Central venous access by trainees: a systematic review and meta-analysis of the use of simulation to improve success rate on patients.
BACKGROUND
Simulation training for invasive procedures may improve patient safety by enabling efficient training. This study is a meta-analysis with rigorous inclusion and exclusion criteria designed to assess the real patient procedural success of simulation training for central venous access.


METHODS
Published randomized controlled trials and prospective 2-group cohort studies that used simulation for the training of procedures involving central venous access were identified. The quality of each study was assessed. The primary outcome was the proportion of trainees who demonstrated the ability to successfully complete the procedure. Secondary outcomes included the mean number of attempts to procedural success and periprocedural adverse events. Proportions were compared between groups using risk ratios (RRs), whereas continuous variables were compared using weighted mean differences. Random-effects analysis was used to determine pooled effect sizes.


RESULTS
We identified 550 studies, of which 5 (3 randomized controlled trials, 2 prospective 2-group cohort studies) studies of central venous catheter (CVC) insertion were included in the meta-analysis, composed of 407 medical trainees. The simulation group had a significantly larger proportion of trainees who successfully placed CVCs (RR, 1.09; 95% confidence interval [CI], 1.03-1.16, P<0.01). In addition, the simulation group had significantly fewer mean attempts to CVC insertion (weighted mean difference, -1.42; 95% CI, -2.34 to -0.49, P<0.01). There was no significant difference in the rate of adverse events between the groups (RR, 0.50; 95% CI, 0.19-1.29; P=0.15).


CONCLUSIONS
Training programs should consider adopting simulation training for CVC insertion to improve the real patient procedural success of trainees.
From the University of Michigan Medical School (A.L.M.), Ann Arbor, MI; Harvard School of Public Health (A.L.M., C.V.S.); and Division of Trauma, Emergency Surgery and Surgical Critical Care (M.A.D.M.), Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery (C.V.S.), Duke University Medical Center, Durham, NC.
Arin L
AL
Madenci
Carolina V
CV
Solis
Marc A
MA
de Moya
D002405:Catheterization, Central Venous / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D016544:Patient Simulation; D013337:Students, Medical