Doctors' life-support skills fade after training

NEW YORK Sun Mar 18, 2012 10:31am EDT

A doctor checks the blood pressure of a patient at the J.W.C.H. safety-net clinic in the center of skid row in downtown Los Angeles July 30, 2007. REUTERS/Lucy Nicholson

A doctor checks the blood pressure of a patient at the J.W.C.H. safety-net clinic in the center of skid row in downtown Los Angeles July 30, 2007.

Credit: Reuters/Lucy Nicholson

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NEW YORK (Reuters Health) - Doctors and nurses are trained in how to save a cardiac arrest victim's life, but those skills can fade quickly if they're not used, a new study shows.

In a review of 11 international studies, researchers found that health providers' skills in advanced life support typically deteriorated six months to a year after training, based on test performance.

That's concerning, since the standard guideline calls for re-training every two years, note the researchers, led by Dr. Matthew Huei-Ming Ma of National Taiwan University Hospital.

Advanced life support refers to the measures doctors and nurses can take when someone is in cardiac arrest, where the heart stops pumping blood to the rest of the body. Cardiac arrest is quickly fatal unless it's treated right away -- though treatment often fails too.

Advanced life support includes the CPR chest compressions that laypeople are familiar with. But professionals can also give medication, clear the airways or use a defibrillator to "shock" the heart back into a normal rhythm.

Many experts have long believed that re-training at two-year intervals is "not optimal," said Dr. Lance Becker, director of the Center for Resuscitation Science at the University of Pennsylvania in Philadelphia.

"For those of us in the field, this isn't a new finding," Becker said of the study, which appears in the journal Resuscitation.

But he added that he was glad to see the research on the question pulled together in a systematic review.

Becker, who is also a spokesman for the American Heart Association (AHA), said that the standard recommendation for re-training remains every two years.

But individual medical centers are taking their own steps, he told Reuters Health.

At the University of Pennsylvania, for example, teams in the intensive care unit (ICU) will take 15 minutes to rehearse incubating a patient, using a mannequin. The center also has drills of sorts, where doctors and nurses will be called into a patient's room for a cardiac arrest, and only discover that it's a mannequin when they arrive.

Then they proceed just as if it's a patient. "So they're practicing in the real environment that we're in," and not a classroom, Becker said.

There are also "rolling refreshers," where a mannequin-toting cart is rolled around the ICU and offered up to anyone who wants to practice their life-support skills.

"There are many places that are looking at this," Becker said. "We're trying to figure out the best ways to train adult learners."

UNEVEN EVIDENCE FOR TWO YEAR INTERVAL

At one time, he noted, doctors and nurses learned life-support skills only in a classroom. Now it's understood that real-life simulations make more sense.

So why do widespread guidelines recommend re-training every two years?

One reason, according to Becker, is that historically the two-year time frame was seen as convenient.

Another, he said, is the lack of good research showing a shorter interval is necessary.

Of the 11 studies in the review, Ma's team judged none to be any better than "fair" quality because of limits in their design.

And many were more than a decade old.

Without evidence from well-designed studies, it's hard to change guidelines, Becker noted.

What's needed, he said, is more research into the best ways to train and retrain people in advanced life support.

SOURCE: bit.ly/FO7vjn Resuscitation, online March 3, 2012.

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