Rapid-cycle deliberate practice versus after-event debriefing clinical simulation in cardiopulmonary resuscitation: a cluster randomized trial
Tóm tắt
Rapid-cycle deliberate practice (RCDP) is a simulation-based educational strategy that consists of repeating a simulation scenario a number of times to acquire a planned competency. When the objective of a cycle is achieved, a new cycle initiates with increased skill complexity. There have been no previous randomized studies comparing after-event debriefing clinical manikin-based simulation to RCDP in adult cardiopulmonary resuscitation (CPR). We invited physicians from the post-graduate program on Emergency Medicine of the Hospital Israelita Albert Einstein. Groups were randomized 1:1 to RCDP or after-event debriefing simulation prior to the first station of CPR training. During the first 5 min of the pre-intervention scenario, both groups participated in a simulated case of an out-of-hospital cardiac arrest without facilitator interference; after the first 5 min, each scenario was then facilitated according to group allocation (RCDP or after-event debriefing). In a second scenario of CPR later in the day with the same participants, there was no facilitator intervention, and the planned outcomes were evaluated. The primary outcome was the chest compression fraction during CPR in the post-intervention scenario. Secondary outcomes comprised time for recognition of the cardiac arrest, time for first verbalization of the cardiac arrest initial rhythm, time for first defibrillation, and mean pre-defibrillation pause. We analyzed data of three courses conducted between June 2018 and July 2019, with 76 participants divided into 9 teams. Each team had a median of 8 participants. In the post-intervention scenario, the RCDP teams had a significantly higher chest compression fraction than the after-event debriefing group (80.0% vs 63.6%; p = 0.036). The RCDP group also demonstrated a significantly lower time between recognition of the rhythm and defibrillation (6 vs 25 s; p value = 0.036). RCDP simulation strategy is associated with significantly higher manikin chest compression fraction during CPR when compared to an after-event debriefing simulation.
Tài liệu tham khảo
Yan S, Gan Y, Jiang N, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020;24(1):61. https://doi.org/10.1186/s13054-020-2773-2.
Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254–743. https://doi.org/10.1161/cir.0000000000000950.
Kurz MC, Donnelly JP, Wang HE. Variations in survival after cardiac arrest among academic medical center-affiliated hospitals. PLoS ONE. 2017;12(6):e0178793. https://doi.org/10.1371/journal.pone.0178793.
Wang L, Gan X, Wang X, et al. Does time of day influences outcome in out-of-hospital cardiac arrest patients? Medicine. 2020;99(40):e22290. https://doi.org/10.1097/md.0000000000022290.
Cheng A, Magid DJ, Auerbach M, et al. Part 6: Resuscitation Education Science: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2):S551–79. https://doi.org/10.1161/cir.0000000000000903.
Ziv A, Ben-David S, Ziv M. Simulation based medical education: an opportunity to learn from errors. Med Teach. 2009;27(3):193–9. https://doi.org/10.1080/01421590500126718.
Hunt EA, Duval-Arnould JM, Nelson-McMillan KL, et al. Pediatric resident resuscitation skills improve after “rapid cycle deliberate practice” training. Resuscitation. 2014;85(7):945–51. https://doi.org/10.1016/j.resuscitation.2014.02.025.
Lemke DS, Fielder EK, Hsu DC, Doughty CB. Improved Team Performance During Pediatric Resuscitations After Rapid Cycle Deliberate Practice Compared With Traditional Debriefing: A Pilot Study. Pediatr Emerg Care. 2019;35(7):480-86. https://doi.org/10.1097/PEC.0000000000000940.
Kutzin JM, Janicke P. Incorporating rapid cycle deliberate practice into nursing staff continuing professional development. J Continuing Educ Nurs. 2015;46(7):299–301. https://doi.org/10.3928/00220124-20150619-14. Billings DM, Kowalski K, eds.
Hunt EA, Duval-Arnould JM, Chime NO, et al. Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study. Resuscitation. 2017;114:127–32. https://doi.org/10.1016/j.resuscitation.2017.03.014.
Lemke DS, Young AL, Won SK, et al. Rapid-cycle deliberate practice improves time to defibrillation and reduces workload: a randomized controlled trial of simulation-based education. Aem Educ Train. 2021;5(4):e10702. https://doi.org/10.1002/aet2.10702.
Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simul Healthc J Soc Simul Healthc. 2015;10(2):106–15. https://doi.org/10.1097/sih.0000000000000072.
Kolb DA. Experiential learning: experience as the source of learning and development 2nd Ed. Prentice-Hall; 2014. ISBN-13: 9780133892406.
de Castro LT, Couto TB. Rapid cycle deliberate practice: a modern simulation strategy. Sci Medica. 2017;28(1):28849. https://doi.org/10.15448/1980-6108.2018.1.28849.
Bækgaard JS, Viereck S, Møller TP, Ersbøll AK, Lippert F, Folke F. The effects of public access defibrillation on survival after out-of-hospital cardiac arrest. Circulation. 2017;136(10):954–65. https://doi.org/10.1161/circulationaha.117.029067.
Cummins RO, Thies W, Paraskos J, et al. Encouraging early defibrillation: the American Heart Association and automated external defibrillators. Ann Emerg Med. 1990;19(11):1245–8. https://doi.org/10.1016/s0196-0644(05)82282-6.
Wright D, James C, Marsden AK, Mackintosh AF. Defibrillation by ambulance staff who have had extended training. Brit Med J. 1989;299(6691):96. https://doi.org/10.1136/bmj.299.6691.96.
Paris PM. EMT-defibrillation: a recipe for saving lives. Am J Emerg Medicine. 1988;6(3):282–7. https://doi.org/10.1016/0735-6757(88)90018-6.
Kaplow R, Cosper P, Snider R, et al. Impact of CPR quality and adherence to advanced cardiac life support guidelines on patient outcomes in in-hospital cardiac arrest. Aacn Adv Critical Care. 2020;31(4):401–9. https://doi.org/10.4037/aacnacc2020297.
Talikowska M, Tohira H, Finn J. Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2015;96:66–77. https://doi.org/10.1016/j.resuscitation.2015.07.036.
Gross TI, Abraham DG, Kumar A, et al. Rapid cycle deliberate practice (RCDP) as a method to improve airway management skills – a randomized controlled simulation study. Cureus. 2019;11(9):e5546. https://doi.org/10.7759/cureus.5546.
Cory MJ, Colman N, McCracken CE, Hebbar KB. Rapid Cycle Deliberate Practice Versus Reflective Debriefing for Pediatric Septic Shock Training. Pediatr Crit Care Med. 2019;20(5):481-89. https://doi.org/10.1097/PCC.0000000000001891.
Yan DH, Slidell MB, McQueen A. Using rapid cycle deliberate practice to improve primary and secondary survey in pediatric trauma. Bmc Med Educ. 2020;20(1):131. https://doi.org/10.1186/s12909-020-02038-z.
Frye AW, Hemmer PA. Program evaluation models and related theories: AMEE Guide No 67. Med Teach. 2012;34(5):e288–99. https://doi.org/10.3109/0142159x.2012.668637.