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Randomized Controlled Trial
. 2021 Oct 15;21(1):121.
doi: 10.1186/s12873-021-00509-0.

Adherence to the ABCDE approach in relation to the method of instruction: a randomized controlled simulation study

Marjolein Linders #  1 , Mathijs Binkhorst #  2 , Jos M T Draaisma  1 , Arno F J van Heijst  3 , Marije Hogeveen  3
Affiliations
Randomized Controlled Trial

Adherence to the ABCDE approach in relation to the method of instruction: a randomized controlled simulation study

Marjolein Linders et al. BMC Emerg Med. .

Abstract

Background: The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is widely recommended and taught in many resuscitation courses. This study assessed the adherence to the ABCDE algorithm and whether this was affected by the instruction method used to teach this approach.

Methods: Randomized controlled trial in which simulation was used as investigational method. Between June 2017 and January 2018, neonatal healthcare providers routinely participated in simulated neonatal advanced life support (NALS) scenarios, using a high-fidelity manikin. They were randomly assigned to a video-based instruction (intervention group) or a conventional lecture (control group) as the method of instruction. One blinded researcher evaluated the adherence to the ABCDE approach on video with an assessment tool specifically designed and tested for this study. The primary outcomes were: 1) the overall adherence and 2) the between-group difference in individual adherence to the ABCDE approach, both expressed as a percentage score. Secondary outcomes were: 1) the scores of each profession category (nurses, neonatal ward clinicians, fellows/neonatologists) and 2) the scores for the separate domains (A, B, C, D, and E) of the algorithm.

Results: Seventy-two participants were assessed. Overall mean (SD) percentage score (i.e. overall adherence) was 31.5% (19.0). The video-based instruction group (28 participants) adhered better to the ABCDE approach than the lecture group (44 participants), with mean (SD) scores of 38.8% (18.7) and 27.8% (18.2), respectively (p = 0.026). The difference in adherence between both groups could mainly be attributed to differences in the adherence to domain B (p = 0.023) and C (p = 0.007). Neonatal ward clinicians (39.9% (18.2)) showed better adherence than nurses (25.0% (15.2)), independent of the study group (p = 0.010).

Conclusions: Overall adherence to the ABCDE algorithm was rather low. Video-based instruction resulted in better adherence to the ABCDE approach during NALS training than lecturing.

Trial registration: ISRCTN registry, trial ID ISRCTN95998973 , retrospectively registered on October 13th, 2020.

Keywords: ABCDE approach; Audiovisual aids; Cardiopulmonary resuscitation; Education; Simulation training.

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Conflict of interest statement

MH is course director of the Newborn (Advanced) Life Support course, and JD is course director of the European Paediatric Advanced Life Support course of the Dutch Foundation for the Emergency Medical Care of Children. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of participant inclusion
Fig. 2
Fig. 2
Percentage scores per profession category in both groups
See this image and copyright information in PMC

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