Development and Pilot of an Online, Interactive Defibrillator Simulation for Advanced Cardiovascular Life Support Providers.

Abstract

Background: To decrease the risk of device mismanagement when using manual external defibrillators (MED), we created and piloted an online simulation to build and assess skills in using an MED.

Methods: Subject matter experts from anesthesiology, critical care, and nursing developed an online, interactive simulation-based curriculum for the MED device used at the VA Health System (R Series, Zoll) following the successive approximation method. Content was from the 2020 American Heart Association advanced cardiac life support (ACLS) guidelines and product manufacturer recommendations. Instructions for ACLS providers on how to correctly place defibrillator pads and perform synchronized cardioversion, defibrillation, and transcutaneous pacing were included. During the pilot study, 22 users from one institution completed a pre-assessment (baseline ability to place pads, perform the 3 defibrillator tasks), watched instructional videos and engaged with an interactive tutorial, and, in the post-assessment, must have correctly completed each task independently. The assessments tracked "pass/fail," number of attempts, and the time to complete each task.

Results: Feedback from users was positive. Completing the simulation-based curriculum resulted in improved device management on a simulated device. Wilcoxon signed-rank tests showed no significant change in time to place defibrillator pads, but there was a significant reduction in time to perform a cardioversion (median [interquartile range] = 31.31 [34.23] vs 20.10 [13.92] seconds; P = .001), defibrillation (19.79 [19.24] vs 15.54 [6.22] seconds; P < .0001), and pacing (39.51 [30.72] vs 20.07 [10.59] seconds; P < .0001).

Conclusions: The online simulation-based curriculum was well received and should be particularly useful for those who do not have ready access to in-person MED training.