Part 12: Education, Implementation, and Teams
2010; Lippincott Williams & Wilkins; Volume: 122; Issue: 16_suppl_2 Linguagem: Inglês
10.1161/circulationaha.110.971143
ISSN1524-4539
AutoresMary E. Mancini, Jasmeet Soar, Farhan Bhanji, John E. Billi, Jennifer Dennett, Judith Finn, Matthew Huei‐Ming, Gavin D. Perkins, David L. Rodgers, Mary Fran Hazinski, Ian Jacobs, Peter T. Morley, Tom P. Aufderheide, Dianne L. Atkins, A. Barelli, Michael Baubin, Michaël Bernhard, Martin Botha, Nicholas Brennan, Stephen J. Brett, Franklin H.G. Bridgewater, Ian Bullock, Bernd W. Böttiger, Clifton W. Callaway, Maaret Castrén, Erga Cerchiari, Robin P. Davies, Linda Denke, Michael A. DeVita, Jordan Duval‐Arnould, Dana P. Edelson, Vanessa J. Elliott, Barbara Furry, Elaine Gilfoyle, Anthony J. Handley, R. Van Harrison, Tetsuo Hatanaka, Elizabeth A. Hunt, Masami Ishikawa, Sung Oh Hwang, Patrick Chow‐In Ko, Yasuhiro Kuroda, E. Brooke Lerner, Geoffrey K. Lighthall, Anne Lippert, Andrew Lockey, Jane E. McGowan, Peter A. Meaney, Reylon A. Meeks, Graham Nichol, Deems Okamoto, Joseph P. Ornato, David C. Parish, Nicola Poplett, Rani Robson, Andrea Scapigliati, Terri A. Schmidt, Nalini Singhal, Jonathan R. Skinner, Gary B. Smith, Keiichi Tada, Satoshi Takeda, Antoine R Trammell, Matthew J. Weiss, Casandra L. Williams, Chih‐Wei Yang, Zui‐Shen Yen, Joyce Yeung, Judy Young, Trevor C. Yuen,
Tópico(s)Disaster Response and Management
ResumoHomeCirculationVol. 122, No. 16_suppl_2Part 12: Education, Implementation, and Teams Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBPart 12: Education, Implementation, and Teams2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Mary E. Mancini, Jasmeet Soar, Farhan Bhanji, John E. Billi, Jennifer Dennett, Judith Finn, Matthew Huei-Ming Ma, Gavin D. Perkins, David L. Rodgers, Mary Fran Hazinski, Ian Jacobs, Peter T. Morley, Education, Implementation, and Teams Chapter Collaborators Tom P. Aufderheide, Dianne L. Atkins, Alessandro Barelli, Michael Baubin, Michael Bernhard, Martin Botha, Nicholas Brennan, Stephen Brett, Franklin H.G. Bridgewater, Ian Bullock, Bernd W. Böttiger, Clifton W. Callaway, Maaret Castrén, Erga Cerchiari, Robin P. Davies, Linda Denke, Michael DeVita, Jordan Duval-Arnould, Dana P. Edelson, Vanessa Elliott, Barbara Furry, Elaine Gilfoyle, Anthony J. Handley, R. Van Harrison, Tetsuo Hatanaka, Elizabeth A. Hunt, Masami Ishikawa, Sung Oh Hwang, Patrick Chow-In Ko, Yasuhiro Kuroda, E. Brooke Lerner, Geoffrey K. Lighthall, Anne Lippert, Andrew Lockey, Jane E. McGowan, Peter A. Meaney, Reylon A. Meeks, Graham Nichol, Deems Okamoto, Joseph P. Ornato, David C. Parish, Nicola Poplett, Rani Robson, Andrea Scapigliati, Terri Schmidt, Nalini Singhal, Jonathan Skinner, Gary Smith, Keiichi Tada, Satoshi Takeda, Antoine Trammell, Matthew Weiss, Casandra L. Williams, Chih-Wei Yang, Zui-Shen Yen, Joyce Yeung, Judy Young and Trevor Yuen Mary E. ManciniMary E. Mancini , Jasmeet SoarJasmeet Soar , Farhan BhanjiFarhan Bhanji , John E. BilliJohn E. Billi , Jennifer DennettJennifer Dennett , Judith FinnJudith Finn , Matthew Huei-Ming MaMatthew Huei-Ming Ma , Gavin D. PerkinsGavin D. Perkins , David L. RodgersDavid L. Rodgers , Mary Fran HazinskiMary Fran Hazinski , Ian JacobsIan Jacobs , Peter T. MorleyPeter T. Morley , Education, Implementation, and Teams Chapter Collaborators , Tom P. AufderheideTom P. Aufderheide , Dianne L. AtkinsDianne L. Atkins , Alessandro BarelliAlessandro Barelli , Michael BaubinMichael Baubin , Michael BernhardMichael Bernhard , Martin BothaMartin Botha , Nicholas BrennanNicholas Brennan , Stephen BrettStephen Brett , Franklin H.G. BridgewaterFranklin H.G. Bridgewater , Ian BullockIan Bullock , Bernd W. BöttigerBernd W. Böttiger , Clifton W. CallawayClifton W. Callaway , Maaret CastrénMaaret Castrén , Erga CerchiariErga Cerchiari , Robin P. DaviesRobin P. Davies , Linda DenkeLinda Denke , Michael DeVitaMichael DeVita , Jordan Duval-ArnouldJordan Duval-Arnould , Dana P. EdelsonDana P. Edelson , Vanessa ElliottVanessa Elliott , Barbara FurryBarbara Furry , Elaine GilfoyleElaine Gilfoyle , Anthony J. HandleyAnthony J. Handley , R. Van HarrisonR. Van Harrison , Tetsuo HatanakaTetsuo Hatanaka , Elizabeth A. HuntElizabeth A. Hunt , Masami IshikawaMasami Ishikawa , Sung Oh HwangSung Oh Hwang , Patrick Chow-In KoPatrick Chow-In Ko , Yasuhiro KurodaYasuhiro Kuroda , E. Brooke LernerE. Brooke Lerner , Geoffrey K. LighthallGeoffrey K. Lighthall , Anne LippertAnne Lippert , Andrew LockeyAndrew Lockey , Jane E. McGowanJane E. McGowan , Peter A. MeaneyPeter A. Meaney , Reylon A. MeeksReylon A. Meeks , Graham NicholGraham Nichol , Deems OkamotoDeems Okamoto , Joseph P. OrnatoJoseph P. Ornato , David C. ParishDavid C. Parish , Nicola PoplettNicola Poplett , Rani RobsonRani Robson , Andrea ScapigliatiAndrea Scapigliati , Terri SchmidtTerri Schmidt , Nalini SinghalNalini Singhal , Jonathan SkinnerJonathan Skinner , Gary SmithGary Smith , Keiichi TadaKeiichi Tada , Satoshi TakedaSatoshi Takeda , Antoine TrammellAntoine Trammell , Matthew WeissMatthew Weiss , Casandra L. WilliamsCasandra L. Williams , Chih-Wei YangChih-Wei Yang , Zui-Shen YenZui-Shen Yen , Joyce YeungJoyce Yeung , Judy YoungJudy Young and Trevor YuenTrevor Yuen Originally published19 Oct 2010https://doi.org/10.1161/CIRCULATIONAHA.110.971143Circulation. 2010;122:S539–S581Note From the Writing Group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (eg, "Precourse PreparationEIT-018A"). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.Application of resuscitation science to improve patient care and outcomes requires effective strategies for education and implementation. Systematic reviews suggest that there are significant opportunities to improve education, enhance individual and team performance, and avoid delays in implementation of guidelines into practice. It is within this context that the International Liaison Consensus on Resuscitation (ILCOR) Education, Implementation, and Teams (EIT) Task Force was established and addressed 32 worksheet topics. Reviewers selected topics from the 2005 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations1 and new topics identified by an expert group.One challenge for the EIT Task Force was extrapolating outcomes from simulation studies to actual patient outcomes. During the evidence evaluation, if the PICO (Population, Intervention, Comparator, Outcome) question outcomes were limited to training outcomes such as improved performance on a manikin or simulator, studies were classified to a level of evidence (LOE) according to study design (eg, a randomized controlled trial [RCT] on a manikin would be LOE 1). Manikin or simulator studies were labeled as LOE 5 irrespective of the study design if the PICO question also included patient outcomes.The following is a summary of key 2010 recommendations or changes related to EIT Efforts to implement new resuscitation guidelines are likely to be more successful if a carefully planned, multifaceted implementation strategy is used. Education, while essential, is only one element of a comprehensive implementation strategy.All courses should be evaluated to ensure that they reliably achieve the program objectives. Training should aim to ensure that learners acquire and retain the skills and knowledge that will enable them to act correctly in actual cardiac arrests.Life support knowledge and skills, both basic and advanced, can deteriorate in as little as 3 to 6 months. Frequent assessments and, when needed, refresher training are recommended to maintain knowledge and skills.Short video/computer self-instruction courses with minimal or no instructor coaching, combined with hands-on practice ('practice-while-you-watch'), can be considered as an effective alternative to instructor-led basic life support (cardiopulmonary resuscitation [CPR] and automated external defibrillator [AED]) courses.Laypeople and healthcare providers (HCPs) should be trained to start CPR with chest compressions for adult victims of cardiac arrest. If they are trained to do so, they should perform ventilations. Performing chest compressions alone is reasonable for trained individuals if they are incapable of delivering airway and breathing maneuvers to cardiac arrest victims.AED use should not be restricted to trained personnel. Allowing use of AEDs by individuals without prior formal training can be beneficial and may be lifesaving. Since even brief training improves performance (eg, speed of use, correct pad placement), it is recommended that training in the use of AEDs be provided.CPR prompt or feedback devices improve CPR skill acquisition and retention and may be considered during CPR training for laypeople and healthcare professionals. These devices may be considered for clinical use as part of an overall strategy to improve the quality of CPR.It is reasonable to wear personal protective equipment (PPE) (eg, gloves) when performing CPR. CPR should not be delayed or withheld if PPE is not available unless there is a clear risk to the rescuer.Manual chest compressions should not continue during the delivery of a shock because safety has not been established.Several important knowledge gaps were identified during the evidence review process: The optimal duration and type of initial training to acquire resuscitation knowledge and skills.The optimal frequency and type of refresher training required to maintain resuscitation knowledge and skills.The optimal use of assessment as a tool to promote the learning of resuscitation knowledge and skills.The impact of experience in actual resuscitation attempts on skill decay and the need for refresher training.The impact of specific training interventions on patient outcomes.A standardized nomenclature and definitions for different types of simulation training and terms such as "high fidelity simulation," "feedback," "briefing" and "debriefing."The most effective and efficient methods of disseminating information about new resuscitation interventions or guidelines to reduce time to implementation.For cardiac resuscitation centers (facilities providing a comprehensive package of post resuscitation care), the optimal emergency medical services (EMS) system characteristics, safe patient transport interval (time taken to travel from scene to hospital), optimal mode of transport (eg, ground ambulance, helicopter,), and role of secondary transport (transfer from receiving hospital to a resuscitation center).The EIT Task Force organized its work into 5 major sections Education—including who should be trained and how to prepare for training, the use of specific instructional strategies and techniques, retraining intervals, retention of knowledge and skills, and assessment methodsRisks and effects on the rescuer of CPR training and actual CPR performanceRescuer willingness to respondImplementation and teams—including a framework for implementation efforts as well as individual and team factors associated with successEthics and outcomesEducationEffective and efficient resuscitation education is one of the essential elements in the translation of guidelines into clinical practice. Educational interventions need to be population specific (eg, lay rescuers, HCPs) and evaluated to ensure that they achieve the desired educational outcomes—not just at the end of the course but also during actual resuscitation events. Retention of knowledge and skills should be confirmed through assessment and not be assumed to persist for pre-established time intervals.PopulationsWho should be trained and how should they prepare for training?Focused TrainingEIT-012A, EIT-012BFor lay providers requiring basic life support training, does focusing training on high-risk populations, compared with no such targeting improve outcomes (eg, bystander CPR, survival)?Consensus on ScienceIn 3 studies (LOE 12; LOE 23,4), people reported that they would be more willing to perform bystander CPR on family members than on nonrelatives.One LOE 2 study5 of people who called 911 found that unless family members had received CPR training, they were less likely to perform CPR than unrelated bystanders. Computer modeling (LOE 5)6 suggested that very large numbers of older adults would need to be trained to achieve a sufficient increase in private residence bystander CPR rates to improve survival. Twelve studies (LOE 12,7–11; LOE 23,12; LOE 413,14; LOE 515,16) reported that training of patients and family members in CPR provided psychological benefit. Two LOE 1 studies7,17 reported that negative psychological effects on patients can be avoided by providing social support.Treatment RecommendationThere is insufficient evidence to support or refute the use of training interventions that focus on high-risk populations. Training with social support reduces family member and patient anxiety, improves emotional adjustment, and increases feelings of empowerment.Precourse PreparationEIT-018AFor advanced life support providers undergoing advanced life support courses, does the inclusion of specific precourse preparation (eg, e-learning and pretesting), as opposed to no such preparation, improve outcomes (eg, same skill assessment but with less face-to-face [instructor] hands-on training)?Consensus on ScienceEight studies (LOE 118; LOE 419; LOE 520–25) reported that a diverse range of precourse preparatory actions (eg, computer-assisted learning, pretests, video-based learning, textbook reading) improved learner outcomes in advanced life support courses.One large LOE 1 RCT26 of use of a commercially available e-learning simulation program before attending an advanced life support course, compared with standard preparation with a course manual, did not improve either cognitive or psychomotor skill performance during cardiac arrest simulation testing.Eighteen studies (LOE 227; LOE 419,28; LOE 520,25,29–41) showed that alternative course delivery formats such as electronically delivered (CD or Internet-based) courses produced as good or better learner outcomes compared with traditional courses, and also reduced instructor-to-learner face-to-face time.Treatment RecommendationPrecourse preparation including, but not limited to, use of computer-assisted learning tutorials, written self-instruction materials, video-based learning, textbook reading, and pretests are recommended as part of advanced life support courses. Any method of precourse preparation that is aimed at improving knowledge and skills or reducing instructor-to-learner face-to-face time should be formally assessed to ensure equivalent or improved learning outcomes compared with standard instructor-led courses.Instructional MethodsThere are multiple methods to deliver course content. This section examines specific instructional methods and strategies that may have an impact on course outcomes.Alternative Instructor MethodsEIT-002A, EIT-002BFor lay rescuers and HCPs, does the use of specific instructional methods (video/computer self-instruction), compared with traditional instructor-led courses, improve skill acquisition and retention?Consensus on ScienceTwelve studies (LOE 142–47; LOE 2 or 348–53) demonstrated that basic life support skills can be acquired and retained at least as well and, in some cases, better using video-based self-instruction ("practice-while-you-watch") compared with traditional instructor-led courses. Video-based self-instruction lasted from 8 to 34 minutes, whereas instructor-led courses were usually 4 to 6 hours in duration. One LOE 1 study54 demonstrated that prior viewing of a video on infant CPR before an instructor-led course improved skill acquisition.When compared with traditional instructor-led CPR courses, various self-instructional and shortened programs have been demonstrated to be efficient (from the perspective of time) and effective (from the perspective of skill acquisition) in teaching CPR skills to various populations.Treatment RecommendationShort video/computer self-instruction (with minimal or no instructor coaching) that includes synchronous hands-on practice ("practice-while-you-watch") in basic life support can be considered as an effective alternative to instructor-led courses.AED Training InterventionsEIT-013A, EIT-013BFor basic life support providers (lay or HCP) requiring AED training, are there any specific training interventions, compared with traditional lecture/practice sessions, that increase outcomes (eg, skill acquisition and retention, actual AED use)?Consensus on ScienceOne LOE 2 study55 demonstrated that training delivered by laypeople is as effective as training by HCPs. One LOE 1 study56 reported that instruction by nurses, as compared with physicians, resulted in better skill acquisition. Four studies (LOE 246,51,57; LOE 458) reported that the use of computer-based AED training improved skill acquisition and retention, particularly when combined with manikin practice. One LOE 1 study47 supported the use of video-self instruction when compared with instructor-led training. Three LOE 1 studies59–61 showed that the use of video self-instruction was less effective for some elements when compared with instructor-led training. One LOE 1 study62 supported the use of a training poster and manikin for learning AED skills. Three studies (LOE 246,63; LOE 464) reported that laypeople and HCPs could use an AED without training. Three LOE 2 studies65–67 reported that untrained individuals could deliver a shock with an AED. However, even minimal training (15-minute lecture, 1-hour lecture with manikin practice, or reading instructions) improved performance (eg, time to shock delivery, correct pad placement, safety).Treatment RecommendationAED use should not be restricted to trained personnel. Allowing use of AEDs by individuals without prior formal training can be beneficial and may be lifesaving. Since even brief training improves performance (eg, speed of use, correct pad placement), it is recommended that training in the use of AEDs be provided. Laypeople can be used as AED instructors.Short video/computer self-instruction (with minimal or no instructor coaching) that includes synchronous hands-on practice in AED use ("practice-while-you-watch") may be considered as an effective alternative to instructor-led AED courses.Advanced Life Support Leadership/Team TrainingEIT-017AFor advanced life support providers undergoing advanced life support courses, does the inclusion of specific leadership/team training, as opposed to no such specific training, improve outcomes (eg, performance during cardiac arrest)?Consensus on ScienceFour studies (LOE 168,69 LOE 270,71) of advanced life support in simulated in-hospital cardiac arrest and 7 LOE 5 studies72–78 of actual and simulated arrest demonstrated improved resuscitation team performance when specific team and/or leadership training was added to advanced life support courses.Treatment RecommendationSpecific teamwork training, including leadership skills, should be included in advanced life support courses.Teaching Chest Compressions to Achieve RecoilEIT-032Is there a method for teaching chest compressions, compared with current teaching, to achieve full chest recoil (complete release) after each compression?Consensus on ScienceOne LOE 5 clinical case series79 documented a 46% incidence of incomplete chest recoil by professional rescuers using the 2005-recommended CPR technique. One LOE 4 study80 electronically recorded chest recoil during in-hospital pediatric cardiac arrests, and found that leaning on the chest (>2.5 kg; an adult feedback threshold) occurred in 50% of chest compressions/decompressions using the recommended hand position, and that incomplete recoil was reduced with real-time automated feedback. Another LOE 4 in-hospital pediatric study81 demonstrated a 23.4% incidence of incomplete recoil. One LOE 5 study82 has shown that without specific training in complete chest recoil technique, 22% of trained rescuers leaned on the chest when performing CPR. Two LOE 5 studies79,83 demonstrated that incomplete chest recoil was significantly reduced with 3 techniques (ie, "two-finger fulcrum," "five-finger fulcrum," and "hands-off") of lifting the heel of the hand slightly but completely off the chest during CPR in a manikin model. However, duty cycle and compression depth were reduced when professional and lay rescuers applied these techniques.Treatment RecommendationThere is insufficient evidence to recommend teaching any specific technique to optimize complete chest recoil during actual CPR.Use of CPR Prompt/Feedback DevicesEIT-005A, EIT-005BFor lay rescuers and HCPs performing CPR, does the use of CPR prompt/feedback devices, compared with no device, improve acquisition, retention, and actual performance of CPR skills?Consensus on ScienceMost devices considered in this review combine prompting (a signal to perform an action, eg, metronome for compression rate) with feedback (after-event information about the effect of an action, eg, visual display of compression depth). The effects have been considered together in this question and devices are referred to as prompt/feedback devices.Seven LOE 5 manikin studies84–90 demonstrated that CPR prompt/feedback devices either in addition to or in place of instructor-led training improved basic CPR skill acquisition (tested without use of the device). Another LOE 5 manikin study85 showed that automated feedback might be less effective than instructor feedback for more complex skills (eg, bag-mask ventilation).Two LOE 5 manikin studies84,87 showed improved skill retention when a CPR prompt/feedback device was used during initial training. An additional LOE 5 manikin study89 showed that unsupervised refresher training with a CPR prompt/feedback device, compared with no refresher training, also improved skill retention. The LOE 5 follow-up arm of the manikin study of bag-mask ventilation/CPR85 continued to show poorer ventilation skills in the voice-activated manikin–feedback arm compared with the instructor-feedback arm.Evidence from 21 manikin studies (LOE 5)84,86,89–107 consistently demonstrated that CPR prompt/feedback devices used during CPR improved the quality of CPR performance on manikins. Three additional manikin studies (LOE 5) examined the utility of video/animations on mobile-phone devices: 2 studies showed improved checklist scores and quality of CPR92,95 and faster initiation of CPR,92 while the third study showed that participants using multimedia phone CPR instruction took longer to complete tasks than dispatcher-assisted CPR.103 Two manikin studies (LOE 5)108–109 that used 2-way video communication to enable the dispatcher to review and comment on CPR in real time produced equivocal findings.There are no studies demonstrating improved patient outcomes with CPR prompt/feedback devices. One study each in children (LOE 2)110 and adults (LOE 2)111 showed that metronomes improved chest compression rate and increased end-tidal carbon dioxide (thought to correlate with improved cardiac output and blood flow to the lungs). Five studies evaluating the introduction of CPR prompt/feedback devices in clinical practice (pre/post comparisons) found improved CPR performance (LOE 3).80,112–115There may be some limitations to the use of CPR prompt/feedback devices. Two LOE 5 manikin studies116,117 reported that chest-compression devices may overestimate compression depth if CPR is being performed on a compressible surface such as a mattress on a bed. One LOE 5 study100 reported harm to a single participant when a hand got stuck in moving parts of the CPR feedback device. Another LOE 5 manikin study118 demonstrated that additional mechanical work from the CPR provider was required to compress the spring in one of the pressure-sensing feedback devices. One case report (LOE 5)119 documented soft tissue injury to a patient's chest when an accelerometer device was used for prolonged CPR.Treatment RecommendationCPR prompt/feedback devices may be considered during CPR training for laypeople and HCPs. CPR prompt/feedback devices may be considered for clinical use as part of an overall strategy to improve the quality of CPR. Instructors and rescuers should be made aware that a compressible support surface (eg, mattress) may cause a feedback device to overestimate depth of compression.Training InterventionsEIT-009AFor adult and pediatric advanced life support providers, are there any specific training interventions (eg, duration of session, interactive computer programs, e-learning, video self-instruction) compared with traditional lecture/practice sessions that increase outcomes (eg, skill acquisition and retention)?Consensus on ScienceThere is limited evidence about interventions that enhance learning and retention from advanced life support courses. One LOE 3 study120 suggested that the 2005 Guidelines have helped to improve "no-flow" fraction (ie, percent of total resuscitation time that compressions are not performed) but not other elements of quality of CPR performance. One LOE 1 study121 demonstrated that clinical training before an advanced life support (ALS) course might improve long-term retention of ALS knowledge and skills. One LOE 5 advanced trauma life support (ATLS) study122 suggested that postcourse experience might play a role in knowledge and skill retention. In one LOE 3 study123 unscheduled mock-codes improved mock-code performance in hospital personnel. One LOE 2 study124 found no difference in knowledge retention when live actors were used in ALS course training compared with manikins.Treatment RecommendationThere is insufficient evidence to recommend any specific training intervention, compared with traditional lecture/practice sessions, to improve learning, retention, and use of advanced life support skills.Realistic Training TechniquesEIT-019A, EIT-019BFor participants undergoing basic or advanced life support courses, does the inclusion of more realistic techniques (eg, high-fidelity manikins, in situ training), as opposed to standard training (eg, low-fidelity manikins, education center), improve outcomes (eg, skill performance on manikins, skill performance in an actual arrest, willingness to perform)?Consensus on ScienceStudies report conflicting data on the effect of increasing realism (eg, use of actual resuscitation settings, high-fidelity manikins) on learning, and few data on patient outcomes. Two studies (LOE 1125; LOE 2126) supported an improvement in performance of skills in actual arrest, but were underpowered to identify improved survival rate. One small LOE 1 study127 showed no overall effect on performance, although the simulation-trained group demonstrated superior teamwork skills. Thirteen studies (LOE 1125,128–132; LOE 2133–135; LOE 3136,137; LOE 4138,139) reported an improvement in skills assessed using a manikin. Seven LOE 1 studies140–146 reported no effect on skills assessed using a manikin. Eleven LOE 1 studies tested the effect of simulation fidelity on the participants' knowledge using multiple-choice questions; nine of these studies found no effect124,127,128,130,140,141,143,144,147 and two of the 11 studies demonstrated an improvement in participant knowledge with the more realistic techniques.148,149Two studies (LOE 3136; LOE 4138) that focused on resuscitation in trauma reported improved skill performance (on a manikin) with higher-fidelity simulation. One LOE 1 study140 found no difference in skill performance or knowledge in advanced trauma life support (ATLS) with the use of high-fidelity simulation. One LOE 1 study148 reported a significant increase in knowledge when using manikins or live patient models for trauma teaching compared with no manikins or no live models. In this study there was no difference in knowledge acquisition between using manikins or live patient models, although learners preferred using the manikins.Four studies (LOE 1128,140,141; LOE 2148) reported that higher-fidelity simulation was associated with improved learner satisfaction rate compared with a traditional curriculum. One LOE 1 study144 questioned the cost-effectiveness of higher-fidelity approaches compared with standard manikins.Three studies (LOE 1125; LOE 2134; LOE 3137) reported that requiring learners to perform all of the steps of psychomotor skills in simulation as they would in an actual clinical situation could reveal inadequacies in training.Treatment RecommendationThere is insufficient evidence to support or refute the use of more realistic techniques (eg, high-fidelity manikins, in situ training) to improve outcomes (eg, skill performance on manikins, skill performance in actual arrest, willingness to perform) compared with standard training (eg, low-fidelity manikins, education center) in basic and advanced life support courses.Course Format and DurationResuscitation training courses vary widely in their duration and how different elements of the curriculum are taught. This section examines the effect of course format and duration on learning outcomes.Course DurationEIT-029A, EIT-029BFor basic life support providers (lay or HCP), does a longer-duration instructor-led course, compared with a shorter course, improve skill acquisition and retention?Consensus on ScienceA single, randomized manikin LOE 1 study150 demonstrated that a 7-hour basic life support (with AED) instructor-led course resulted in better initial skill acquisition than a 4-hour instructor-led course; and a 4-hour instructor-led course resulted in better skill acquisition than a 2-hour course. Retesting at 6 months after a 2-hour course resulted in skill retention at 12 months that was equivalent to a 7-hour course with no intermediate testing. This study150 along with 2 LOE 2 manikin studies151,152 demonstrated that for periods between 4 and 12 months, skill retention is higher for longer courses, but deterioration is at similar rates. The differences in learning outcomes for courses of different durations may not be significant, particularly if assessment and refresher training are undertaken.Treatment RecommendationIt is reasonable to consider shortening the duration of traditional instructor-led basic life support courses. Brief reassessment (eg, at 6 months) should be considered to improve skills and retention. The optimal duration of an instructor-led basic life support course has not been determined. New course formats should be assessed to ensure that they achieve their objectives.Nontraditional Scheduling FormatsEIT-020For participants undergoing advanced life support courses, does the use of
Referência(s)