Improved recognition of ineffective chest compressions after a brief Crew Resource Management (CRM) training: a prospective, randomised simulation study.

BACKGROUND: Chest compressions are a core element of cardio-pulmonary resuscitation. Despite periodic training, real-life chest compressions have been reported to be overly shallow and/or fast, very likely affecting patient outcomes. We investigated the effect of a brief Crew Resource Management (CRM) training program on the correction rate of improperly executed chest compressions in a simulated cardiac arrest scenario. METHODS: Final-year medical students (n = 57) were randomised to receive a 10-min computer-based CRM or a control training on ethics. Acting as team leaders, subjects performed resuscitation in a simulated cardiac arrest scenario before and after the training. Team members performed standardised overly shallow and fast chest compressions. We analysed how often the team leader recognised and corrected improper chest compressions, as well as communication and resuscitation quality. RESULTS: After the CRM training, team leaders corrected improper chest compressions (35.5%) significantly more often compared with those undergoing control training (7.7%, p = 0.03*). Consequently, four students have to be trained (number needed to treat = 3.6) for one improved chest compression scenario. Communication quality assessed by the Leader Behavior Description Questionnaire significantly increased in the intervention group by a mean of 4.5 compared with 2.0 (p = 0.01*) in the control group. CONCLUSION: A computer-based, 10-min CRM training improved the recognition of ineffective of chest compressions. Furthermore, communication quality increased. As guideline-adherent chest compressions have been linked to improved patient outcomes, our CRM training might represent a brief and affordable approach to increase chest compression quality and potentially improve patient outcomes.

Basic life support is effectively taught in groups of three, five and eight medical students: a prospective, randomized study.

BACKGROUND: Resuscitation is a life-saving measure usually instructed in simulation sessions. Small-group teaching is effective. However, feasible group sizes for resuscitation classes are unknown. We investigated the impact of different group sizes on the outcome of resuscitation training. METHODS: Medical students (n = 74) were randomized to courses with three, five or eight participants per tutor. The course duration was adjusted according to the group size, so that there was a time slot of 6 minutes hands-on time for every student. All participants performed an objective structured clinical examination before and after training. The teaching sessions were videotaped and resuscitation quality was scored using a checklist while we measured the chest compression parameters with a manikin. In addition, we recorded hands-on-time, questions to the tutor and unrelated conversation. RESULTS: Results are displayed as median (IQR). Checklist pass rates and scores were comparable between the groups of three, five and eight students per tutor in the post-test (93%, 100% and 100%). Groups of eight students asked fewer questions (0.5 (0.0 - 1.0) vs. 3.0 (2.0 - 4.0), p < .001), had less hands-on time (2:16 min (1:15 - 4:55 min) vs. 4:07 min (2:54 - 5:52 min), p = .02), conducted more unrelated conversations (17.0 ± 5.1 and 2.9 ± 1.7, p < 0.001) and had lower self-assessments than groups of three students per tutor (7.0 (6.1 - 9.0) and 8.2 (7.2 - 9.0), p = .03). CONCLUSIONS: Resuscitation checklist scores and pass rates after training were comparable in groups of three, five or eight medical students, although smaller groups had advantages in teaching interventions and hands-on time. Our results suggest that teaching BLS skills is effective in groups up to eight medical students, but smaller groups yielded more intense teaching conditions, which might be crucial for more complex skills or less advanced students.

Factors associated with delayed defibrillation in cardiopulmonary resuscitation: A prospective simulation study.

INTRODUCTION: Early defibrillation is an important factor of survival in cardiac arrest. However, novice resuscitators often struggle with cardiac arrest patients. We investigated factors leading to delayed defibrillation performed by final-year medical students within a simulated bystander cardiac arrest situation. METHODS: Final-year medical students received a refresher lecture and basic life support training before being confronted with a simulated cardiac arrest situation in a simulation ambulance. The scenario was analyzed for factors leading to delayed defibrillation. We compared the time intervals the participants needed for various measures with a benchmark set by experienced resuscitators. After training, the participants were interviewed regarding challenges and thoughts during the scenario. RESULTS: The median time needed for defibrillation was 158 s (n = 49, interquartile range: 107-270 s), more than six-fold of the benchmark time. The major part of total defibrillation time (49%; median, n = 49) was between onset of ventricular fibrillation and beginning to prepare the defibrillator, more specifically the time between end of preparation of the defibrillator and actual delivery of the shock, with a mean proportion of 26% (n = 49, SD = 17%) of the overall time needed for defibrillation (maximum 67%). Self-reported reasons for this delay included uncertainty about the next step to take, as reported by 73% of the participants. A total of 35% were unsure about which algorithm to follow. Diagnosing the patient was subjectively difficult for 35% of the participants. Overall, 53% of the participants felt generally confused. CONCLUSIONS: Our study shows that novice resuscitators rarely achieve guideline-recommended defibrillation times. The most relative delays were observed when participants had to choose what to do next or which algorithm to follow, and thus i.e. performed extensive airway management before a life-saving defibrillation. Our data provides a first insight in the process of defibrillation delay and can be used to generate new hypotheses on how to provide a timely defibrillation.