High‐Fidelity Simulation Fails to Improve Clinical Performance in a Randomized Study of Actual In‐Hospital Cardiac Resuscitation

Background:

Simulation is increasingly being incorporated into cardiopulmonary resuscitation (CPR) training. This educational method has been shown to improve trainee performance in simulated settings, but the effect on actual patient care remains unknown.

Methods:

Matriculating residents were randomized to participate in a 4‐hour resuscitation leadership course using a high‐fidelity simulator (Human Patient Simulator, Medical Education Technologies), with video debriefing, prior to assuming the role of resuscitation team leaders at an academic medical center. Following a month of actual in‐hospital resuscitations, the residents were surveyed regarding their knowledge of the 2005 consensus resuscitation guidelines. Additionally, objective metrics of resuscitation performance were obtained from a CPR‐sensing monitor/defibrillator (MRx‐QCPR, Philips Medical Systems), and the 2 groups were compared.

Results:

Half the 32 residents were randomized to receive simulation training (ST) between April and July 2007, and data were collected following actual resuscitations between July and December 2007. During this time, 16 residents served as team leaders (7 ST, 9 control [C]) during 67 resuscitations (32 ST, 35 C). Surveys were completed by 16 of 16 residents (100%) and showed no difference in knowledge of the resuscitation guidelines between the groups. Additionally there were no differences in CPR quality as measured by chest compression rate (107 ± 7/min vs. 106 ± 7/min, P = .36), compression depth (47 ± 7 vs. 47 ± 7 mm, P = .81), ventilation rate (8 ± 5/min vs. 9 ± 5/min, P = .21), and no‐flow fraction (0.16 ± 0.17 vs. 0.17 ± 0.21, P = .81).

Conclusions:

In this small sample, simulation experience did not offer any incremental benefit over the current training methods. This may have been because of the sample size, an inadequate simulation course, or a previously optimized training regimen. However, assessing the effects of a simulation‐based resuscitation curriculum on actual resuscitation performance is feasible using CPR‐sens‐ing technology. Future work should evaluate the impact of a longer simulation course.

Author Disclosure:

G. Bell, none; E. Weidman, none; S. Small, none; T. Vanden Hoek, Philips Medical Systems, research funding; L. Becker, Philips Medical Systems, research funding, consulting fees; Laerdal Medical, research funding; B. Abella, Philips Medical Systems, research funding, consulting fees; Laerdal Medical, consulting fees or other remuneration; D. Edelson, Philips Medical Systems, research funding, consulting fees; Laerdal Medical, consulting fees or other remuneration.