The Role of Simulation in Cardiac Rhythm Identification During Cardiopulmonary Arrest

Abstract

Accurate identification of cardiac rhythm during cardiopulmonary arrest (CPA) is crucial for patient survival. According to American Heart Association guidelines [1–3], early defibrillation is essential for shockable rhythms—ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT)—while early epinephrine administration is required for non-shockable rhythms such as pulseless electrical activity (PEA) and asystole.
This quasi-experimental pretest/posttest study aimed to compare rhythm recognition before and after simulation-based training. Seventy-five incoming pediatric residency physicians participated (final posttest sample: 53). Three rhythm-identification items—sinus bradycardia/PEA, VT, and VF—were evaluated in both assessments.
Training took place within an intensive course on pediatric emergency assessment and initial management. Pretest results showed correct recognition rates of 88% for VF, 84% for PEA, and 73.3% for pulseless VT. Posttest data demonstrated improved discrimination between shockable and non-shockable rhythms, particularly by eliminating confusion between PEA and shockable rhythms. However, persistent errors in rhythm interpretation and a statistically significant decline in VF recognition highlighted important weaknesses.
These findings underscore the need for more comprehensive and targeted training to ensure rapid and appropriate decisions during CPA. Although simulation was beneficial in specific aspects, its overall effectiveness for consolidating precise rhythm identification was limited. Future iterations of the program should incorporate a dedicated rhythm-recognition station and longitudinal reinforcement strategies.