Academic literature on the topic 'Advanced cardiac life support (ACLS) course'

A standardized approach to advanced cardiac life support (ACLS) improves the morbidity and mortality from cardiac arrest. Physicians should receive formal training, certification, and periodic recertification in ACLS. This paper describes the system we have developed to provide all the medical graduates of our university with training and American Heart Association (AHA) certification in ACLS.MethodThe course takes place during the third year of medical school in four afternoons during the students' medical clerkship. The students are required to take this course and are freed from all other commitments during these afternoons. Several weeks before the course, the students are given a brief introductory lecture, registered, and strongly encouraged to read the AHA manual for providers of advanced cardiac life support.

Introduction: Advanced Cardiac Life Support (ACLS) course is one of the mandatory certifications for the majority of medical as well as some nursing professionals. There are, however, multiple variations in its instruction model worldwide. We aim to evaluate the efficacy of traditional ACLS course versus a hybrid ACLS course utilised during the COVID-19 pandemic. Methods: This retrospective study was carried out at SingHealth Duke-NUS Institute of Medical Simulation using course results of participants in the centre’s ACLS course between May to October 2019 for the traditional course were compared with participants attending the hybrid course from February to June 2021. Results: A total of 925 participants were recruited during the study period. Of these, 626 participants were from the traditional group and 299 participants were from the hybrid learning group. There is no statistically significant difference between the two group (χ2=1.02 p = 0.313) in terms of first pass attempts; first pass attempt at MCQ (p=0.805) and first pass attempt at practical stations (p=0.408). However, there was statistically significant difference between the mean difference in results of traditional vs hybrid MCQ score, -0.29 (95% CI: -0.57 to -0.01, p=0.0409). Finally, senior doctors were also found to perform better than junior doctors in both traditional (p=0.0235) and hybrid courses (p=0.0309) at the first pass attempt of ACLS certification. Conclusion: Participants in the hybrid ACLS course demonstrated at least equal overall proficiency in certification of ACLS as compared to the traditional instruction.

ABSTRACT Introduction: The American Heart Association (AHA) revises the Advanced Cardiac Life Support (ACLS) course approximately every 5 years, citing the scientific literature for any changes to content and management recommendations. With ACLS 2005, the AHA also revised the methods used to teach course content. The AHA cited no evidence in making these changes. The ACLS 2005 course, distributed in early 2007, makes greater use of videos to teach students. This prospective study surveyed opinions of both students and instructors in an effort to determine the level of satisfaction with this method of teaching. Methods: During 16 consecutive ACLS courses, all students and instructors were asked to complete a questionnaire. The students provided demographic information, but completed the survey anonymously. Four questions probed the participants' opinions about the effectiveness of videos in learning ACLS skills. Experienced participants were asked to compare the new teaching methods with previous courses. Opinions were compared among several subgroups based on sex, occupation and previous experience. Results: Of the 180 students who participated, 71% felt the videos were unequivocally useful for teaching ACLS skills. Fewer first-time students were unequivocally positive (59%) compared with those who had taken 2 or more previous courses (84%). A small proportion of students (13%) desired more hands-on practice time. Of the 16 instructors who participated, 31% felt that the videos were useful for teaching ACLS skills. No differences were found between doctors and nurses, or between men and women. Conclusion: The use of standardized videos in ACLS courses was felt by the majority of students and a minority of instructors to be unequivocally useful. First-time students had more doubts about the effectiveness of videos.

Background Internet adoption during the past decade has provided opportunities for innovation in advanced cardiac life support (ACLS) training. With pressure on budgets across health care systems, there is a need for more cost-effective solutions. Recently, traditional ACLS training has evolved from passive to active learning technologies. The objective of this study is to compare the cost, cost-savings and return on investment (ROI) of blended ACLS (B-ACLS) and face-to-face ACLS (F-ACLS) in Singapore. Methods: B-ACLS and F-ACLS courses are offered in two training institutes in Singapore. Direct and indirect costs of training were obtained from one of the training providers. ROI was computed using cost-savings over total cost if B-ACLS was used instead of F-ACLS. Results: The estimated annual cost to conduct B-ACLS and F-ACLS were S$43,467 and S$72,793, respectively. Discounted total cost of training over the life of the course (five years) was S$107,960 for B-ACLS and S$280,162 for F-ACLS. Annual productivity loss cost account for 52% and 23% of the costs among the F-ACLS and B-ACLS, respectively. B-ACLS yielded a 160% return on the money invested. There would be 61% savings over the life of the course if B-ACLS were to be used instead of F-ACLS. Conclusion: The B-ACLS course provides significant cost-savings to the provider and a positive ROI. B-ACLS should be more widely adopted as the preferred mode of ACLS training. As a start, physicians looking for reaccreditation of the ACLS training should be encouraged to take B-ACLS instead of F-ACLS.

Abstract We sought to evaluate the impact of Advanced Cardiac Life Support (ACLS) training in the professional career and work environment of physicians who took the course in a single center certified by the American Heart Association (AHA). Of the 4631 students (since 1999 to 2009), 2776 were located, 657 letters were returned, with 388 excluded from the analysis for being returned lacking addressees. The final study population was composed of 269 participants allocated in 3 groups (< 3 years, 3-5 and > 5years). Longer training was associated with older age, male gender, having undergone residency training, private office, greater earnings and longer time since graduation and a lower chance to participate in providing care for a cardiac arrest. Regarding personal change, no modification was detected according to time since taking the course. The only change in the work environment was the purchase of an automated external defibrillator (AED) by those who had taken the course more than 5 years ago. In multivariable analysis, however, the implementation of an AED was not independently associated with this group, which showed a lower chance to take a new ACLS course. ACLS courses should emphasize also how physicians could reinforce the survival chain through environmental changes.

Of the 250 000 patients who undergo major cardiac operations in the United States annually, 0.7% to 2.9% will experience a postoperative cardiac arrest. Although Advanced Cardiac Life Support (ACLS) is the standard approach to management of cardiac arrest in the United States, it has significant limitations in these patients. The European Resuscitation Council (ERC) has endorsed a new guideline specific to resuscitation after cardiac surgery that advises important, evidence-based deviations from ACLS and is under consideration in the United States. The ACLS and ERC recommendations for resuscitation of these patients are contrasted on the basis of the essential components of care. Key to this approach is the rapid elimination of reversible causes of arrest, followed by either defibrillation or pacing (as appropriate) before external cardiac compressions that can damage the sternotomy, cautious use of epinephrine owing to potential rebound hypertension, and prompt resternotomy (within 5 minutes) to promote optimal cerebral perfusion with internal massage, if prior interventions are unsuccessful. These techniques are relatively simple, reproducible, and easily mastered in Cardiac Surgical Unit–Advanced Life Support courses. Resuscitation of patients after heart surgery presents a unique opportunity to achieve high survival rates with key modifications to ACLS that warrant adoption in the United States.

AbstractThe objective of this review is to establish a framework about the educational activities of the Cardiopulmonary Resuscitation (CPR) National Committee of the Saudi Heart Association (SHA) and determine if it has had any effect on the survival rate in daily hospital work. Further, the review puts forward recommendations regarding the key to success for future implementations and improvement in the outcome of heart attacks in the Kingdom of Saudi Arabia (KSA).Cardiopulmonary resuscitation (CPR) was introduced into the Kingdom of Saudi Arabia in the 1980s. The birth of CPR in the Kingdom was conducted by the American Heart Association (AHA) provision of the first instructor course in Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) in the spring of 1984. This educational activity was initiated by the Postgraduate Center of the College of Medicine and currently is a function of the Saudi Heart Association (SHA). The National Heart Center (NHC) continually expands its activities. The number of courses organized, conducted, and reported herein totaled 459 for providers and instructors in BCLS and advanced cardiac life support. This resulted in certification of 916 and 204 instructors in basic and advanced CPR respectively. There were 80 centers established in the Kingdom over the span of 15 years. They all provide BCLS courses; only 13 provide advanced cardiac life support courses. The SHA issued a total of 84,659 certificates.

Aim: The overall aim of this thesis was to undertake and report the findings of a health technology assessment (HTA) on the effectiveness, cost-effectiveness and acceptability of online and LAN-based eLearning, and blended learning, among post-registration healthcare professionals. Methods: This HTA comprised three studies. The first study was a systematic review of 93 randomised controlled trials evaluating the effectiveness of online and LAN-based eLearning on physicians' knowledge, skills, attitude and satisfaction. The second study compared the cost, cost-savings and return on investment between a blended and a face-to-face advanced cardiac life support course for physicians in Singapore. The third study was an online survey that assessed the acceptability of the technology among a sample of optometrists and opticians in Singapore and their scope of practice, primary eye care knowledge, views on extended roles in primary eye care, preferred mode of learning for continuing professional education, and referral behaviour. Results: The systematic review showed that online and LAN-based eLearning or blended learning compared with self-directed or face-to-face learning resulted in higher post-intervention knowledge scores (21 studies; small to large effect size; very poor quality); higher post-intervention skills scores (seven studies; large effect size; low quality); higher attitude scores (one study; very low quality); higher post-intervention satisfaction (four studies; large effect size; low quality); and higher post-intervention practice or behaviour changes (eight studies; large effect size; low quality) among physicians in the intervention groups. Fourteen studies compared eLearning with other forms of eLearning. Among these, four studies reported higher post-intervention knowledge scores (large effect size; very low quality) for participants in the intervention group. Unintended or adverse effects of the intervention were not reported among the included studies. Ninety-three studies (N=16,895) were included of which seventy-six studies compared ODE (including blended) vs self-directed/face-to-face learning. Overall the effect of ODE (including blended) on post-intervention knowledge, skills, attitude, satisfaction, practice or behaviour change and patient outcomes was inconsistent and ranged mostly from no difference between the groups to higher post-intervention score in the intervention group (small to large effect size, very low to low quality evidence). Twenty-one studies reported higher knowledge score (small to large effect size; very low quality) for the intervention while 20 studies reported no difference in knowledge between the groups. Seven studies reported higher skill score in the intervention (large effect size; low quality) while thirteen studies reported no difference in skill score between the groups. One study reported higher attitude score for the intervention (very low quality), while 4 studies reported no difference in attitude score between the groups. Four studies reported higher post-intervention physician satisfaction with the intervention (large effect size; low quality), while six studies reported no difference in satisfaction between the groups. Eight studies reported higher post-intervention practice or behaviour change for the ODE group (small to moderate effect size; low quality) while five studies reported no difference in practice or behaviour change between the groups. One study reported higher improvement in patient outcome, while three others reported no difference in patient outcome between the groups. None of the included studies reported any unintended/adverse effects, cost-effectiveness of the interventions. Although the review only focused on post-registration medical doctors, the technology could be used for the interprofessional education of post-registration medical doctors and other healthcare professionals. Such an initiative would encourage collaborative learning and facilitate task-shifting, which could address the problem of fragmentation in health care. Although eLearning and blended learning technology interventions have been implemented, primary studies have not assessed their cost-effectiveness. Hence, to ascertain the technology’s cost-saving potential, we used a blended advanced cardiac life support (B-ACLS) course as an exemplar and compared its cost to face-to-face advanced life support (F-ACLS) training. The analysis showed that the annual cost of F-ACLS training (USD$72,793) was 1.7 times higher than B-ACLS training (USD$43,467). The discounted total cost of training over the life of the course (5-years) was SGD $107,960 for B-ACLS and S$280,162 for F-ACLS. The cost of productivity loss accounted for 52% and 23% of the costs for F-ACLS and B-ACLS, respectively. B-ACLS yielded a 160% return on the money invested, yielding $1.60 for every dollar spent. There would be a 61% saving for course providers if they delivered a B-ACLS instead of F-ACLS course. The effectiveness component of the HTA showed that online eLearning and blended learning is as effective as traditional learning and has cost-saving potential. We also sought to determine if this technology could be used to train and equip optometrists and opticians in Singapore to take on an extended role in primary care, which would allow some simple primary eye care tasks to be shifted from ophthalmologists to optometrists and ease healthcare access issues at specialist hospital outpatient clinics. The survey of optometrists showed that the current roles of opticians and optometrists in Singapore were limited to diagnostic refraction (92%); colour vision assessment (65%); contact lens fitting and dispensing (62%) amongst others. The average self-rated primary eye care knowledge score was 8.2 ± 1.4; (score range 1-10; 1 = very poor, 10 = excellent). Average self-rated confidence scores for screening for cataract, diabetic retinopathy, chronic glaucoma and age-related macular degeneration were 2.7 ± 1.5; 3.7 ± 1.9; 4.0 ± 1.0 and 2.7 ± 1.5, respectively. Three fourths of the optometrists surveyed felt that they should undertake regular continuing professional education (CPE) to improve their primary eye care knowledge. Blended learning (eLearning and traditional face-to-face lectures) was the most preferred mode (46.8%) for CPE delivery. Conclusions: Overall, the findings from the HTA provide evidence of effectiveness, cost-saving of online eLearning and blended learning for training medical doctors and the acceptance of the technology in a local context to facilitate its wider adoption for training post-registration healthcare professionals’. These research outputs would have direct impact on the adoption of online eLearning, blended learning technologies in universities and educational institutes across the region with consequent impacts on post-registration health professionals’ education and policy. The results of learning will serve as a guide for policy makers to decide on investment in the learning technology and to learn about the associated factors, which would influence its adoption. This thesis resulted in three papers, of which one has been accepted for publication, the two other papers are under review.
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2018

This chapter explores advanced cardiovascular life support (ACLS) after cardiac surgery. In 2009, the European Association of Cardiothoracic Surgeons provided recommendations for the management of post–cardiac surgery arrest, which have since been augmented by publication of consensus guidelines from the European Resuscitation Council in 2015 and the Society of Thoracic Surgeons in 2017. These guidelines are preferred over traditional ACLS guidelines for cardiac arrest resuscitation of post–cardiac surgery patients. Ventricular fibrillation is the cause of 25%–50% of cardiac arrests in post–cardiac surgery patients. Guidelines recommend up to 3 attempted shocks prior to external cardiac massage (ECM) if they can be delivered within 1 minute of arrest. Early defibrillation is often successful in this population and minimizes potential intrathoracic trauma from ECM on a fresh sternotomy. In patients with severe bradycardia or asystole, the epicardial pacer should be set to emergency mode, which provides dual-chamber, asynchronous pacing at 80–100 bpm with maximum atrial and ventricular amperage. Resternotomy within 5 minutes is recommended when resuscitation after cardiac arrest has been unsuccessful or when cardiac arrest from tamponade is highly likely.