Most in-hospital cardiac arrests occur in intensive care units (ICUs). Providers should be trained to use available ICU monitoring to titrate CPR to patient physiology.
CPR Booster Trainings with biofidelic hemodynamic feedback targeted to arterial blood pressure (ABP) would improve CPR skill acquisition and end of shift (12 hour) retention during simulated pediatric cardiac arrest.
A novel manikin displaying ABP during CPR was engineered, piloted, and then deployed in this randomized trial. Relationship between CC depth and ABP was biofidelic, derived from data captured from actual children in cardiac arrest. ICU providers were randomized to one of two brief (120s) hemodynamic bedside CPR skill retrainings: 1) Booster Plus (ABP visible during training, pre-test and post-test) vs. 2) Booster Alone (ABP visible during training and pre-test only). Subjects performed CCs; an investigator provided ventilations (intubated manikin). Training targets were CC depth to achieve SBP = 100mmHg and CC rate 100 – 120 CC/min. Subjects completed 60s skill tests pre-, immediately post-, and 12 hrs post-training (shift end). The primary outcome was proportion of providers with excellent CPR (both SBP = 100mmHg and CC rate 100 – 120 CC/min) evaluated using McNemar’s test for paired binary data.
Twenty-four ICU providers were randomized 10 ± 6 months after standard AHA CPR certification. Demographics were not different between groups. Pre-training, 42% of providers performed CCs achieving ABP target; 38% within rate target, and 25% with excellent CPR (both within targets). Excellent CPR pre-training was not different between groups: Booster Plus 17% vs. Booster Alone 33% (p=0.6). Compared to pre-training, excellent CPR increased in Booster Plus to 67% after training (p=0.03), and remained improved at 12 hrs (67%; p=0.03). Similar increases were not evident in Booster Alone: 42% after training (p=0.9); 50% at 12 hrs (p=0.7).
CPR certified ICU providers performed poorly in skills tests prior to training. Using a novel manikin, Booster Trainings plus biofidelic hemodynamic feedback during simulated cardiac arrest improved CPR skill acquisition and end of shift (12 hour) retention.