Successful outcome from cardiopulmonary arrest requires effective chest compressions (CC) and efficient initial airway management (IAM). Advanced Cardiac Life Support (ACLS) certification implies proficiency in these skills. All medical house staff are required to be ACLS certified. We investigated the adequacy of such training by using a high-fidelity computerized patient simulator (CPS) with scenario based testing (SBT).
All in-coming medical house staff (n = 35) to our tertiary care teaching hospital were included. Each house officer was tested on the focused tasks of CC and IAM using appropriate clinical scenarios on the CPS. Performance of each task was scored using an objective scoring scheme by two independent observers. For standardization and accuracy, the observers received training on criteria for scoring each element of the task. For the purposes of analysis, house staff were divided in to two groups based on ACLS certification status at the time of testing.
Of the 35 house officers, 25 had received ACLS training (group 1) and 10 had not (group 2), prior to our testing. For CC, the maximum possible score was 11. Group 1 scored 3.16(± 1.95 (mean ± SD) and group 2 scored 4.40 ± 1.65 (mean ± SD); p = 0.07. For IAM, the maximum possible score was 12. Group 1 scored 2.12 ± 1.17 (mean ± SD) and group 2 scored 1.60 ± 1.27 (mean ± SD); p = 0.28. The aggregate score for both tasks was 5.28 ± 2.57 (mean ± SD) in group 1 and 6 ± 2.40 (mean ± SD) in group 2 (p = 0.44).
ACLS certification had no impact on performance of key tasks of CC and IAM during a simulated in-hospital cardio-pulmonary arrest. ACLS training requires simultaneous integration of numerous skills, which may overwhelm the learner.
We conclude that ACLS training may be inadequate for effective management of cardio-pulmonary arrests. Scenario-based training with CPS at frequent intervals could supplement ACLS skills in medical house staff.
Pralay Sarkar, No Financial Disclosure Information; No Product/Research Disclosure Information