Abstract Details

Simulation is a core element of resuscitation team training in hospitals who are top survival performers following IHCA. Though simulation is an effective tool, its implementation may be limited by barriers including lack of faculty expertise in course development, logistics, and debriefing.

To assess whether adaptation of a pre-existing code simulation improves neurocritical care (NCC) fellow knowledge of and confidence in management of in-hospital cardiac arrest (IHCA).

An established code leader simulation course for medicine residents was implemented for NCC fellows. The course consisted of two scenarios (ventricular fibrillation arrest secondary to myocardial ischemia and pulseless electrical activity arrest secondary to hypoxemia) and was followed by debriefing with good judgement. Participants completed pre-, immediate post-, and delayed post-course surveys including confidence assessments. A knowledge assessment was added in the second year of the course.

Eight NCC fellows were enrolled. All participants had previously participated in a code and two had prior experience as a designated code leader. Four noted low confidence as a barrier to code leadership. Median confidence in ability to lead a successful code increased immediately following the intervention (5 point-Likert scale median= 3.6 vs 4.3, p= 0.017). There was no difference in confidence between the immediate post- and delayed post-course time points (4.3 vs 4.3, p= 1.0). Cardiac arrest management knowledge increased immediately following the intervention (percent correct [SD]= 67% [7%] vs 92% [7%], p= 0.005). All participants agreed that they gained knowledge or skills that would help them provide better patient care and wanted additional cardiac arrest simulation training.

Adaptation and implementation of a pre-existing simulation curriculum is feasible for improving cardiac arrest management knowledge among NCC fellows. Low confidence was identified as a barrier to code leadership and improved following the intervention. Further studies would be helpful to identify whether simulation improves code leader competency.