ASSESSMENT TOOL FOR A STANDARDIZED VENTRICULAR FIBRILLATION CARDIAC ARREST

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ASSESSMENT TOOL FOR A STANDARDIZED VENTRICULAR
FIBRILLATION CARDIAC ARREST

• Jessie Weaver, Meds IV
• Damon Dagnone, MD

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Disclosure
? I do not have an affiliation (financial or
otherwise) with any commercial organization that
may have a direct or indirect connection to the
content of my presentation. ? I have/had an
affiliation (financial or otherwise) with a
commercial organization that may have a direct or
indirect connection to the content of my
presentation.
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• RESEARCH OBJECTIVE
• We set out to derive and test the performance of
  a preliminary assessment tool for a standardized
  ventricular fibrillation cardiac arrest scenario

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• INTRODUCTION
• Emergency Medicine training programs need
  competency-based assessment tools to evaluate how
  trainees perform in resuscitation
• We used the ILCOR 2005 algorithm for ventricular
  fibrillation to help derive an assessment tool
  for our initial study

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• INTRODUCTION
• Standardized performance assessments of trainees
  during ED resuscitations is challenging and can
  compromise patient safety
• Initial testing of the assessment tool was
  carried out in a high fidelity simulation-based
  environment at Queens University

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• METHODS
• We developed a standardized ventricular
  fibrillation arrest scenario that required 2
  defibrillation attempts
• The assessment tool was comprised of three
  separate checklists
• Essential Actions, Time to Action, and Global
  Assessment
• The checklists were derived by a panel of medical
  experts in resuscitation from within our
  institution

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• METHODS
• Our study group included 4th year medical
  students, 4th year nursing students, junior
  medical residents, and senior medical residents
  in Emergency Medicine
• Each of the study groups (n 5 per group)
  performances were videotaped and reviewed by 3
  blinded medical experts
• Correlation analyses and analyses of variance
  were applied to the assessment tools performance

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CRITICAL ACTIONS checklist NOT DONE (0)
DONE POORLY (1) DONE WELL (2) N
/ A PRIMARY ASSESSMENT LOC assessed AIRWAY/BREATHI
NG assessed BVM 2 breaths delivered PULSE
check Call for HELP / CODE BLUE INITIATION OF
TASKS BVM CPR 302 X 5 cycles MONITOR IV
ACCESS TEAM LEADER position COORDINATION OF
TASKS Initial RHYTHM IDENTIFICATION Initial
DECISION for DEFIBRILLATION First DEFIBRILLATORY
SHOCK Reassessment of RHYTHM Reassessment of
VITAL SIGNS with ROSC
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TIME TO ACTION checklist NOT DONE
DONE TIME (sec) Call for help / code blue /
crash cart Initial 2 breaths BVM with O2 Initial
PULSE check Initiation of CPR Initial RHYTHM
IDENTIFICATION Initial DECISION for
DEFIBRILLATION First DEFIBRILLATORY
SHOCK Reassessment of RHYTHM Reassessment of
VITAL SIGNS with ROSC
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• GLOBAL ASSESSMENT checklist
• 1 2 3 4 5
• FAIL MARGINAL PASS GOOD EXCELLENT

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• RESULTS
• A total of 18 study groups were assessed in their
  performance of the VFIB arrest scenarios
• They were categorized based on the educational
  level of the team leader
• 4 senior residents
• 7 junior residents
• 7 medical/nursing students

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Table 1 Summary of Checklist Scores
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Table 2 Inter-rater agreement for Essential
Actions Global Assessment
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Table 3 Correlation scores for Essential Actions
and Global Assessment
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• DISCUSSION
• The simulated VFIB arrest scenario was easily
  reproducible with the high-fidelity medical
  simulator
• Videotaping performances allowed for independent
  and standardized expert evaluation that
  facilitated the use of the assessment tool
  checklists

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• DISCUSSION
• The assessment tool was able to discriminate
  performance with respect to level of training
• Essential Actions and Global Assessment but not
  Time to Action
• Inter-rater reliability for Essential Actions and
  Global Assessment were strong
• Scores for Essential Actions correlated well with
  Global Assessment

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• LIMITATIONS
• The assessment tool has only been piloted in a
  small sample population of trainees
• Checklist scoring items were equally weighted
  regardless of necessity of action or therapeutic
  benefit
• Expert examiners were not blinded to the training
  level of all study subjects

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• CONCLUSIONS
• This pilot study demonstrates a valid
  simulation-based assessment tool for a
  standardized ventricular fibrillation cardiac
  arrest scenario
• The study shows great promise for the development
  and implementation of additional simulation-based
  assessment tools

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• ACKNOWLEDGEMENTS

Dr. Damon Dagnone (Supervisor) dagnoned_at_kgh.kari.n
et Dr. Bob McGraw Cheryl Pulling, RN Marian
Luctkar-Flude, RN Will Pickett, PhD
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QUESTIONS ?
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