background Simulation training is widely accepted as an effective teaching tool, especially for dealing with high-risk situations. Objective We assessed whether standardized, simulation-based advanced cardiac life support (ACLS) training improved performance in managing simulated and actual cardiac arrests. Methods A total of 103 second- and third-year internal medicine residents were randomized to 2 groups. The first group underwent conventional ACLS training. The second group underwent two 2 1/2-hour sessions of standardized simulation ACLS teaching. The groups were assessed by evaluators blinded to their assignment during in-hospital monthly mock codes and actual inpatient code sheets at 3 large academic hospitals. Primary outcomes were time to initiation of cardiopulmonary resuscitation, time to administration of first epinephrine/vasopressin, time to delivery of first defibrillation, and adherence to American Heart Association guidelines. Results There were no differences in primary outcomes among the study arms and hospital sites. During 21 mock codes, the most common error was misidentification of the initial rhythm (67% [6 of 9] and 58% [7 of 12] control and simulation arms, respectively, P = .70). There were no differences in primary outcome among groups in 147 actual inpatient codes. Conclusions This blinded, randomized study found no effect on primary outcomes. A notable finding was the percentage of internal medicine residents who misidentified cardiac arrest rhythms.

Code Blue: methodology for a qualitative study of teamwork during simulated cardiac arrest

“…A recent study of simulation-based code training for physician team leaders found that it yielded no significant improvement in key processes of cardiac arrest care: time to initiation of CPR, time to administration of cardiac medication and time to defibrillation. 24 Yet, processes such as CPR initiation and defibrillator deployment rely on the actions of multiple providers, and they often unfold prior to the arrival of a physician leader. 25 The dynamic and unpredictable nature of response to cardiac arrest creates a tension between interdependence and the need for autonomous action within a diverse group of providers.…”

“…This study will follow a grounded theory approach in which the process of data collection and analysis occur simultaneously. 24 The approach allows for the pursuit of emergent themes through early data analysis, as well as the discovery of basic social processes within the data that may shape subsequent data collection. Grounded theory is an inductive process by which abstract categories are constructed to explain and synthesise data.…”

Randomized Controlled Trial of Simulation vs. Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation

“…There is also literature that has shown no benefit to simulation training in resuscitation. A prospective study evaluating whether simulation-based ACLS training improves performance in managing simulated and actual cardiac arrest found no difference in adherence to the AHA guidelines 39. Another study evaluated whether participants who receive ACLS training on high-fidelity manikins performed better than those trained on low-fidelity manikins found no difference in groups on written tests scores 40.…”

Implementation and evaluation of an interprofessional simulation-based education program for undergraduate nursing students in operating room nursing education: a randomized controlled trial

“…A contribution to counteracting negative cultural traits within the OR may be made by increasing opportunities for positive practice and modeling of effective team-based competencies by students in an IPE setting [ 21 ]. There is increased emphasis on the need to produce “safe” practitioners in increasing numbers while, at the same time, there are increasing restrictions on practicing on real patients [ 22 ]. Simulation-based learning can help to overcome this problem by providing students with an opportunity to apply learned concepts and skills in a realistic clinical setting [ 8 , 23 ].…”