Department of Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital Medical Simulation Center, Department of Nursing, Rhode Island Hospital, Providence, RI 02903, USA.
Simul Healthc. 2010 Apr;5(2):82-90. doi: 10.1097/SIH.0b013e3181ccd75c.
Multifaceted approaches using simulation and human factors methods may optimize in-hospital sudden cardiac arrest (SCA) response. The Arrhythmia Simulation/Cardiac Event Nursing Training-Automated External Defibrillator phase (ASCENT-AED) study used in situ medical simulation to compare traditional and AED-supplemented SCA first-responder models.
The study was conducted at an academic 719-bed hospital with institutional review board approval. Two simulation scenarios were developed and featured either respiratory arrest with perfusing bradycardia or ventricular fibrillation (VF) arrest. Study floors were equipped with either a semiautomated defibrillator (SD) only (control) or with both SD and AED (experimental); subjects functioned as solitary first responders and did not receive resuscitation training.
Fifty nurses were enrolled on control (n=25) and experimental (n=25) floors. The groups' nonblinded performances exhibited the following differences during VF scenario: slower calls for help by the control group [mean time to completion of 25+/-17 seconds versus 18+/-11 seconds for the experimental group (P<0.05)] and fewer subjects in the control group performing chest compressions [44.0% versus experimental group's 95.8% (P<0.001)]. Eighty-eight percent of the control group defibrillated the manikin at an average of 155+/-59 seconds, with 32.0% of those subjects using semiautomated rhythm analysis; 100% (not significant [NS]) of experimental group defibrillated at 154+/-72 seconds (NS) with 100% AED analysis (P<0.001). Fewer control group subjects (28.0%) were observed during the bradycardia scenarios to perform inappropriate chest compressions than the AED-supplemented subjects [69.6% (P=0.01)]; nonindicated defibrillation was delivered during these scenarios by a single subject in the control group. Twenty-eight percent and 72% of VF scenarios were managed appropriately by control and experimental groups, respectively; bradycardia scenarios were managed without severe adverse event by 64% of control group and 28% of experimental group.
In situ simulation can provide useful information, both anticipated and unexpected, to guide decisions about proposed defibrillation technologies and SCA response models for in-hospital resuscitation system design and education before implementation.
使用模拟和人为因素方法的多方面方法可能会优化医院内突发性心脏骤停 (SCA) 的反应。心律失常模拟/心脏事件护理培训-自动体外除颤器阶段 (ASCENT-AED) 研究使用现场医学模拟来比较传统和 AED 补充的 SCA 第一响应者模型。
该研究在一家拥有机构审查委员会批准的 719 张病床的学术医院进行。开发了两个模拟场景，分别具有呼吸骤停伴灌注性心动过缓和心室颤动 (VF) 骤停。研究楼层配备了半自动除颤器 (SD) （对照组）或 SD 和 AED （实验组）；受试者作为单一的第一响应者，没有接受复苏培训。
50 名护士被纳入对照组 (n=25) 和实验组 (n=25)。VF 场景中两组非盲表现存在以下差异：对照组的求助时间较慢[完成时间平均为 25+/-17 秒，而实验组为 18+/-11 秒 (P<0.05)]，对照组中进行胸外按压的受试者较少[44.0%与实验组的 95.8% (P<0.001)]。对照组中有 88%的人在平均 155+/-59 秒后对模型进行除颤，其中 32.0%的人使用半自动节律分析；实验组 100%（不显著[NS]）在 154+/-72 秒除颤（NS），100%使用 AED 分析（P<0.001）。在心动过缓场景中，观察到对照组的受试者进行不适当的胸外按压的比例（28.0%）低于 AED 补充组[69.6%（P=0.01）]；对照组中有一名受试者在这些场景中进行了非指示性除颤。VF 场景分别由对照组和实验组正确处理 28%和 72%；对照组中有 64%的心动过缓场景没有严重不良事件，而实验组有 28%。
现场模拟可以提供有用的信息，无论是预期的还是意外的，以指导关于拟议的除颤技术和 SCA 反应模型的决策，以便在实施前为医院复苏系统设计和教育提供信息。
