Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation.
BACKGROUND
High-fidelity medical simulation of sudden cardiac arrest (SCA) presents an opportunity for systematic probing of in-hospital resuscitation systems. Investigators developed and implemented the SimCode program to evaluate simulation's ability to generate meaningful data for system safety analysis and determine concordance of observed results with institutional quality data.


METHODS
Resuscitation response performance data were collected during in situ SCA simulations on hospital medical floors. SimCode dataset was compared with chart review-based dataset of actual (live) in-hospital resuscitation system performance for SCA events of similar acuity and complexity.


RESULTS
135 hospital personnel participated in nine SimCode resuscitations between 2006 and 2008. Resuscitation teams arrived at 2.5+/-1.3 min (mean+/-SD) after resuscitation initiation, started bag-valve-mask ventilation by 2.8+/-0.5 min, and completed endotracheal intubations at 11.3+/-4.0 min. CPR was performed within 3.1+/-2.3 min; arrhythmia recognition occurred by 4.9+/-2.1 min, defibrillation at 6.8+/-2.4 min. Chart review data for 168 live in-hospital SCA events during a contemporaneous period were extracted from institutional database. CPR and defibrillation occurred later during SimCodes than reported by chart review, i.e., live: 0.9+/-2.3 min (p<0.01) and 2.1+/-4.1 min (p<0.01), respectively. Chart review noted fewer problems with CPR performance (simulated: 43% proper CPR vs. live: 98%, p<0.01). Potential causes of discrepancies between resuscitation response datasets included sample size and data limitations, simulation fidelity, unmatched SCA scenario pools, and dissimilar determination of SCA response performance by complementary reviewing methodologies.


CONCLUSIONS
On-site simulations successfully generated SCA response measurements for comparison with live resuscitation chart review data. Continued research may refine simulation's role in quality initiatives, clarify methodologic discrepancies and improve SCA response.
Kobayashi
Leo
L
Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St, Providence, RI 02903, USA. LKobayashi@lifespan.org
Lindquist
David G
DG
Jenouri
Ilse M
IM
Dushay
Kevin M
KM
Haze
Donna
D
Sutton
Elizabeth M
EM
Smith
Jessica L
JL
Tubbs
Robert J
RJ
Overly
Frank L
FL
Foggle
John
J
Dunbar-Viveiros
Jennifer
J
Jones
Mark S
MS
Marcotte
Scott T
ST
Werner
David L
DL
Cooper
Mary R
MR
Martin
Peggy B
PB
Tammaro
Dominick
D
Jay
Gregory D
GD
D016887:Cardiopulmonary Resuscitation; D004554:Electric Countershock; D006323:Heart Arrest / Q000628:therapy*; D006753:Hospital Records; D006801:Humans; D012151:Resuscitation / Q000592:standards*