title: Simulation-based Randomized Comparative Assessment of Out-of-Hospital Cardiac Arrest Resuscitation Bundle Completion by Emergency Medical Service Teams Using Standard Life Support or an Experimental Automation-assisted Approach.
abstract: BACKGROUND
  Effective resuscitation of out-of-hospital cardiac arrest (OHCA) patients is challenging. Alternative resuscitative approaches using electromechanical adjuncts may improve provider performance. Investigators applied simulation to study the effect of an experimental automation-assisted, goal-directed OHCA management protocol on EMS providers' resuscitation performance relative to standard protocols and equipment.
  
  
  METHODS
  Two-provider (emergency medical technicians (EMT)-B and EMT-I/C/P) teams were randomized to control or experimental group. Each team engaged in 3 simulations: baseline simulation (standard roles); repeat simulation (standard roles); and abbreviated repeat simulation (reversed roles, i.e., basic life support provider performing ALS tasks). Control teams used standard OHCA protocols and equipment (with high-performance cardiopulmonary resuscitation training intervention); for second and third simulations, experimental teams performed chest compression, defibrillation, airway, pulmonary ventilation, vascular access, medication, and transport tasks with goal-directed protocol and resuscitation-automating devices. Videorecorders and simulator logs collected resuscitation data.
  
  
  RESULTS
  Ten control and 10 experimental teams comprised 20 EMT-B's; 1 EMT-I, 8 EMT-C's, and 11 EMT-P's; study groups were not fully matched. Both groups suboptimally performed chest compressions and ventilations at baseline. For their second simulations, control teams performed similarly except for reduced on-scene time, and experimental teams improved their chest compressions (P=0.03), pulmonary ventilations (P<0.01), and medication administration (P=0.02); changes in their performance of chest compression, defibrillation, airway, and transport tasks did not attain significance against control teams' changes. Experimental teams maintained performance improvements during reversed-role simulations.
  
  
  CONCLUSIONS
  Simulation-based investigation into OHCA resuscitation revealed considerable variability and improvable deficiencies in small EMS teams. Goal-directed, automation-assisted OHCA management augmented select resuscitation bundle element performance without comprehensive improvement.
authors: From the Department of Emergency Medicine (B.C., N.A., C.C.P., S.S., K.A.W., G.D.J., L.K., L.H.M.), Alpert Medical School of Brown University, Providence, RI; Lifespan Medical Simulation Center (M.D., L.K.), Providence, RI; Biostatistics Core (J.T.M.), Rhode Island Hospital, Providence, RI; Department of Diagnostic Imaging (D.L.M., L.H.M.), Alpert Medical School of Brown University, Providence, RI; School of Engineering (G.D.J.), Brown University, Providence, RI.
authors: Bryan
authors: B
authors: Choi
authors: Nicholas
authors: N
authors: Asselin
authors: Catherine C
authors: CC
authors: Pettit
authors: Max
authors: M
authors: Dannecker
authors: Jason T
authors: JT
authors: Machan
authors: Derek L
authors: DL
authors: Merck
authors: Lisa H
authors: LH
authors: Merck
authors: Selim
authors: S
authors: Suner
authors: Kenneth A
authors: KA
authors: Williams
authors: Gregory D
authors: GD
authors: Jay
authors: Leo
authors: L
authors: Kobayashi
mesh_terms: D000328:Adult; D001331:Automation; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000295:instrumentation / Q000379:methods; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest; D000066908:Simulation Training; D055815:Young Adult