Time matters--realism in resuscitation training.
BACKGROUND
The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting.


METHODS
This study was designed as a randomised control trial. Fifty-four 4th-year medical students with no prior advanced resuscitation training participated in an extra-curricular one-day advanced life support course. Participants were either randomised to simulation-based training using real-time (120s) or shortened CPR cycles (30-45s instead of 120s) in the scenarios. Adherence to time was measured using the European Resuscitation Council's Cardiac Arrest Simulation Test (CASTest) in retention tests conducted one and 12 weeks after the course.


RESULTS
The real-time group adhered significantly better to the recommended 2-min CPR cycles (time-120s) (mean 13; standard derivation (SD) 8) than the shortened CPR cycle group (mean 45; SD 19) when tested (p<0.001.)


CONCLUSIONS
This study indicates that time is an important part of fidelity. Variables critical for performance, like adherence to time in resuscitation, should therefore be kept realistic during training to optimise outcome.
Centre for Medical Education, Aarhus University, Denmark; SkejSim, Aarhus, Denmark. Electronic address: kk@medu.au.dk.
Kristian B
KB
Krogh
Centre for Medical Education, Aarhus University, Denmark.
Christian B
CB
Høyer
Danish Institute for Medical Simulation, Herlev Hospital and Copenhagen University, Denmark.
Doris
D
Ostergaard
Centre for Medical Education, Aarhus University, Denmark.
Berit
B
Eika
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D004501:Education, Medical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D016037:Single-Blind Method; D013337:Students, Medical
Advanced life support training; CPR cycles; CPR intervals; Negative learning; Negative training; Resuscitation training; Simulation; Time fidelity