PURPOSE: The purpose of this blinded, randomized pilot study is to determine whether standardized advanced cardiac life support (ACLS) simulation training improves educational and clinical outcomes compared to standard training.
METHODS: 103 second and third-year internal medicine residents were randomized into two groups. The first group underwent usual experiental learning of ACLS. The second group underwent two 2.5-hour sessions of standardized simulation ACLS teaching. The groups were evaluated throughout the academic year on their performance during in-hospital monthly mock codes, as well as real codes at three large academic hospitals,to be concluded in June. Primary outcomes were time to first epinephrine, time to first defibrillation and adherence to American Heart Association (AHA) guidelines.
RESULTS: As of April 2011, 14 mock codes have been conducted among the three hospitals. Data are also available for 89 real codes. There is no difference between the groups in both real code and mock code performance in time to first epinephrine, time to defibrillation, or adherence to AHA guidelines. As predicted, adherence to AHA guidelines did correlate with survival, though not to a statistically significant extent (p=0.059). The most common errors in codes with shockable rythms were administering medication and defibrillation in the wrong sequence. In the mock codes, the most common errors were misidentifying the intial rhythm and delivering inappropriate defibrillation.
CONCLUSIONS: This blinded, randomized pilot study is the largest study to our knowledge analyzing how standardized resident simulation training correlates with real patient outcomes in ACLS performance. We found that resident ACLS simulation training did not have any meaningful effect on clinical outcomes.
CLINICAL IMPLICATIONS: This study suggests that resident ACLS simulation training may not have any meaningful impact on clinical outcomes. We theorize that providing bedside simulation education, using in-hospital mock codes followed by an immediate debrief, is likely a more effective method of improving physician, nursing, respiratory therapy and pharmacy performance in codes, which will have a greater impact on clinical outcomes.
DISCLOSURE: The following authors have nothing to disclose: Jenny Han, Antoine Trammell, James Finklea, Timothy Udoji, Daniel Dressler, Eric Honig, Prasad Abraham, Micah Fisher, Douglas Ander, Greg Martin, David Schulman
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