The association of recent simulation training and clinical experience of team leaders with cardiopulmonary resuscitation quality during in-hospital cardiac arrest.

OBJECTIVE: We aimed to investigate the association of recent team leader simulation training (<6 months) and years of clinical experience (≥4 years) with chest compression quality during in-hospital cardiac arrest (IHCA). METHODS: This cohort study of IHCA in four Danish hospitals included cases with data on chest compression quality and team leader characteristics. We assessed the impact of recent simulation training and experienced team leaders on longest chest compression pause duration (primary outcome), chest compression fraction (CCF), and chest compression rates within guideline recommendations using mixed effects models. RESULTS: Of 157 included resuscitation attempts, 45% had a team leader who recently participated in simulation training and 66% had an experienced team leader. The median team leader experience was 7 years [Q1; Q3: 4; 11]. The median duration of the longest chest compression pause was 16 s [10; 30]. Having a team leader with recent simulation training was associated with significantly shorter longest pause durations (difference: -7.11 s (95%-CI: -12.0; -2.2), p = 0.004), a higher CCF (difference: 3% (95%-CI: 2.0; 4.0%), p < 0.001) and with less guideline compliant chest compression rates (odds ratio: 0.4 (95%-CI: 0.19; 0.84), p = 0.02). Having an experienced team leader was not associated with longest pause duration (difference: -1.57 s (95%-CI: -5.34; 2.21), p = 0.42), CCF (difference: 0.7% (95%-CI: -0.3; 1.7), p = 0.17) or chest compression rates within guideline recommendations (odds ratio: 1.55 (95%-CI: 0.91; 2.66), p = 0.11). CONCLUSION: Recent simulation training of team leaders, but not years of team leader experience, was associated with shorter chest compression pauses during IHCA.

Why Do Not Physicians Attend Hospital Cardiopulmonary Resuscitation Training?

INTRODUCTION: Cardiopulmonary resuscitation (CPR) training is mandatory in most hospitals. Despite this, some hospital staff do not attend CPR training on a regular basis, but the barriers to training attendance are sparsely investigated. This study aimed to investigate CPR course attendance, barriers to participation, and possible initiatives to increase CPR course attendance. METHODS: Physicians from one university hospital and one regional hospital in the Central Denmark Region were included. Questionnaires were handed out at daily staff meetings at departments of internal medicine and surgery. RESULTS: In total, 233 physicians responded (response rate: 92%, male: 54%). Overall, 32% of physicians had not attended CPR training at the hospital. Mean (±standard deviation) time since the last CPR course participation was 17 (±3) months. Frequent barriers to attending courses included not knowing when courses are conducted (70%) and where to sign up for training (45%). The majority (60%) of physicians responded that the reason why they prioritize course participation is to be professionally updated. In contrast, 16% stated that they had sufficient CPR skills and therefore CPR training was unnecessary. Physicians stated that the following factors would improve CPR training participation: an annual day protected (no clinical work) for course attendance (72%), use of short booster sessions (49%), shorter courses combined with e-learning (51%) and shorter courses held over 2 days (46%). CONCLUSION: One-third of physicians did not attend hospital CPR training at two Danish hospitals. Several barriers to course participation exist, of which course registration seems to be a crucial factor. Alternative CPR training methods may help improve training participation.

Barriers and facilitators for in-hospital resuscitation: A prospective clinical study.

INTRODUCTION: Guideline deviations with impact on patient outcomes frequently occur during in-hospital cardiopulmonary resuscitation (CPR). However, barriers and facilitators for preventing these guideline deviations are understudied. We aimed to characterize challenges occurring during IHCA and identify barriers and facilitators perceived by actual team members immediately following IHCA events. METHODS: This was a prospective multicenter clinical study. Following each resuscitation attempt in 6 hospitals over a 4-year period, we immediately sent web-based structured questionnaires to all responding team members, reporting their perceived resuscitation quality, teamwork, and communication and what they perceived as barriers or facilitators. Comments were analyzed using qualitative inductive thematic analysis methodology. RESULTS: We identified 924 resuscitation attempts and 3,698 survey responses were collected including 2,095 qualitative comments (response rate: 65%). Most frequent challenges were overcrowding (27%) and poor ergonomics/choreography of people in the room (17%). Narrative comments aligned into 24 unique barrier and facilitator themes in 4 domains: 6 related to treatment (most prevalent: CPR, rhythm check, equipment), 7 for teamwork (most prevalent: role allocation, crowd control, collaboration with ward staff), 6 for leadership (most prevalent: visible and distinct leader, multiple leaders, leader experience), and 5 for communication (most prevalent: closed loops, atmosphere in room, speaking loud/clear). CONCLUSION: Using novel, immediate after-event survey methodology of individual cardiac arrest team members, we characterized challenges and identified 24 themes within 4 domains that were barriers and facilitators for in-hospital resuscitation teams. We believe this level of detail is necessary to contextualize guidelines and training to facilitate high-quality resuscitation.