ABSTRACT
Objectives: Simulation sessions were designed and introduced into the Cardiff University Clinical Neurosciences placement for 4th-year medical students. We present our approach to delivering these simulation sessions, student feedback and our recent experience in the context of the COVID19 pandemic. Design: Three emergency clinical neuroscience simulation scenarios were designed, aimed at final phase (Year 4-5) medical students. Subjects: Final phase (Year 4-5) medical students. Methods: The sessions are delivered weekly during the academic year by the Clinical Neurosciences teaching fellows at The University Hospital of Wales, (UHW) to groups of sixeight students. Student pairs work through each scenario in a high-fidelity simulation suite under the guidance of the tutor. Observing students remain engaged through participation as patient relatives or medical colleagues. Upon completion, learners are debriefed using the Pendleton Model for feedback/reflection, and anonymised feedback is then collected. Results: One year of collated feedback revealed that 90% (109/122) of respondents strongly stated that the sessions were enjoyable, achieved the desired learning outcomes, and advanced their clinical knowledge. One hundred percent of respondents (122/122) agreed that the sessions improved their confidence at managing medical emergencies. Due to the COVID19 pandemic, session modifications included: a larger simulation suite to facilitate social distancing;procurement of appropriate personal-protective-equipment, and a reduction in session size, (<6 students) offset by higher session frequency. Conclusions: Simulation sessions provide a safe, structured environment in which learners can gain confidence managing emergencies. Feedback confirms that our sessions achieve these goals for most students. The possibility of further restrictions on students' exposure to patients remains high due to rising medical student numbers and potential COVID19 resurgences. There may thus be a need to expand the volume and scope of these simulations to cover more scenarios and broader learning outcomes, to ensure future students gain necessary skills and confidence to manage neurological emergencies.
ABSTRACT
Background: Current research comparing CPR-associated injuries between those receiving LUCAS device and manual CPR has primarily focused on patients who suffered out-of-hospital cardiac arrest. During the SARS-CoV-2 pandemic, more hospitals leveraged mechanical CPR devices to provide distant yet high quality chest compressions for in-hospital cardiac arrest (IHCA) patients. We sought to investigate autopsy thoracic injury patterns in in-hospital non-traumatic cardiac arrests, comparing traditional manual compressions with the mechanical LUCAS device compressions. Design: Autopsies were screened for a history of in-hospital cardiopulmonary resuscitation in the absence of prior traumatic injuries at a single, large quaternary care center from 1/1/2018 to 06/30/2021. 20 received LUCAS compressions and 40 received manual compressions. Student's T-Tests were used to compare means for continuous variables, while chi-squared and Fischer's exact tests were used for categorical variables. An alpha of 0.05 was chosen as the threshold for statistical significance. Results: A statistically significant decrease in the rate of sternal fractures and rate of multiple sternal fractures during mechanical CPR was found. A statistically significant increase in other soft tissue injuries, such as pleural wall or lung injuries was seen in mechanical CPR cases, while an increased rate of bilateral rib fractures was noted in manual compression cases. Conversely, no difference in the number or laterality of rib fractures were noted. There was no significant difference in age, biological sex, or rate of scoliosis or kyphosis between cohorts. Results are listed in table 1. (Table Presented) Little research has looked at the injury patterns of mechanical CPR in the IHCA patient population. These results point to a potential difference in thoracic injury patterns from manual compressions when compared to LUCAS device compressions. The statistically significant decrease in sternal fractures with mechanical compressions is noteworthy. Conversely, the increase in other soft tissue injury demands further examination. The decrease in bilateral rib fractures with LUCAS use suggests that placement of the device may play a role in the epidemiology of rib injuries, but not in the number of ribs injured. Further research should examine rib injuries in more detail, and quantify additional comorbidities in both survivors and non-survivors of cardiac arrest.