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October 16, 2010
3:00:00 PM - 4:30:00 PM
Room Mezzanine 14B
Use of Cognitive Aids Significantly Increases Retention of Skill for Management of Cardiac Arrest
  **   Matthew D. McEvoy, M.D., Jeremy C. Smalley, B.S., Larry C. Field, M.D., Cory M. Furse, M.D., Horst Rieke, M.D.
Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
INTRODUCTION: Adherence to Advanced Cardiac Life Support (ACLS) guidelines during in-hospital cardiac arrest (IHCA) is associated with improved outcomes. However, the best educational and training methods for increasing ACLS adherence during these events remains unknown. Accordingly, we performed a randomized trial to test whether use of a cognitive aid (card) improves performance during simulations of American Heart Association (AHA) MegaCodes.

METHODS: Anesthesia residents, interns, and medical students (N=50) were randomized to MUSC (N=27) or AHA (N=23) card groups. Prior to ACLS training, each participant managed two IHCA scenarios, one using a card and one without. After pre-testing, the participants were given a standard ACLS course, including training on use of the AHA or MUSC card. Subjects then underwent post-testing. Six months after initial training/testing, the subjects were re-tested. The scenario stems were altered to prevent repetition bias, but patient states were the same (e.g. PEA, VFIB). Each participant tested alone with a standardized 'code team.[start_en]0027; All participants managed the same scenarios. Simulation sessions were video recorded and graded according to checklists derived from the ACLS/AHA training manuals. Checklist reliability was tested using 4 raters who graded 8 video-recorded simulation sessions. Their results were compared to an expert rater grade for each session (agreed upon by 2 expert raters). The global kappa statistic for agreement with the expert rater grade was 0.77, showing excellent checklist reliability. Data was analyzed by t-test and presented as Mean ± SEM.

RESULTS: There were no differences in baseline demographics, and no intragroup or intergroup differences in pre-test performance. The ACLS training sessions provided a significant improvement in performance at initial post-test. There was no significant difference in post-test performance between the AHA group and the MUSC group. At six-month follow-up without a card, participants demonstrated significant loss of skill from their training day post-test (AHA, p = 0.0033; MUSC, p < 0.0083). Use of a card at 6 months returned participant performance to a level comparable to their post-test performance immediately after training, and significantly improved their performance over 6-month testing without a card (AHA, p = 0.0038; MUSC, p = 0.0001. See Figure 1). The MUSC card group showed better performance than the AHA group, but the difference was not statistically significant.

DISCUSSION/CONCLUSIONS: The current study has two key findings. First, there is a significant loss of skill in ACLS management only 6 months following training. Second, use of cognitive aids improves performance at 6-month follow-up to levels comparable to initial post-test.[figure1]

From Proceedings of the 2010 Annual Meeting of the American Society Anesthesiologists.
Figure 1