Primary Author:	Leonid Bunegin, BS
Co-Principal Investigators/Collaborators:	Paul Cash, BS, LP, Lee Williams, MD, FAAEM
Organization	UT Health Science Center San Antonio, Department of Anesthesiology

Abstract

Purpose

This study compares resuscitation of cardiac arrest by RN and MD led resuscitation teams during arrest scenarios on a High Fidelity Human Simulator.

Background

Advanced cardiac life support (ACLS) trained RNs rarely lead resuscitation efforts during in hospital cardiac arrest. Generally, this responsibility is relegated to a physician.

Materials & Methods

RNs and MDs completing an ACLS re-certification were evaluated. Participants (n=333) were formed into 9 member resuscitation teams with pre-assigned roles. RNs lead 11 teams, and MDs lead 26 teams. Teams were further divided into non-Human Simulation (nHS) trained (n=6 RN led, n=13 MD led) and HS trained (n=5 RN led, n=13 MD led). Each team was challenged by a ventricular fibrillation (V-fib) scenario on SimMan® as the first code of the day. After a didactic review, a practice session was held where 5 to 9 additional V-fib megacodes were presented. The percent adherence to American Heart Association (AHA) guidelines was compared for each group at each level of training.

Results

Adherence to AHA pulseless guidelines was 26.4 % for RN and 25.6 % for MD led teams (NS) in the nHS training group, and 21.7 % for RN and 28.8 % for MD led teams (NS) for previously HS trained teams. After didactic review, adherence improved to 52.8% for RN and 42.3 % for MD led in nHS teams (NS) and 61.7% for RN and 54.2 % for MD in HS teams (NS). After practice an additional improvement was observed increasing to 63.9% for RN and 60.3% for MD led in nHS teams (NS). The greatest increase in adherence was observed in HS teams after practice; 65.0 % RN led teams and 73.1 % in the MD led teams (NS).

Conclusion

This study supports the idea that the level of competence demonstrated by nurses suggests code team leadership headed by rapidly responding appropriately trained nurses would offer a benefit over awaiting physician arrival to assume the code team leader role in the hospital setting.

© Improvement Science Research Network, 2012

The ISRN published this as received and with permission from the author(s).