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

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

Research output: Contribution to journalArticlepeer-review

Abstract

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): 9 s (7–12) vs. 22 s (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: [10 s (6–11) vs. 36 s (27–63), p < 0.001]. All teams utilized the hospital AED to defibrillate within 180 s per AHA guidelines [HospBLS: 122 s (103–149) vs. TradBLS: 139 s (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.

Original languageEnglish (US)
Pages (from-to)127-132
Number of pages6
JournalResuscitation
Volume114
DOIs
StatePublished - May 1 2017

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Education
  • Simulation
  • Teamwork
  • Time sensitive

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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