Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study.
The objective was to compare resuscitation performance on simulated in-hospital cardiac arrests after traditional American Heart Association (AHA) Healthcare Provider Basic Life Support course (TradBLS) versus revised course including in-hospital skills (HospBLS).



This study is a prospective, randomized, controlled curriculum evaluation.



Johns Hopkins Medicine Simulation Center.



One hundred twenty-two first year medical students were divided into fifty-nine teams.



HospBLS course of identical length, containing additional content contextual to hospital environments, taught utilizing Rapid Cycle Deliberate Practice (RCDP).



The primary outcome measure during simulated cardiac arrest scenarios was chest compression fraction (CCF) and secondary outcome measures included metrics of high quality resuscitation.



Out-of-hospital cardiac arrest HospBLS teams had larger CCF: [69% (65-74) vs. 58% (53-62), p<0.001] and were faster than TradBLS at initiating compressions: [median (IQR): 9s (7-12) vs. 22s (17.5-30.5), p<0.001]. In-hospital cardiac arrest HospBLS teams had larger CCF: [73% (68-75) vs. 50% (43-54), p<0.001] and were faster to initiate compressions: [10s (6-11) vs. 36s (27-63), p<0.001]. All teams utilized the hospital AED to defibrillate within 180s per AHA guidelines [HospBLS: 122s (103-149) vs. TradBLS: 139s (117-172), p=0.09]. HospBLS teams performed more hospital-specific maneuvers to optimize compressions, i.e. utilized: CPR button to flatten bed: [7/30 (23%) vs. 0/29 (0%), p=0.006], backboard: [21/30 (70%) vs. 5/29 (17%), p<0.001], stepstool: [28/30 (93%) vs. 8/29 (28%), p<0.001], lowered bedrails: [28/30 (93%) vs. 10/29 (34%), p<0.001], connected oxygen appropriately: [26/30 (87%) vs. 1/29 (3%), p<0.001] and used oral airway and/or two-person bagging when traditional bag-mask-ventilation unsuccessful: [30/30 (100%) vs. 0/29 (0%), p<0.001].



A hospital focused BLS course utilizing RCDP was associated with improved performance on hospital-specific quality measures compared with the traditional AHA course.
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Department of Pediatrics, Baltimore, Maryland, USA; Division of Health Sciences Informatics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA. Electronic address: ehunt@jhmi.edu.
Elizabeth A
EA
Hunt
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Division of Health Sciences Informatics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
Jordan M
JM
Duval-Arnould
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA.
Nnenna O
NO
Chime
Stanford University School of Medicine, Palo Alto, California, USA; Department of Anesthesiology, Perioperative and Pain Medicine, New York, USA.
Kareen
K
Jones
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA.
Michael
M
Rosen
Montefiore Einstein Center for Innovation in Simulation, Bronx, New York, USA.
Merona
M
Hollingsworth
Johns Hopkins Hospital, Baltimore, Maryland, USA.
Deborah
D
Aksamit
Johns Hopkins Hospital, Baltimore, Maryland, USA.
Marida
M
Twilley
Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
Cheryl
C
Camacho
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Daniel P
DP
Nogee
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA; Department of Emergency Medicine, Baltimore, Maryland, USA.
Julianna
J
Jung
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
Kristen
K
Nelson-McMillan
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
Nicole
N
Shilkofski
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
Julianne S
JS
Perretta
D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000592:standards; D003479:Curriculum; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000592:standards*; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D000066908:Simulation Training / Q000379:methods*; D013337:Students, Medical; D013997:Time Factors
Cardiac arrest; Cardiopulmonary resuscitation; Education; Simulation; Teamwork; Time sensitive