Optimizing the educational efficiency of resuscitation training programs and local implementation of resuscitation guidelines can save more lives than scientific breakthroughs in the clinical management of cardiac arrest, according to a scientific statement recently released by the American Heart Association (AHA).
Developing new standards in resuscitation education
Over a decade ago, the International Liaison Committee on Resuscitation (ILCOR) identified three interactive factors that determine survival following cardiac arrest. These factors included updated medical science, educational efficiency of the caregivers, and local-level implementation. The AHA capitalized on the robust medical science review process already in place to create evidence-based education recommendations with the goal of improving resuscitation performance, both in the classroom and at the bedside.
Committees composed of experts in resuscitation science and education focused their evidence review on six instructional design topics and two knowledge translation and implementation topics. Early in 2017, the AHA held an education summit in Chicago, where the individual committees presented the results of their respective reviews. This statement represents the most up-to-date review of education strategies for improving individual and team performance in caring for patients suffering from cardiac arrest.
After incorporating suggestions and comments and finally reaching consensus, the AHA released its scientific statement in June 2018.
How to account for varied cardiac arrest survivability across the country
Geographically, there is a six-fold variation in survival following out-of-hospital cardiac arrest in the United States. While a variety of factors may contribute to this variability, performance inconsistencies among EMS systems and personnel may play a critical role. Survival following out-of-hospital cardiac arrest should not depend on what part of the country the patient was in when the cardiac arrest occurred.
Most EMS agencies across the country follow the same basic clinical guidelines recommended by the AHA, such as providing CPR, defibrillation and advanced life support. Agencies achieving higher survival rates are not administering a “magic” medication that is not available in other parts of the country.
Instead, it is reasonable to assume survival difference may result from training and practice variability. Although the optimal method of resuscitation education remains unidentified, incorporating more evidence-based education strategies may help bridge the survival gap that currently exists.
How to implement new education standards
Education of EMS providers has experienced something of a renaissance in the last two decades. Gone are the days of stagnant and prescriptive curricula.
Replaced with broad education standards, current educational programs are fluid and allow for rapid changes at the local level, as clinical evidence dictates. Although the scientific statement released by the AHA targets resuscitation education, implementation of those training strategies in initial and continuing education programs targeting EMS personnel can improve outcomes for a variety of clinical conditions, especially those with time-sensitive components where effective teamwork is critical.
The future of cardiac arrest resuscitation education
Over the coming months, the AHA will focus on incorporating these educational strategies into the resuscitation training programs currently offered. In addition, the AHA is currently developing a set of tools resuscitation instructors can use to implement these evidence-based recommendations. In the meantime, EMS educators and members of the Emergency Cardiovascular Care Training Network should carefully review the scientific statement and compare their current education practices to the AHA recommendations for areas of similarity and differences.
