将院内心脏骤停情境课程融入基础生命支持课程：一项随机对照模拟研究。

Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study.

作者信息

Hunt Elizabeth A, Duval-Arnould Jordan M, Chime Nnenna O, Jones Kareen, Rosen Michael, Hollingsworth Merona, Aksamit Deborah, Twilley Marida, Camacho Cheryl, Nogee Daniel P, Jung Julianna, Nelson-McMillan Kristen, Shilkofski Nicole, Perretta Julianne S

机构信息

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Department of Pediatrics, Baltimore, Maryland, USA; Division of Health Sciences Informatics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Division of Health Sciences Informatics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.

出版信息

Resuscitation. 2017 May;114:127-132. doi: 10.1016/j.resuscitation.2017.03.014. Epub 2017 Mar 18.

OBJECTIVE

The objective was to compare resuscitation performance on simulated in-hospital cardiac arrests after traditional American Heart Association (AHA) Healthcare Provider Basic Life Support course (TradBLS) versus revised course including in-hospital skills (HospBLS).

DESIGN

This study is a prospective, randomized, controlled curriculum evaluation.

SETTING

Johns Hopkins Medicine Simulation Center.

SUBJECTS

One hundred twenty-two first year medical students were divided into fifty-nine teams.

INTERVENTION

HospBLS course of identical length, containing additional content contextual to hospital environments, taught utilizing Rapid Cycle Deliberate Practice (RCDP).

MEASUREMENTS

The primary outcome measure during simulated cardiac arrest scenarios was chest compression fraction (CCF) and secondary outcome measures included metrics of high quality resuscitation.

MAIN RESULTS

Out-of-hospital cardiac arrest HospBLS teams had larger CCF: [69% (65-74) vs. 58% (53-62), p<0.001] and were faster than TradBLS at initiating compressions: [median (IQR): 9s (7-12) vs. 22s (17.5-30.5), p<0.001]. In-hospital cardiac arrest HospBLS teams had larger CCF: [73% (68-75) vs. 50% (43-54), p<0.001] and were faster to initiate compressions: [10s (6-11) vs. 36s (27-63), p<0.001]. All teams utilized the hospital AED to defibrillate within 180s per AHA guidelines [HospBLS: 122s (103-149) vs. TradBLS: 139s (117-172), p=0.09]. HospBLS teams performed more hospital-specific maneuvers to optimize compressions, i.e. utilized: CPR button to flatten bed: [7/30 (23%) vs. 0/29 (0%), p=0.006], backboard: [21/30 (70%) vs. 5/29 (17%), p<0.001], stepstool: [28/30 (93%) vs. 8/29 (28%), p<0.001], lowered bedrails: [28/30 (93%) vs. 10/29 (34%), p<0.001], connected oxygen appropriately: [26/30 (87%) vs. 1/29 (3%), p<0.001] and used oral airway and/or two-person bagging when traditional bag-mask-ventilation unsuccessful: [30/30 (100%) vs. 0/29 (0%), p<0.001].

CONCLUSION

A hospital focused BLS course utilizing RCDP was associated with improved performance on hospital-specific quality measures compared with the traditional AHA course.

目的

本研究旨在比较传统美国心脏协会（AHA）医疗保健提供者基础生命支持课程（传统基础生命支持课程）与包含院内技能的修订课程（院内基础生命支持课程）在模拟院内心脏骤停时的复苏表现。

设计

本研究为前瞻性、随机对照课程评估。

地点

约翰霍普金斯医学模拟中心。

研究对象

122名一年级医学生被分成59个小组。

干预措施

时长相同的院内基础生命支持课程，包含与医院环境相关的额外内容，采用快速循环刻意练习（RCDP）进行授课。

测量指标

模拟心脏骤停场景中的主要结局指标为胸外按压分数（CCF），次要结局指标包括高质量复苏的各项指标。

主要结果

院外心脏骤停时，院内基础生命支持课程小组的CCF更高：[69%（65 - 74）对58%（53 - 62），p<0.001]，且开始按压的速度比传统基础生命支持课程小组更快：[中位数（四分位间距）：9秒（7 - 12）对22秒（17.5 - 30.5），p<0.001]。院内心脏骤停时，院内基础生命支持课程小组的CCF更高：[73%（68 - 75）对50%（43 - 54），p<0.001]，开始按压也更快：[10秒（6 - 11）对36秒（27 - 63），p<0.001]。所有小组均按照AHA指南在180秒内使用医院自动体外除颤器（AED）进行除颤[院内基础生命支持课程小组：122秒（103 - 149）对传统基础生命支持课程小组：139秒（117 - 172），p = 0.09]。院内基础生命支持课程小组进行了更多针对医院的操作以优化按压，即使用：CPR按钮放平病床：[7/30（23%）对0/29（0%），p = 0.006]，背板：[21/30（70%）对5/29（17%），p<0.001]，脚凳：[28/30（93%）对8/29（28%），p<0.001]，放下床栏：[28/30（93%）对10/29（34%），p<0.001]，正确连接氧气：[26/30（87%）对1/29（3%），p<0.001]，以及在传统面罩球囊通气不成功时使用口咽气道和/或双人球囊面罩通气：[30/30（100%）对0/29（0%），p<0.001]。

结论

与传统AHA课程相比，采用RCDP的以医院为重点的基础生命支持课程在医院特定质量指标方面表现更佳。