title: Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial.
abstract: BACKGROUND
  Traditional American Heart Association (AHA) cardiopulmonary resuscitation (CPR) curriculum focuses on teams of two performing quality chest compressions with rescuers on their knees but does not include training specific to In-Hospital Cardiac Arrests (IHCA), i.e. patient in hospital bed with large resuscitation teams and sophisticated technology available.
  
  
  METHODS
  A randomized controlled trial was conducted with the primary goal of evaluating the effectiveness and ideal frequency of in-situ training on time elapsed from call for help to; (1) initiation of chest compressions and (2) successful defibrillation in IHCA.
  
  
  METHODS
  Non-intensive care unit nurses were randomized into four groups: standard AHA training (C) and three groups that participated in 15 min in-situ IHCA training sessions every two (2M), three (3M) or six months (6M). Curriculum included specific choreography for teams to achieve immediate chest compressions, high chest compression fractions and rapid defibrillation while incorporating use of a backboard, stepstool.
  
  
  RESULTS
  More frequent training was associated with decreased median (IQR) seconds to: starting compressions: [C: 33(25-40) vs. 6M: 21(15-26) vs. 3M: 14(10-20) vs. 2M: 13(9-20); p < 0.001]; and defibrillation: [C: 157(140-254) vs. 6M: 138(107-158) vs. 3M: 115(101-119) vs. 2M: 109(98-129); p < 0.001]. A composite outcome of key priorities, compressions within 20s, defibrillation within 180 s and use of a backboard, revealed improvement with more frequent training sessions: [C:5%(1/18) vs. 6M: 23%(4/17) vs. 3M: 56%(9/16) vs. 2M: 73%(11/15); p < 0.001].
  
  
  CONCLUSIONS
  Results revealed short in-situ training sessions conducted every 3 months are effective in improving timely initiation of chest compressions and defibrillation in IHCA.
authors.affiliation: The Johns Hopkins University School of Nursing, 525N Wolfe St, Baltimore, MD, 21205, USA. Electronic address: nsulliv@jhmi.edu.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Sullivan
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Duval-Arnould
authors.affiliation: The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.
authors.forename: Marida
authors.initials: M
authors.lastname: Twilley
authors.affiliation: The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Smith
authors.affiliation: The Johns Hopkins Hospital CPR Office, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Aksamit
authors.affiliation: Johns Hopkins Outpatient Center, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.
authors.forename: Pam
authors.initials: P
authors.lastname: Boone-Guercio
authors.affiliation: Johns Hopkins University, 3400N Charles Street, 265 Garland Hall, Baltimore, MD 21218, USA.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Jeffries
authors.affiliation: Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Division of Health Science Informatics, Johns Hopkins Medicine Simulation Center, 1800 Orleans St, Baltimore, MD 21287, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D000066908:Simulation Training; D016037:Single-Blind Method; D014481:United States; D055815:Young Adult
keywords: Cardiopulmonary resuscitation priorities; In-Hospital Cardiac Arrests; In-situ simulation training