• Resuscitation · May 2017

    Randomized Controlled Trial

    Integration of In-Hospital Cardiac Arrest Contextual Curriculum into a Basic Life Support Course: A Randomized, Controlled Simulation Study.

    • Elizabeth A Hunt, Jordan M Duval-Arnould, Nnenna O Chime, Kareen Jones, Michael Rosen, Merona Hollingsworth, Deborah Aksamit, Marida Twilley, Cheryl Camacho, Daniel P Nogee, Julianna Jung, Kristen Nelson-McMillan, Nicole Shilkofski, and Julianne S Perretta.
    • Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Department of Pediatrics, Baltimore, Maryland, USA; Division of Health Sciences Informatics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA. Electronic address: ehunt@jhmi.edu.
    • Resuscitation. 2017 May 1; 114: 127-132.

    ObjectiveThe objective was to compare resuscitation performance on simulated in-hospital cardiac arrests after traditional American Heart Association (AHA) Healthcare Provider Basic Life Support course (TradBLS) versus revised course including in-hospital skills (HospBLS).DesignThis study is a prospective, randomized, controlled curriculum evaluation.SettingJohns Hopkins Medicine Simulation Center.SubjectsOne hundred twenty-two first year medical students were divided into fifty-nine teams.InterventionHospBLS course of identical length, containing additional content contextual to hospital environments, taught utilizing Rapid Cycle Deliberate Practice (RCDP).MeasurementsThe primary outcome measure during simulated cardiac arrest scenarios was chest compression fraction (CCF) and secondary outcome measures included metrics of high quality resuscitation.Main ResultsOut-of-hospital cardiac arrest HospBLS teams had larger CCF: [69% (65-74) vs. 58% (53-62), p<0.001] and were faster than TradBLS at initiating compressions: [median (IQR): 9s (7-12) vs. 22s (17.5-30.5), p<0.001]. In-hospital cardiac arrest HospBLS teams had larger CCF: [73% (68-75) vs. 50% (43-54), p<0.001] and were faster to initiate compressions: [10s (6-11) vs. 36s (27-63), p<0.001]. All teams utilized the hospital AED to defibrillate within 180s per AHA guidelines [HospBLS: 122s (103-149) vs. TradBLS: 139s (117-172), p=0.09]. HospBLS teams performed more hospital-specific maneuvers to optimize compressions, i.e. utilized: CPR button to flatten bed: [7/30 (23%) vs. 0/29 (0%), p=0.006], backboard: [21/30 (70%) vs. 5/29 (17%), p<0.001], stepstool: [28/30 (93%) vs. 8/29 (28%), p<0.001], lowered bedrails: [28/30 (93%) vs. 10/29 (34%), p<0.001], connected oxygen appropriately: [26/30 (87%) vs. 1/29 (3%), p<0.001] and used oral airway and/or two-person bagging when traditional bag-mask-ventilation unsuccessful: [30/30 (100%) vs. 0/29 (0%), p<0.001].ConclusionA hospital focused BLS course utilizing RCDP was associated with improved performance on hospital-specific quality measures compared with the traditional AHA course.Copyright © 2017. Published by Elsevier B.V.

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