Emergency Resuscitation Center, University of Chicago, Chicago, USA.
Resuscitation. 2010 Nov;81(11):1556-61. doi: 10.1016/j.resuscitation.2010.05.021. Epub 2010 Aug 17.
Advanced simulation tools are increasingly being incorporated into cardiopulmonary resuscitation (CPR) training. These educational methods have been shown to improve trainee performance in simulated settings, but translation into clinical practice remains unknown for many aspects of CPR quality. This study attempts to measure the impact of simulation-based training for resuscitation team leaders on some measures of CPR quality during actual in-hospital resuscitation attempts.
In this prospective, randomized interventional cluster trial, internal medicine resident physicians (post-graduate year 2) were randomized using a random number generator to participate in a 4-h, immersive simulation course in cardiopulmonary resuscitation leadership using a high-fidelity simulator with video debriefing prior to serving as resuscitation team leaders at an academic medical center. Objective metrics of actual resuscitation performance were obtained from a CPR-sensing monitor/defibrillator.
Thirty-two residents were randomized to receive simulation training or no additional training between April and July 2007 and data were collected following 98 actual resuscitations between July 2007 and June 2008. CPR quality from resuscitations led by 14 simulation-trained and 16 control group residents was similar in terms of mean compression depth (48 vs 49 mm; p = 0.53); compression rate (107 vs 104 min⁻¹; p = 0.30); ventilation rate (12 vs 12 min⁻¹; p = 0.45) and no-flow fraction (0.08 vs 0.07; p = 0.34).
Although we failed to detect any significant differences in objective measures of CPR quality, we have demonstrated that CPR-sensing technology has the potential for use in assessing the impact of a simulation curriculum on some aspects of actual resuscitation performance. A larger study, performed in a setting with lower baseline performance, would be required to assess the specific simulation curriculum.
心肺复苏术(CPR)培训中越来越多地采用高级模拟工具。这些教育方法已被证明可以提高模拟环境中的学员表现,但在许多 CPR 质量方面,其在临床实践中的转化仍不为人知。本研究试图衡量基于模拟的复苏团队领导培训对实际院内复苏尝试中某些 CPR 质量措施的影响。
在这项前瞻性、随机干预性集群试验中,使用随机数生成器将内科住院医师(研究生第二年)随机分为两组,一组参加使用高保真模拟器进行的 4 小时沉浸式心肺复苏领导力模拟课程,并在学术医疗中心担任复苏团队领导之前进行视频讨论,另一组则不参加。实际复苏表现的客观指标是从 CPR 感应监测仪/除颤器中获得的。
2007 年 4 月至 7 月期间,32 名住院医师被随机分配接受模拟培训或不接受额外培训,并在 2007 年 7 月至 2008 年 6 月期间进行了 98 次实际复苏后收集数据。由 14 名接受过模拟培训的和 16 名对照组的住院医师领导的复苏的 CPR 质量在以下方面相似:平均按压深度(48 与 49mm;p=0.53);按压频率(107 与 104 次/min;p=0.30);通气频率(12 与 12 次/min;p=0.45)和无血流分数(0.08 与 0.07;p=0.34)。
尽管我们未能检测到 CPR 质量的客观指标有任何显著差异,但我们已经证明,CPR 感应技术具有用于评估模拟课程对某些实际复苏表现方面的影响的潜力。在基线表现较低的环境中进行更大规模的研究将有助于评估特定的模拟课程。