Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St, Providence, RI 02903, USA.
Resuscitation. 2010 Apr;81(4):463-71. doi: 10.1016/j.resuscitation.2010.01.003. Epub 2010 Feb 1.
High-fidelity medical simulation of sudden cardiac arrest (SCA) presents an opportunity for systematic probing of in-hospital resuscitation systems. Investigators developed and implemented the SimCode program to evaluate simulation's ability to generate meaningful data for system safety analysis and determine concordance of observed results with institutional quality data.
Resuscitation response performance data were collected during in situ SCA simulations on hospital medical floors. SimCode dataset was compared with chart review-based dataset of actual (live) in-hospital resuscitation system performance for SCA events of similar acuity and complexity.
135 hospital personnel participated in nine SimCode resuscitations between 2006 and 2008. Resuscitation teams arrived at 2.5+/-1.3 min (mean+/-SD) after resuscitation initiation, started bag-valve-mask ventilation by 2.8+/-0.5 min, and completed endotracheal intubations at 11.3+/-4.0 min. CPR was performed within 3.1+/-2.3 min; arrhythmia recognition occurred by 4.9+/-2.1 min, defibrillation at 6.8+/-2.4 min. Chart review data for 168 live in-hospital SCA events during a contemporaneous period were extracted from institutional database. CPR and defibrillation occurred later during SimCodes than reported by chart review, i.e., live: 0.9+/-2.3 min (p<0.01) and 2.1+/-4.1 min (p<0.01), respectively. Chart review noted fewer problems with CPR performance (simulated: 43% proper CPR vs. live: 98%, p<0.01). Potential causes of discrepancies between resuscitation response datasets included sample size and data limitations, simulation fidelity, unmatched SCA scenario pools, and dissimilar determination of SCA response performance by complementary reviewing methodologies.
On-site simulations successfully generated SCA response measurements for comparison with live resuscitation chart review data. Continued research may refine simulation's role in quality initiatives, clarify methodologic discrepancies and improve SCA response.
高保真度的心脏骤停（SCA）医学模拟为系统研究医院复苏系统提供了机会。研究人员开发并实施了 SimCode 计划，以评估模拟在系统安全分析中生成有意义数据的能力，并确定观察结果与机构质量数据的一致性。
在医院医疗楼层的现场 SCA 模拟中收集复苏反应性能数据。SimCode 数据集与基于图表回顾的实际（现场）院内复苏系统 SCA 事件表现数据集进行了比较，这些事件具有相似的严重程度和复杂性。
2006 年至 2008 年期间，共有 135 名医院人员参与了 9 次 SimCode 复苏。复苏团队在复苏开始后 2.5+/-1.3 分钟（平均值+/-标准差）到达，在 2.8+/-0.5 分钟内开始进行球囊面罩通气，并在 11.3+/-4.0 分钟内完成气管插管。CPR 在 3.1+/-2.3 分钟内进行；心律失常识别在 4.9+/-2.1 分钟时发生，除颤在 6.8+/-2.4 分钟时发生。同时期从机构数据库中提取了 168 例现场院内 SCA 事件的图表回顾数据。SimCode 中的 CPR 和除颤时间晚于图表回顾报告的时间，即现场：0.9+/-2.3 分钟（p<0.01）和 2.1+/-4.1 分钟（p<0.01）。图表回顾指出，CPR 表现的问题较少（模拟：43%的适当 CPR 与现场：98%，p<0.01）。复苏反应数据集之间存在差异的潜在原因包括样本量和数据限制、模拟保真度、不匹配的 SCA 情景池以及互补审查方法对 SCA 反应性能的不同确定。
现场模拟成功生成了 SCA 反应测量值，可与现场复苏图表回顾数据进行比较。进一步的研究可能会改进模拟在质量计划中的作用，阐明方法学差异，并改善 SCA 反应。
