Effects of high-fidelity simulation in the management of cardiac arrest among emergency and critical care nurses: A randomized trial

Abstract

• Cardiac arrest is an extremely urgent complication that can occur during hospitalization. Thus, early cardio-pulmonary resuscitation may guarantee a better survival. • Nurses frequently serve as the first responders in IHCA scenarios, highlighting the importance of advanced training in CPR for intensive care unit (ICU) nurses. • The lack of practical exposure and the limited availability of ACLS-trained nurses have led to a substantial knowledge gap in the management of in-hospital cardiac arrest (IHCA) in high-risk settings. • To address this issue, targeted educational interventions focusing on IHCA management among nurses are imperative. High-fidelity simulation (HFS) represents an effective strategy. • A randomized trial was conducted to compare two training methods: theoretical learning alone versus theoretical learning supplemented by a high-fidelity simulation session. The assessment was based on the Nurse Cardio-Pulmonary Resuscitation Survey (NCRS). • We found that after a HFS session, the median Nurse-Cardio-Pulmonary-Resuscitation Survey (NCRS) was 9 [7.25–9] for the simulation group, significantly higher than 7 [6–7.5] for the theoretical-only group (p < 10–3),. Interestingly, no significant difference was observed between the two groups at baseline. • The simulation group showed improvement in nearly all steps of CPR. Notably, significant improvements were observed in the optimal timing to defibrillation (p = 0.04) and the optimal depth of chest compressions (p = 0.003). • After a simulation training, 25% of participants in the simulation group continued to agree that defibrillation is a medical activity, compared to 41.8% in the group that did not attend the simulation session. Additionally, 95% of participants felt confident initiating defibrillation on their own, compared to 75% in the group without simulation training. Furthermore, 95% of participants in the simulation group believed they had sufficient knowledge to perform defibrillation, whereas only 63% of participants in the non-simulation group shared this confidence. The lack of practical exposure and the limited availability of ACLS-trained nurses have led to a knowledge gap in the management of in-hospital cardiac arrest (IHCA) in high-risk settings. High-fidelity simulation(HFS)is acknowledged as a training strategy for enhancing clinical competence by offering hands-on learning experiences. This study aimed to evaluate its effects on critical care nurses’ knowledge and attitudes toward the initial management of IHCA. A randomized trial was conducted to compare two training approaches: theoretical learning alone versus theoretical learning followed by HFS. At baseline(T0), all participants completed the Nurse-Cardio-Pulmonary-Resuscitation Survey(NCRS)and attended a common theoretical course. Subsequently, twenty participants were assigned to undergo an additional HFS session(T1). Thirty nine folded papers, among which 20 labeled “simulation” were used ensuring unbiased selection. Finally, the NCRS was re-administered to all participants(T2). Thirty-nine participants were included, with twenty nurses assigned to the HFS. The mean NCRS score improved significantly from 3.83 to 7.48. At T2, the median NCRS score was significantly higher in the simulation group compared to the theoretical learning group ( p < 10 −3 ). CPR skills showed notable improvement, particularly in the time to defibrillation ( p = 0.04)and the depth of chest compressions( p = 0.003). After the simulation, only 25% of participants still viewed defibrillation as a strictly medical task, down from 56.4% at baseline. Additionally,95% of participants expressed confidence in initiating defibrillation and felt they had adequate knowledge to perform it in the future, compared to only 28.2% at baseline. Our findings suggest that HFS effectively enhances nurses’ knowledge, practical skills and confidence in managing IHCA. Incorporating HFS into resuscitation training programs for nurses in high-risk settings, coupled with ongoing training, could significantly support the improvement of their proficiency over time.