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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

The additional ımpact of simulation based medical training to traditional medical training alone in advanced cardiac life support: a scenario based evaluation


Objectives. The principal aim of medical education is to provide medical student with the fundamental knowledge and required skills that can be specifically used in real-life conditions such as high-quality cardiopulmonary resuscitation (CPR). Traditional medical training (TMT) is an effective method in Advanced cardiac life support (ACLS) training. Simulation-based medical training (SBMT), with the advancements in technology, is a relatively new, but a preferred ACLS training method since it implements a safe educational environment. We planned a scenario-based study to evaluate the additional impact of SBMT to TMT alone in ACLS training.

Methods. This before-after type, comparative, cohort study was performed in a simulation center. One hundred thirty-six 6th grade medical students who took ACLS training with TMT on their emergency medicine clerkship were enrolled in 34 teams. All students managed a specific ACLS scenario before and after SBMT with a high-fidelity manikin. All data regarding chest compression, airway management, defibrillation and drug administration were recorded by the sensors of the high-fidelity manikin.

Results. Median age was 23 and 51.5% were male. After SBMT, we found significant increases in the successful CPR cycle rate and successful scenario completion rate (60.3%; 61.8%, respectively). Median time to chest compression (Tcc) and defibrillation (Tdef) were significantly decreased after SBMT (1 sec., 1 sec., respectively). For the adequacy of chest compressions, compression depth, recoil, and frequency are all significantly increased after SBMT, 7.0 mm, 6.0 mm and 8.5/min, respectively.

Conclusion. SBMT in combination with TMT is a promising ACLS training method when compared to TMT alone.

Key words: simulation-based medical training, traditional medical training, high-fidelity manikin, CPR, ACLS

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Influence of rescuer strength and shift cycle time on chest compression quality


Introduction. Previous studies have suggested that differences in rescuer strength and compression shift cycle are strongly associated with the quality of chest compression. We hypothesised that changing the shift cycle from two minutes to one would have a positive effect on the quality of chest compression in two-rescuer cardiopulmonary resuscitation (CPR), regardless of rescuer strength.

Methods.Thirty-nine senior medical students participated in this prospective, simulation-based, crossover study. After evaluation of muscle strength using a handgrip dynamometer, each participant was required to perform two sets of compressions separated by a 15-minute rest. Participants started with either four cycles of chest compressions for one minute followed by a one-minute rest (1-MCS), or with two cycles of chest compressions for two minutes followed by a two-minute rest (2-MCS). After a 15-minute break, participants switched groups and performed the other set of compressions. Mean compression depth (MCD), mean adequate compression (MAC), and adequate compression ratio (ACR) per minute were measured for each group. Subjective fatigue was reported after the completion of each set of compression cycles. Results. Rescuer strength was strongly correlated with MCD (p <0.01), MAC ratio (p <0.01), and ACR (p <0.01), and cycle group was correlated with MCD (p <0.01) and ACR (p =0.03). Subjective fatigue with 1-MCS was lower than with 2-MCS, regardless of rescuer strength.

Conclusion. We found that the quality of chest compressions could be improved by changing the shift cycle from two minutes to one, regardless of rescuer strength. Therefore, reducing the existing shift cycle recommended in guidelines for two rescuers could be beneficial.

Key words: CPR, fatigue, hand strength

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CPR flow to prime the ischemic heart during cardiac arrest?


Cardiac arrest is unique among cardiac ischemic syndromes in that all circulation must be generated external to the heart. Although, chest compressions deliver limited blood flow, it may be possible to take advantage of this cardiopulmonary resuscitation (CPR) low-flow state to “prime” the heart in advance of return of restoration of spontaneous circulation. Prior investigation has demonstrated improved cardiac function after perfusing the globally ischemic heart with a cardioprotective agent under low-flow perfusion conditions (modeling CPR flow). These results raise the question as to whether CPR-generated flow can be utilized to induce pharmacological post-conditioning in the arrested heart.

Key words: low-flow, CPR, post-conditioning, cardioprotect

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From Science to Guidelines: The Future for Resuscitation


The periodic development and publication of treatment guidelines is integral to the field of cardiopulmonary resuscitation and emergency cardiovascular care. The methods for guideline development have evolved over the past few decades, and the process itself has become the subject of increasing scientific investigation. An internationally validated tool for assessing the quality of clinical practice guidelines is The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Applying this tool to the ILCOR 2010 International Consensus on CPR (cardiopulmonary resuscitation) and ECC (emergency cardiac care) Science with Treatment Recommendations (CoSTR) and the resulting member council guidelines will be a valuable initial step in evaluating both the process and the product. By doing so, important strengths can be recognized as well as opportunities for improvement moving forward. Beyond validated tools to assess and improve the quality of the traditional guidelines process, a critical reassessment of the overall strategy for improving cardiac arrest outcomes is indicated. From the lay-provider perspective, innovative approaches to facilitate performance of bystander CPR are needed. This is likely to entail more individualized instructional methods that are titrated to the provider’s capabilities for learning and performance. What the future might hold for professional providers is a more individualized treatment strategy titrated to real-time physiologic monitoring with mechanized delivery of therapies guided by real-time computer-aided medical decision-making. These individualized instructional and treatment strategies could revolutionize our approach to cardiac arrest resuscitation, and dramatically change how guidelines are developed, implemented and evaluated.

Keywords: cardiac arrest, cardiopulmonary resuscitation, CPR, guidelines

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