Evaluating Simulation-Based ACLS Education on Patient Outcomes: A Randomized, Controlled Pilot Study

摘要

What was known Simulation training is widely accepted for facilitating learning in high-risk situations such as advanced cardiac life support (ACLS).;What is new A study of simulation-based ACLS training for cardiac arrest found no improvement in outcomes relative to standard training.;Limitations Single institution study and confounding by training year limited generalizability.;Bottom line Many residents in the intervention and control groups misidentified cardiac arrest rhythms. Future efforts should focus on improving rhythm recognition and rhythm confirmation during actual codes.;Editor's Note: The online version of this article contains the Megacode skills test, a simulation patient management scenario, and a mock code audit.;Introduction With increasing emphasis on patient safety and provision of quality care, simulation training is widely accepted as an effective teaching tool, especially in managing high-risk situations such as central line placement, airway management, trauma resuscitation, and advanced cardiac life support (ACLS).1 Various studies of simulation training across specialties show improvement in learner and team performance, communication, and confidence.2–4 Simulation-based medical education has evolved from increasing learner confidence and clinical knowledge to improving patient care. A meta-analysis of 14 studies comparing effectiveness of conventional clinical education to simulation with deliberate practice found that simulation training improved patient care in obstetric deliveries, laparoscopic surgery, bronchoscopy, and cases of catheter-related bloodstream infection rates.5 One study demonstrated improved central line placement after simulation training, with successful insertions in 95% of cases for simulation-trained residents versus 81% for the control group.3 Two studies of simulation training for central line insertion found a reduction in bloodstream infection rates from 3.4 per 1000 catheter-days to 1.0 per 1000 catheter-days6 and a reduction of 6.47 per 1000 catheter-days to 2.44 per 1000 catheter-days, respectively, resulting in shorter lengths of stay.6,7 Another study found that simulation-based ACLS education improved quality of care during in-hospital cardiac arrest; 68% of simulation-trained residents compared to 44% of conventionally trained residents demonstrated adherence to American Heart Association (AHA) standards, although there were no differences in patient survival.1 Our aim was to replicate the previously reported ACLS simulation training study to determine whether standardized ACLS simulation training could improve clinical outcomes across multiple hospital sites.;Methods Setting and Participants The study period was September 2010 through June 2011. Simulation training was conducted in the Experiential Learning Center laboratory at Emory University School of Medicine. High-fidelity manikins (Resusci Anne simulator, model 150-00001, Laerdal Medical; and HAL 3000 and Noelle S575, Gaumard Scientific) were used to mimic physiological and rhythm changes of real patients. All second- and third-year internal medicine residents were invited to participate; 103 residents were randomized to 2 groups (figure?1), and only 1 resident declined to participate. Second- and third-year internal medicine residents were selected because trainees at that level are responsible for leading resuscitation efforts during in-hospital cardiac arrests at our institution. All residents participated in an AHA-approved ACLS provider class in 2009 during their internship year. View larger version (28K) FIGURE 1Study Design;Results Of 51 control participants, 40% (20) were PGY-2, 60% (29) were PGY-3, and 41% (21) were women. The simulation arm participants consisted of 60% (32 of 52) PGY-2, 40% (20) PGY-3, and 60% (31) women. On the prestudy survey, there were no differences between groups in their ACLS experience, although second-year residents reported being more nervous and less confident about ru