A tool for immediate and automated assessment of resuscitation skills for a full-scale simulator

For performance assessment during simulation, mostly observers rate the trainees' performance using checklists. Simulator outcome may provide immediate and objective feedback to the participants but requires additional work for the accurate scenario design. High-fidelity simulators are based on physiologic models and store all changes of the simulator conditions during the scenarios and may therefore be used for the assessment of performance. In the present work, the design of a simulator script for the assessment of resuscitation skills using an Emergency Care Simulator (ECS, METI, Sarasota, Florida) is described.

A standardized resuscitation simulator script and a visual basic-based macro were programmed for the immediate and automated extraction of performance-related variables from the log files. The following parameters were assessed: mean cardiac output, time until return of spontaneous circulation, no-flow-time, no-flow-time fraction, the time until the first defibrillation, the number and fraction of indicated and non-indicated defibrillations. Furthermore, mean deviation of defibrillation interval from the 2 minutes interval, the mean interval of defibrillations and the time until the first administration of epinephrine were calculated. As an example, the results of resuscitation efforts according to 2005 guidelines by five teams that consisted of one emergency physician and two paramedics are presented. No data are provided about its validity and reliability.

The tool can be used to assess adherence to European and American cardiopulmonary resuscitation guidelines (both 2005 and 2010) and to compare simulator outcome if different guidelines are trained and applied according to specific curricula. It represents an example of how simulator outcome can be used for performance assessment and may help to design more complex test-scenarios including the field of critical incidents in anesthesia.