Retention of CPR performance in anaesthetists.

Resuscitat
TRAINI
Rete
Feder
a Depart
b Depart
Received
KEYWO
Advanc
(ALS);
Cardiac
Cardiop
resuscit
Training
� A Spa
cle appea
j.resuscita
∗ Corres
fax: +39 0
E-mail
0300-9572
doi:10.101ion (2006) 68, 101—108
NG AND EDUCATION
ntion of CPR performance in anaesthetists�
ico Semeraroa,∗, Luciano Signoreb, Erga L. Cerchiari a
ment of Anaesthesia and Intensive Care, Ospedale Maggiore, Bologna, Italy
ment of Anaesthesia and Intensive Care, University ‘‘La Sapienza’’, Rome, Italy
4 January 2005; received in revised form 3 April 2005; accepted 9 June 2005
RDS
ed life support
arrest;
ulmonary
ation (CPR);
Summary The objective of this study was to evaluate retention of ALS knowledge
and performance among anaesthesiologists, who, in Italy, respond to in-hospital
emergencies as team leaders.
Methods: 47 anaesthesiologists (23 consultants and 24 residents) were invited at one
weeks notice to attend a re-evaluation session, 6 months after successful completion
of an ERC ALS course. Knowledge retention was assessed by a multiple choice ques-
tion test, and skills and management by evaluation of performance as team leader
in one of the six standardized CAStest scenarios. During the performance, the time-
liness of first defibrillation, completion of the three shock sequence, adrenaline
(epinephrine) administration and intubation were recorded. Results were compared
between consultants and residents.
Results: Compared to the results at t
rect answers to the multiple choice
to 79.45± 6.62% (P < 0.001), the num
mance decreased from 47/47 to 30/4
73.38± 18.72 s, time for completion o
and subsequent ALS interventions w
between consultants and residents s
information better, skills decreased c
formed tasks faster.
Conclusions: The significant decay of
anaesthesiologists supports the need
before recertification.
© 2005 Elsevier Ireland Ltd. All rights
nish translated version of the summary of this arti-
rs as Appendix in the online version at 10.1016/
tion.2005.06.011.
ponding author. Tel.: +39 051 6478868;
51 6478867.
address: rareseed@mclink.it (F. Semeraro).
Introduc
The poor
ticularly
document
been prom
resuscitat
/$ — see front matter © 2005 Elsevier Ireland Ltd. All rights reserved.
6/j.resuscitation.2005.06.011he end of the ALS course, the percent of cor-
question test decreased from 85.89± 5.28%
ber of candidates achieving a pass perfor-
7 (P < 0.001). Time to first defibrillation was
f the third defibrillation was 113.04± 35.58 s
ere very delayed or forgotten. Comparison
howed that consultants retained knowledge
omparably in both groups and residents per-
ALS skills 6 months post-ALS recorded among
for periodical reinforcement during intervals
reserved.
tion
quality of resuscitation skills, par-
among medical staff, has been well
ed.1—4 On this basis, major efforts have
oted to provide permanent in-hospital
ion training5 and advanced life support

102
(ALS) card
has becom
cially for
Althoug
tal disch
unequivoc
as a ‘‘gol
for advan
All rep
formance
and nurse
training.1
The tim
planning
programm
pean Resu
is 4 years
In the
pital in Ro
emergenc
gency de
ing anaes
BLS/D, AL
The AL
in 1998 by
with the
Europe, w
replacing
Italian Re
The ob
retention
thesiologi
ing an AL
sen beca
most Itali
cies as te
with the
siologists,
uation of
knowledg
Anaest
cessfully
2001, wer
pate in a
later durin
were asse
of the AL
to the ma
added as
those reco
Besides
mance re
descriptiv
was condu
compariso
residents
rial
dva
cal c
nt th
ed f
and
,24 in
ER
ptio
s w
men
ndid
que
th p
le c
r fo
min.
ed f
ac
is ex
stan
ndid
by t
stru
es t
the
s ariopulmonary resuscitation (CPR) training
e mandatory for physicians6 and espe-
those involved in the resuscitation team.7
h an effect on survival to hospi-
arge has not yet been demonstrated
ally,8—13 ALS training is widely accepted
d standard’’ in training and certification
ced cardiopulmonary resuscitation.6,14
orts agree that, following training, per-
deteriorates with time among physicians
s and appears to be lost by 1 year after
5—23
e of skill deterioration is relevant for the
of retraining intervals or reinforcement
es: at the moment, the duration of Euro-
scitation Council (ERC) ALS certification
.14
years 2000—2001 in the San Camillo hos-
me an in-hospital training programme on
y management was conducted and emer-
partment healthcare personnel (includ-
thesia residents) underwent training in
S and ATLS.
S course version used, was that introduced
the European Resuscitation Council,14,24
purpose of standardizing ALS training in
hich was adopted in Italy in the year 2000,
the previous ALS course developed by the
Mate
The A
practi
ticipa
requir
arrest
ERC14
The
descri
ities a
assess
the ca
choice
B). Bo
possib
answe
in 60
requir
The
ment
of six
the ca
uated
two in
requir
sus on
optionsuscitation Council in 1997.
jective of this study was to evaluate
of ALS knowledge and skills among anaes-
sts 6 months after successfully complet-
S course: anaesthesiologists were cho-
use in the San Camillo hospital, as in
an hospitals, they respond to emergen-
am leader. Although several reports deal
resuscitation performance of anaesthe-
with variable results, no specific eval-
retention has been performed, to our
e.25—27
hesiologists, who had participated suc-
in an ALS course during the autumn of
e invited with 1 week notice, to partici-
re-evaluation session conducted 6 months
g which knowledge and skill performance
ssed with the same tests as at the end
S course. The recording of the intervals
jor ALS interventions during CASTest was
an objective measure and compared to
mmended by ERC.28
comparison of knowledge and perfor-
sults at the two intervals, a detailed
e analysis of all the results at 6 months
cted to understand the areas of decay. A
n of retention between consultants and
was analyzed.
subsequen
ent instru
options Pa
During
ALS trainin
participan
physicians
Assessm
performed
two stand
among sce
Quality
by ERC c
San Camil
course.
All eva
group of fi
Six mo
ALS cours
week noti
ticipated
residents
The re
same sett
The as
knowledge
date to p
alent toF. Semeraro et al.
s and methods
nced Life Support is a theoretical and
ourse, with the aim of teaching the par-
e essential knowledge and practical skills
or treating the adult patient in cardiac
the version used was that proposed by
1998.
C instructor manual provides a detailed
n of the programme and training modal-
ell as the suggested procedure for final
t.29 Knowledge is explored by challenging
ate with one of two equivalent multiple
stion post tests (post test A and post test
ost tests consist of 30 questions with four
hoices, each choice requiring a True/False
r a total of 120 answers to be provided
The minimum rate of correct answers
or pass is 75%.
quisition of practical skills and manage-
plored by submitting the candidate to two
dardised CASTest scenarios during which
ate’s performance as team leader is eval-
wo instructors (team members are usually
ctors). The suggested evaluation process
hat the two instructors achieve a consen-
assessment of the performance and the
e Pass/Fail/Retest. In case of retest the
t performance is evaluated by two differ-
ctors who achieve a consensus with two
ss/Fail.
the second half of 2001, an in-hospital
g programme was performed involving 70
ts (47 anaesthesiologists, 11 emergency
, 9 nurses, 3 cardiologist).
ent at the end of the ALS courses was
consistently by offering post test A and
ardised CASTest scenarios (no. 2 plus one
narios no. 3, 4, 5).
of training was guaranteed and enriched
ertified Course directors, outside the
lo training group, and different at each
luations were performed by the same
ve senior instructors.
nths after successful completion of the
e, anaesthesiologists were invited with 1
ce, to a re-evaluation session. All 47 par-
(23 consultant anaesthesiologists and 24
from all the 4 years of specialization).
valuation session was organized in the
ing as the final ALS course evaluation.
sessment was performed as follows:
was explored by submitting the candi-
ost test B, proposed by ERC as equiv-
post test A. Post test B was chosen as

Retention
an assessm
acquisitio
ity of ans
with ques
sheet.
Practic
ting the
CASTest s
formance
instructor
evaluation
nature of
During
authors (F
and was n
four rele
arrest to
to first i.v
and to tra
Retenti
paring the
ALS course
Retenti
was measu
offering a
end of AL
post-ALS.
In orde
or perform
was carrie
The 120
according
gories: air
rillation,
rhythm re
the numb
correctly
The nu
action wa
formance
rillation.
results to
tions shou
ing cardia
trated wit
shock.
Knowle
interventi
anaesthes
Statisti
statistical
Chicago,
results at
were test
Being t
parison of
t 6
t-t
nu
at
LS w
co
nts
edg
f Pa
erva
ion,
lts
ana
eted
the
nsw
), a
kills
re-e
rect
63—
ass
ed
ctic
passof CPR performance in anaesthetists
ent of knowledge to explore the actual
n of concepts while avoiding the possibil-
wers provided by automatic association
tions or by graphical recall of the answer
al performance was explored by submit-
candidate to one of the standardised
cenarios (CASTest 1). The practical per-
was evaluated by the same five senior
s who had performed the final ALS course
, who were blinded at all times to the
the study.
the 6 months the CASTest of one of the
S), who assisted as a potential instructor
ever involved in the evaluation, recorded
vant intervals: from simulated cardiac
first defibrilation, to third defibrillation,
. adrenaline (epinephrine) administration
cheal intubation.
on of knowledge was evaluated by com-
number of correct answers at the end of
versus the number at 6 months post-ALS.
on of practical skills and management
red comparing the number of candidates
satisfactory performance (Pass) at the
S course versus the number at 6 months
r to understand the areas of knowledge
and a
paired
The
uation
post-A
The
reside
knowl
ber o
for int
deviat
Resu
All 47
compl
At
rect a
73—94
tical s
At
of cor
(range
75% p
achiev
Pra
a fullance decay better, a descriptive analysis
d out as follows.
questions of post test B were regrouped,
to the topic explored in five major cate-
way management, monitoring/safe defib-
drug administration and iv access, ECG
cognition, ALS algorithm sequence and
er of candidates answering each question
was analyzed.
mber of candidates performing each
s analysed in a step-by-step study of per-
focused on the sequence of safe defib-
Intervals were analysed comparing the
those recommended by ERC28: defibrilla-
ld be performed within 60 s from confirm-
c arrest and adrenaline should be adminis-
hin the first minute of CPR after the third
dge, performance and intervals to major
ons were compared between consultant
iologists and residents.
cal analysis30 was performed using the
software package SPSS (SPSS Inc.,
IL). The normal distribution of post test
end of the ALS course, and at 6 months
ed by Kolmogorov—Smirnov.
he variable normally distributed, a com-
post test results at the end of ALS course
The po
Smirnov
tribuited
MaxDif = 0
(Z = 0.75;
The po
pared to
ALS course
nificant lo
CI = 4.32—
The nu
tory skill p
compared
Table 1
n
ALS
(mean±
6 month
(mean±
P
Results at
months po
correct an
paired t-te
95% CI = 4.103
months post-ALS was evaluated by the
est.
mber of passes in skill performance eval-
the end of ALS course and at 6 months
as compared by McNemar test.
mparison between the consultants and
was performed by an unpaired t-test for
e post test results, by McNemar for num-
ss in CASTest, and by an unpaired t-test
ls. Data are reported as mean± standard
P values <0.05 are reported.
esthesiologists who entered the study had
the ALS course successfully.
end of the ALS course the percent of cor-
ers in post test A was 85.89± 5.28% (range
ll above the 75% pass rate, and their prac-
assessment was 47/47 full pass.
valuation 6 months post-ALS the percent
answers to post test B was 79.45± 6.62%
95) with 14 candidates not achieving the
rate (3 candidates achieved <70% and 11
a rate between 70 and 75%).
al skill assessment 6 months post-ALS was
in 30/47.
st test results tested by Kolmogorov—
one sample test were normally dis-
at the end of the ALS course (Z = 0.697;
.102; P = 0.715) and at 6 months post-ALS
MaxDif = 0.111; P = 0.61).
st test results at 6 months post-ALS, com-
the post test results at the end of the
(Table 1) by paired t-test, showed a sig-
ss of knowledge (t = 5.941; P < 0.001; 95%
8.75).
mber of candidates offering a satisfac-
erformance (Pass) at 6 months post-ALS,
to the end of the ALS course (Table 2)
Knowledge retention
Knowledge (% correct answers)
47
course
S.D.)
85.89± 5.28 (73—94)
s post-ALS
S.D.)
79.45± 6.62 (63—95)
<0.001
the end of ALS course (post test A) and at 6
st-ALS (post test B), expressed as percent of
swers, are reported as mean± s.d. Comparison by
st showed a significant decay (t = 5.941; P < 0.001;
32—8.75).

104
Table 2 Skills retention
n
ALS cours
6 months
P
Results at
expressed
Compariso
skill perfo
by McNem
(�2 = 14.0
The an
in detail
weakness
The qu
and the n
to each q
of knowle
only four
The ste
tion testin
in Table 3
Figure 1
resents the
candidates
(total 120
Table 3
ALS (n = 4
Yes No
rms cardiac arrest (ABC) 47 —
ctly attaches ECG monitor 47 —
rms VF/pulseless VT from
nitor trace
47 —
ts correct energy level (200 J) 47 —
s gel pads on patient’s chest 20 27
ve free flowing oxygen 32 15
es defibrillators with paddles
achine or on patient’s chest
45 2
‘STAND CLEAR’’ and performs
ual safety check
43 4
ks VF/pulseless VT and 47 —Skill performance
(candidates full pass)
47
e 47
post-ALS 30
<0.001
the end of ALS course and at 6 months post-ALS are
as number of candidates who pass the CASTest.
n was by McNemar test that showed a significant
rmance decay (�2 = 14.063; d.f. = 1; P < 0.001).
ar test, showed a significant skill decay
63; d.f. = 1; P < 0.001).
Confi
Corre
Confi
mo
Selec
Place
Remo
Charg
in m
Say ‘
vis
Checswers to post test B were analyzed
to identify the areas of strength and
.
estions were grouped in five major areas
umber of candidates responding correctly
uestion is plotted in Figure 1. The area
dge retained best is ECG recognition with
questions being incorrect.
p-by-step analysis of the safe defibrilla-
g sheet at 6 months post-ALS is reported
. All candidates correctly performed the
Post test B: 6 months post-ALS. Each bar rep-
number of correct answers provided by the
to each of the four options of the 30 questions
T/F answers).
delivers
Administe
interrup
Three sho
200—20
Checks pu
Results at
of candida
analysis of
sequence
nected th
trace, sel
delivered
without in
forgotten
the patien
prior to de
The an
seconds,
manoeuvr
than requ
- Time to
(range 4
- Time to
(range 6
- Time to
87—247)
candida
- Time to
33—410)
candida
All the
tants and
At the
results of
n = 23) w
idents (8
the unpa
CI =−3.36F. Semeraro et al.
Safe defibrillation sequence 6 months post-
7)shock to patient
r shocks without any
tion
47 —
cks at the beginning
0—360 J
42 5
lse if rhythm changes 41 6
6 months post-ALS are expressed as the number
tes performing each action in the step-by-step
the sequence of safe defibrillation.
to confirm cardiac arrest (ABC), con-
e monitor and confirmed VF from the
ected correct energy, checked VF and
shock to patient, and administered shocks
terruption. The actions most frequently
by candidates were placing gel pads on
t chest and removing free flowing oxygen
fibrillation.
alysis of time intervals, expressed in
from simulated cardiac arrest to each
e showed that all candidates were slower
ired:
first defibrillation was 73.38± 18.72
0—130) (n = 47).
third defibrillation was 113.04± 25.54
8—182) (n = 47).
IV adrenaline was 138.05± 35.58 (range
(n = 39). (The number was 39 because 8
tes never administered adrenaline).
intubation was 160.60± 76.30 (range
(n = 40). (The number was 40 because 7
tes never performed intubation).
results were compared between consul-
residents.
end of the ALS course post test A
consultants (85.78± 4.73%; range 75—93;
ere not different from those of res-
6.00± 5.87%; range 73—94; n = 24) by
ired t-test (t =−0.141; P = 0.888; 95%
to 2.92). At 6 months post-ALS the

Retention
Figure 2
represent
group who
perform th
P = 0.038; 9
post test
range 69
of residen
by the un
CI = 0.54—
Skill pe
dates ach
(23/23 pa
by McNem
course an
ALS (cons
d.f. = 1; P
The int
tants and
show a sig
sequence
tants com
Discussi
Our resul
knowledge
gists retes
ful comple
A com
tant anaes
retained k
rable dec
dents perof CPR performance in anaesthetistsTime intervals from simulated cardiac arrest to ALS interve
residents and full symbols represent consultants. The n rep
performed each intervention. Significantly prolonged were
ird shock (t =−3.458; P = 0.001; 95.00% CI =−36.65 to −9.672
5.00% CI =−45.82 to −1.342).
B results of consultants (81.56± 5.96%;
—95; n = 23) were higher than those
ts (77.25± 6.80%; range 63—93; n = 24)
paired t-test (t = 2.307; P = 0.026; 95%
8.0).
rformance expressed as number of candi-
ieving a pass result between consultants
ss) and residents (24/24 pass) compared
ar was not different at the end of the ALS
d remained the same at 6 months post-
ultant 13/23; residents19/24; �2 = 0.214;
= 0.643).
ervals to major interventions of consul-
residents are plotted in Figure 2 and
nificant delay in completion of the shock
and adrenaline administration by consul-
pared to residents.
on
ts showed a significant decrease in ALS
and skills among the 47 anaesthesiolo-
ted for retention 6 months after success-
tion of an ALS course.
parison of the results between consul-
thesiologists and residents showed better
nowledge among consultants, a compa-
rease in psychomotor ALS skills; but resi-
formed ALS tasks faster.
Knowle
rect answ
achieving
between
rect answ
The de
consistent
decrease
cians and
5 months
Howeve
in theore
following
months in
sistently
when the
employed
In our
the ALS c
ing knowl
used. How
posed as e
not been
decrease
months po
part, to a
our result
other repo
ing after a
decay in s105ntions, expressed in seconds. Empty symbols
orted are the number of candidates in each
the time intervals consultants employed to
) and epinephrine administration (t =−2.148;
dge at 6 months showed a rate of cor-
ers of 79.45± 6.62% with three candidates
a <70% correct answers, 11 candidates
70 and 75% and 33 achieving a >75% cor-
ers.
crease of knowledge post-ALS is not a
finding. Some authors have reported no
in theoretical knowledge among physi-
nurses after a time interval varying from
up to 2 years after ALS training.16,17,19
r, other studies have reported a decay
tical knowledge, starting after 6 weeks
ALS training and further decreasing at 4
one report; theoretical knowledge con-
decreased at 12 months post-ALS even
oretical knowledge reinforcement was
at different intervals.18,21—23
study, to avoid automatic recall from
ourse, a different post test for evaluat-
edge retention at 6 months post-ALS was
ever, although the two tests are pro-
quivalent by ERC, their comparability has
tested and we cannot exclude that the
in theoretical knowledge recorded at 6
st-ALS can be attributed, entirely or in
more difficult test. With such a limitation,
s are comparable to those of numerous
rts, describing a knowledge decay occur-
n ALS course, although not as fast as the
kills.16—23

106
The be
was rhyth
sis of the
affecting
The sk
ALS was c
dates not
This fi
reports on
reported
ALS traini
12 month
vent or re
tions of t
effective.
Besides
the perfor
of some o
process.
The de
sheet sho
failure to
gen, the
sequence
of the tim
the first
confirmat
recomme
This pr
of the ER
rhythms,
the ALS co
months.
The an
firmed ca
vide obje
resuscitat
nificant d
sequence
as adrena
helped id
mance.
One of
ing is th
evaluation
and evalu
Our resul
the time
evaluation
dure shou
the stand
assessmen
The re
thesiologi
anaesthes
emergenc
aini
ltan
pr
ory
ts o
cen
utho
to
and
s fin
rary
ts o
g in
t. N
cor
anot
48
nsw
d co
man
ned
main
t in
inc
ists
onn
logi
ndst retained area of theoretical knowledge
m recognition, supporting the hypothe-
important role of pre-existing knowledge
the results of theoretical retention.
ill performance decay at 6 months post-
lear-cut and significant, with 14 candi-
achieving a pass performance.
nding is in full agreement with other
retention. Psychomotor skills have been
to decay in as little as 3 months after
ng and decreased significantly at 6 and
s after ALS.16,20—21 The attempts to pre-
duce skill decay by interposed interven-
heoretical reinforcement did not prove
21
the overall result, detailed analysis of
mances at 6 months allows an hypothesis
f the implications regarding the training
tailed analysis of the safe defibrillation
ws that, despite a relevant incidence of
place the gel pads and remove the oxy-
performance of the safe defibrillation
is well retained. Moreover, the analysis
e intervals to major ALS tasks shows that
defibrillation is undertaken in 70 s from
ion of cardiac arrest—–close to the 60 s
nded in the guidelines.
ALS tr
consu
One
isfact
thetis
had re
The a
mance
tation
Thi
tempo
ologis
trainin
peten
cation
In
where
55% a
judge
perfor
explai
pean
presen
The
siolog
questi
thesio
larly aovides evidence that the major target
C course, i.e. defibrillation of shockable
is not only fully achieved at the end of
urse, but also substantially retained at 6
alysis of intervals from the time of con-
rdiac arrest to major interventions pro-
ctive data to interpret the simulated
ion performance. Specifically, the sig-
elay in the performance of the shock
and the loss/delay of manoeuvres such
line administration or tracheal intubation
entify two areas of unsatisfactory perfor-
the problems identified in ALS train-
e variability of the final performance
and for this purpose the final test
ation scenarios have been standardized.
ts support the importance of recording
sequence to major interventions in the
of ALS performance and this proce-
ld be considered as a useful addition to
ardization of the final ALS performance
t.
ason to evaluate retention among anaes-
sts was determined by the fact that
iologists in Italy respond to in-hospital
ies as team leaders. At present in Italy,
cases, fac
an ALS cou
12%, local
refresher
The on
anaesthes
private pr
uating the
lated eme
scenario,
result. Par
formance
training c
30% of cas
interval b
cases whe
years befo
Our res
a 64% satis
ALS traini
The nee
ever, has
Council a
Council at
Our res
ment of
ing the in
already reF. Semeraro et al.
ng is spreading but is not mandatory for
ts nor for trainees.
evious study reported a 79% rate of sat-
performance in a group of 24 anaes-
f varying experience, although only five
tly participated in an ALS training course,
rs attribute the unusually high perfor-
the daily use of skills involved in resusci-
regular update of resuscitation skills.25
ding was not confirmed in one other con-
study, involving 30 trainee anaesthesi-
f different experience without previous
ALS, where only 30% were found com-
either seniority nor postgraduate qualifi-
related with performance.26
her study among the same specialists,
residents and 7 interns were tested, only
ered the test correctly and 13% were
mpetent at practical skills. This poor
ce, compared to the other studies, was
by drawing attention to the lack in Euro-
land of the strong ALS training tradition
English speaking countries.31
lination/interest of consultant anaesthe-
in ALS training, was analysed in the UK by
aire and showed that consultant anaes-
sts do not undertake resuscitation regu-
do not teach on ALS courses. In 42% of
tors that may persuade them to attend
rse are identified (compulsory 13%, time
provisions 14%, etc.) but a short in-house
course would be preferred overall.32
ly report where ALS retention among 30
iologists (10 residents, 10 faculty and 10
actice) has been analyzed, is a study eval-
management as team leaders in simu-
rgency cases, including a cardiac arrest
and reporting retention as a secondary
ticipants provided a 70% satisfactory per-
when they had participated in an ALS
ourse in during the previous 6 months, in
es when ALS training had occurred at an
etween 6 months and 2 years and 0% of
n ALS training had occurred more than 2
re.27
ults fully agree with this report, showing
factory skill performance, 6 months after
ng.
d for retraining and recertification, how-
been set by the European Resuscitation
t 4 years, and by the UK Resuscitation
3 years.
ults support the need for skill reinforce-
anaesthesiologists every 6 months dur-
terval between ALS re-certification, as
ported for other professionals.

Retention
The co
and reside
the interp
retained t
be easily
rience an
have dete
mation pr
ble psycho
groups, w
categories
plex and
mance of
with time
backgroun
ALS cours
may be e
skill exec
Although
course wa
a recent
tants tow
explaining
Limitati
There are
limitation
edge at
from the
acknowled
A prima
was not e
mance as
the role o
Although
are impor
was desig
support kn
Anothe
ing and tr
ing group
guarantee
directors,
limitation
teaching/
time fram
and the co
An add
inter-asse
Neverth
the same
the ALS co
The va
uation is
que
CPR
onc
f an
ifica
opt
al,
. AL
ator
st e
ipat
ical
effe
nce
cco
man
ict
ow
uth
thetof CPR performance in anaesthetists
mparison of results between consultants
nts results may provide further clues to
retation of our findings. The consultants
heoretical knowledge better and this may
explained by the greater clinical expe-
d richer cultural background, which may
rmined a better integration of the infor-
ovided by the ALS course. The compara-
motor skills retention between the two
hich compares to that reported for all
of professionals, suggest that the com-
integrated skills required for the perfor-
a simulated resuscitation scenario decay
and this occurs without relation to the
d experience of the participant in the
e. The quicker performance by residents
xplained by faster reaction times and
ution related to age or to motivation.
the participation of consultants in the
s lively and the course was well received,
report describes the attitude of consul-
ards the ALS course as critical, possibly
the slower performance.32
ons of the study
several limitations to our study, besides
the se
major
In c
tion o
a sign
Since
surviv
drawn
mand
at lea
partic
period
most
forma
into a
perfor
Confl
None.
Ackn
The a
anaesof assessment of theoretical knowl-
6 months post-ALS by a test different
one used at the end of training already
ged.
ry limitation was that BLS skills retention
valuated, since ALS evaluates the perfor-
team leader, with two instructors playing
f team members and providing basic CPR.
evidence is accumulating that BLS skills
tant determinants of outcome, this study
ned to assess retention of advanced life
owledge and skills.
r limitation of our study was that teach-
aining was provided by the same train-
. The quality of teaching, however, was
d by the external ERC certified course
who were different at each course. This
also represents an advantage, because
training was reproducible given the short
e in which the courses were performed
nsistency of the instructors involved.
itional limitation of the study was that
ssor variability was not tested.
eless, all evaluations were performed by
five senior instructors both at the end of
urse and at 6 months.
lidity of the 6 months retention eval-
further supported by the recording of
of Univers
ticipation
The au
siastic col
group: Cla
Latini, Ca
Petrolati.
Referen
1. Casey W
standard
1984;77:
2. Skinner
tation s
1985;290
3. Lum ME,
graduate
4. Lowenst
DM, Scog
and surg
5. Royal C
tion. Res
Physician
6. Kaye W
the Uni
1998;37:
7. Guidelin
thetic pr
Anaesthe107
nce of interventions and intervals to the
manoeuvers.
lusion, 6 months after successful comple-
ALS course, anaesthesiologists showed
nt clear-cut decay in skill performance.
imal resuscitation performance affects
some relevant implications should be
S training for anaesthesiologists should be
y and re-certification should be required
very 3—4 years for all professionals who
e in ALS responding teams, interposing
refresher sessions, every 6 months. The
ctive means for reinforcing skill per-
deserves further investigation, taking
unt the role of human factors in CPR
ce.33
of interest statement
ledgments
ors are grateful to S. Camillo Hospital
ic consultants and anaesthesia residents
ity of Rome ‘‘La Sapienza’’ for their par-
in the study.
thors wish to specially thank the enthu-
laboration of the S. Camillo ALS training
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