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Published on: January 15, 2017
Effect of low-dose, high-frequency advanced life support training versus annual full-day training on simulation-based
Lisa Moll1, Reimer Riessen1, Philipp Dahlmann2
1Department of Internal Medicine, Intensive Care Unit, University Hospital Tübingen, Tübingen, Germany.
Background:
Skill decay in advanced life support (ALS) is well documented, yet optimal training frequency remains unclear. This trial compared low-dose, high-frequency ALS training with annual full-day training regarding simulation-based resuscitation performance after one year.
Methods:
In this randomized, controlled, simulation-based trial, 35 emergency medical services (EMS) professionals were allocated to either low-dose, high-frequency ALS training (intervention group, n = 18) or a single annual full-day ALS training (control group, n = 17). Performance was assessed at baseline and after 12 months using a validated 29-item rating instrument covering technical and non-technical skills (NTS), with items rated on a 5-point Likert scale (1 = poor performance, 5 = excellent performance). The primary endpoint was the overall performance score for resuscitation management, defined as the mean across all items. Secondary endpoints included domain-specific performance scores (NTS, defibrillation-related, and cardio-pulmonary resuscitation [CPR] items), calculated as the mean scores for each domain, as well as time to key interventions.
Results:
After 12 months, the intervention group showed significantly higher overall performance scores than the control group (4.7 ± 0.2 vs. 4.2 ± 0.3; p < 0.001). The largest between-group difference was observed for NTS (4.8 ± 0.2 vs. 3.9 ± 0.5; p < 0.001). Scores for defibrillation-related and CPR-related items were also significantly higher in the intervention group. Time to CPR initiation (13 ± 2 s vs. 18 ± 7 s; p = 0.015), rhythm analysis (29 ± 9 s vs. 45 ± 24 s; p = 0.015), supraglottic airway insertion (51 ± 13 s vs. 68 ± 30 s; p = 0.013), as well as hands-off time (4 ± 1 s vs. 6 ± 3 s; p = 0.002) were significantly shorter in the intervention group. The rating instrument demonstrated good reliability (Cronbach's alpha 0.793; intraclass correlation coefficient 0.794, 95% confidence interval 0.718-0.854).
Conclusion:
Low-dose, high-frequency ALS training resulted in higher simulation-based resuscitation performance scores than annual full-day training, particularly for non-technical skills and time-critical processes.
Trial Registration:
The study is registered in the German Register of Clinical Studies under the ID DRKS00024822.
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