Cardiopulmonary resuscitation guidance improves medical students' adherence to guidelines in simulated cardiac arrest: a randomised cross-over study.

BACKGROUND

The 2010 Resuscitation Guidelines require high-quality chest compression and rapid defibrillation for patients with ventricular fibrillation with rhythm analysis and defibrillation repeated every 2 min. A lack of adherence to the guidelines by medical students was observed during simulated resuscitation training.

OBJECTIVES

To assess whether real-time cardiopulmonary resuscitation guidance, including an audiovisual countdown timer, a metronome, a display of the chest compression quality and voice prompts, might improve adherence to the guidelines by medical students.

DESIGN

Randomised cross-over simulation study.

SETTING

Studienhospital Münster, Faculty of Medicine University Münster, Germany

PARTICIPANTS

One hundred and forty-one medical students (fifth year) in 47 teams.

INTERVENTION

Simulated resuscitation with and without real-time cardiopulmonary resuscitation guidance.

MAIN OUTCOME MEASURES

The preshock pause, postshock pause, fraction of time without chest compression and defibrillation intervals. Observed quality parameters were chest compression depth and chest compression rate.

RESULTS

With real-time cardiopulmonary resuscitation guidance, there were improved mean (SD) chest compression rates (105 ± 8 vs. 121 ± 12 bpm; P < 0.005), fewer inappropriate shock intervals [median (interquartile range) 0 (1 to 5) vs. 4 (1 to 7); P < 0.005], a smaller fraction of time without chest compression (18.9 ± 4.4 vs. 22.5 ± 7.0%; P < 0.005) and shorter postshock pauses (2.3 ± 0.9 vs. 3.4 ± 1.2 s; P < 0.005).

CONCLUSION

Real-time cardiopulmonary resuscitation guidance significantly increased adherence to the guidelines by medical students treating simulated out-of-hospital cardiac arrest. Using a simple tool such as a countdown timer makes it possible to reduce the number of inappropriate shock intervals and time without chest compression.