Abstract 105: A Prospective, Randomized, Controlled Evaluation of a Contextual In-Hospital BLS Course Versus a Traditional BLS Healthcare Provider Course on Performance in Simulated Cardiac Arrests
INTRODUCTION: Most clinical providers are required to maintain BLS certification. However, the AHA Healthcare Provider BLS course is focused on Out-of-Hospital cardiac arrest (OOHCA) techniques, i.e. performing CPR on your knees, and does not include elements to optimize In-Hospital cardiac arrest (IHCA).
METHODS: A prospective, randomized, controlled evaluation of 1st year medical students enrolled in a traditional Healthcare Provider BLS course “TradBLS” vs. one of equal length that included objectives focused on managing IHCA “HospBLS”. Afterwards, students participated as teams of two in a 5-minute Out-of-Hospital and a 5-minute In-Hospital (IH) simulation scenario.
RESULTS: Fifty-nine teams of students were enrolled and participated in both assessments.
OOHCA - All teams started compressions and successfully operated a public access AED. However, the HospBLS teams were faster than TradBLS teams at initiating compressions: [median: 9 seconds (IQR:7-12) vs. 22 (17.5-30.5), p<0.001], and had lower no-flow fractions: [31%(26-35) vs. 42%(38-47), p<0.001].
IHCA - All teams started compressions and utilized the IH AED to defibrillate within 180 seconds per AHA guidelines, [HospBLS: 122 sec (103-149) vs. TradBLS: 139 (116 vs. 172), p= 0.09]. However, HospBLS teams performed better on other quality BLS measures: time to initiate compressions: [9.5 sec (6-11) vs. 36 (27-63), p<0.001] and no-flow fractions: [27% (25-32) vs. 50% (46-57), 0<0.001]. In addition, HospBLS teams were more successful on IHCA specific maneuvers to optimize compressions: utilized CPR button to quickly flatten bed: [7/30 (23%) vs. 0/29 (0%), p=0.006], lowered side rails: [28/30 (93%) vs. 10/29 (34%), p<0.001], utilized backboard: [21/30 (70%) vs. 5/29 (17%), 0<0.001], utilized stepstool: [28/30 (93%) vs. 8/29 (28%), p<0.001]. HospBLS teams were also more likely to optimize airway management: hooked up O2 tubing and used appropriate flow: [26/30 (87%) vs. 1/29 (3%), p<0.001], used an oral airway and/or 2-person approach to assist with bagging when traditional BMV was unsuccessful: [30/30 (100%) vs. 0/29 (0%), p<0.001].
CONCLUSIONS: An IHCA focused BLS course improved performance on both traditional and IHCA specific quality measures and warrants further exploration.
- © 2012 by American Heart Association, Inc.