"Rolling Refreshers": a novel approach to maintain CPR psychomotor skill competence

High quality CPR skill retention is poor. We hypothesized that "just-in-time" and "just-in-place" training programs would be effective and well-accepted to maintain CPR skills among PICU staff.

"Rolling Refreshers", a portable manikin/defibrillator system with chest compression sensor providing automated corrective feedback to optimize CPR skills, were conducted daily in the PICU with multidisciplinary healthcare providers. Providers practiced CPR until skill success was attained, prospectively defined as <3 corrective prompts within 30s targeting chest compression (CC) rate 90-120/min, CC depth > 38 mm during continuous CPR. Providers completing > or =2 refreshers/month (Frequent Refreshers [FR]) were compared to providers completing < 2 refreshers/month (Infrequent Refreshers [IR]) for time to achieve CPR skill success. Univariate analysis performed using non-parametric methods. Following actual cardiac arrests, CPR providers were surveyed for subjective feedback on training approach efficacy (5-point Likert scale; 1=poor to 5=excellent).

Over 15 weeks, 420 PICU staff were "refreshed": 340 nurses, 34 physicians, 46 respiratory therapists. A consecutive sample of 20 PICU staff was assessed before subsequent refresher sessions (FREQ n=10, INFREQ n=10). Time to achieve CPR skill success was significantly less in FREQ (median 21s, IQR: 15.75-30s) than in INFREQ (median 67s, IQR: 41.5-84s; p<0.001). Following actual resuscitations, CPR providers (n=9) rated "Rolling Refresher" training as effective (mean=4.2; Likert scale 1-5; standard deviation 0.67).

A novel "Rolling Refresher" CPR skill training approach using "just-in-time" and "just-in-place" simulation is effective and well received by PICU staff. More frequent refreshers resulted in significantly shorter times to achieve proficient CPR skills.