Niles Dana E, Nishisaki Akira, Sutton Robert M, Elci Okan U, Meaney Peter A, OʼConnor Kathleen A, Leffelman Jessica, Kramer-Johansen Jo, Berg Robert A, Nadkarni Vinay
From the Center for Simulation, Advanced Education and Innovation (D.E.N., A.N., J.L., V.N.), Department of Anesthesiology and Critical Care Medicine (A.N., R.M.S., P.A.M., R.A.B., V.N.), Westat-Biostatistics and Data Management Core (O.U.E.), Department of Nursing, The Children's Hospital of Philadelphia (K.A.O), PA; and Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS) and Department of Anaesthesiology (J.K.-J.), Oslo University Hospital and University of Oslo, Oslo, Norway.
Simul Healthc. 2017 Aug;12(4):213-219. doi: 10.1097/SIH.0000000000000228.
High-quality cardiopulmonary resuscitation (CPR) is critical to improve survival from cardiac arrest. However, cardiopulmonary resuscitation knowledge and psychomotor skill proficiency are transient. We hypothesized that brief, in situ refresher training will improve chest compression (CC) psychomotor skill retention for bedside providers.
Nurses completed a baseline skill evaluation of CC quality 6 months after traditional basic life support recertification. Data collected using ResusciAnne with SkillReporter included the following: CC depth, rate, complete release, and correct hand position. Total compliance was defined as 100% CC with depth of 50 mm or greater, rate of 100/min or greater, and more than 90% complete release. After the baseline evaluation, the subjects completed "Rolling Refresher" (RR) CC psychomotor training using audiovisual feedback every 2 to 3 months for 12 months until 30 seconds of CCs fulfilling total compliance criteria was achieved. Chest compression quality evaluations were repeated twice ("RR 6 month" and "RR 12 month" evaluation) after implementation of RR program.
Thirty-seven providers enrolled and completed the baseline evaluation. Mean depth was 36.3 (9.7) mm, and 8% met criteria for depth, 35% for rate, and 5% for total compliance. After RRs were implemented, CC quality improved significantly at RR 6-month evaluation: odds ratio for meeting criteria were the following: depth of 35.1 (95% confidence interval = 2.5496, P = 0.009) and total compliance of 22.3 (95% confidence interval = 2.1239, P = 0.010). There was no difference in CC quality at RR 12-month versus RR 6-month evaluation.
Retention of CC psychomotor skill quality is limited to 6 months after traditional basic life support recertification. Rolling Refresher CC training can significantly improve retention of CC psychomotor skills. Whether CC skills are improved, maintained, or deteriorate after 12 months of Refresher training and optimal frequency of Refreshers is unknown.
高质量的心肺复苏对于提高心脏骤停后的生存率至关重要。然而，心肺复苏知识和操作技能熟练程度是短暂的。我们假设简短的现场复习培训将提高床边医护人员胸外按压（CC）操作技能的保持情况。
护士在传统基础生命支持再认证6个月后完成了CC质量的基线技能评估。使用带有技能报告器的复苏安妮收集的数据包括以下内容：CC深度、速率、完全释放和正确的手部位置。总依从性定义为深度50毫米或更大、速率100次/分钟或更高且完全释放超过90%的100%CC。在基线评估后，受试者每2至3个月使用视听反馈完成一次“滚动复习”（RR）CC操作技能培训，持续12个月，直到达到30秒符合总依从性标准的CC。在RR计划实施后，重复进行两次胸外按压质量评估（“RR 6个月”和“RR 12个月”评估）。
37名医护人员登记并完成了基线评估。平均深度为36.3（9.7）毫米，8%符合深度标准，35%符合速率标准，5%符合总依从性标准。在实施RR后，RR 6个月评估时CC质量显著改善：符合标准的优势比如下：深度为35.1（95%置信区间 = 2.5496，P = 0.009），总依从性为22.3（95%置信区间 = 2.1239，P = 0.010）。RR 12个月评估与RR 6个月评估时CC质量无差异。
传统基础生命支持再认证后，CC操作技能质量的保持时间限制在6个月。滚动复习CC培训可显著提高CC操作技能的保持情况。复习培训12个月后CC技能是提高、维持还是恶化以及复习的最佳频率尚不清楚。
