For the important outcome of skill performance at 1 year, we identified low-quality evidence (downgraded for very serious risk of bias) from 1 RCT enrolling a total of 86 participants showing no benefit for high-fidelity training compared with low-fidelity training (standardized mean difference [SMD], 0; 95% CI, −0.42 to 0.42).(Bellomo 2011, R90)
For the important outcome of skill performance between course conclusion and 1 year, we identified very-low-quality evidence (downgraded for risk of bias and imprecision) from 1 RCT enrolling a total of 47 participants showing no benefit for high-fidelity training compared with low-fidelity training (SMD, 0.08; 95% CI, −0.49 to 0.65).(Settles 2011, 271)
For the important outcome of skill performance at course conclusion, we identified very-low-quality evidence (downgraded for risk of bias, inconsistency and imprecision) from 12 RCTs, enrolling a total of 726 participants showing a moderate benefit for high-fidelity training compared with low-fidelity training (SMD, 0.60; 95% CI, 0.17–1.03).(Owen 2006, 204; Cherry 2007, 229; Donoghue 2009, 139; Hoadley 2009, 91; Thomas 2010, 539; Bellomo 2011, R90; Settles 2011, 271; Coolen 2012, 709569; Finan 2012, 287; Cheng 2013, e1-e2; Conlon 2014, 135; Curran 2015, 205) This was supported by very-low-quality evidence (downgraded for inconsistency and imprecision) from 1 non-RCT enrolling a total of 34 participants, which trended in the same direction (SMD, 0.50; 95% CI, −0.19 to 1.18).(Rodgers 2009, 200)
For the important outcome of knowledge at course conclusion, we identified low-quality evidence (downgraded for risk of bias and imprecision) from 8 RCTs enrolling a total of 773 participants showing no benefit for high-fidelity training compared with low-fidelity training (SMD, 0.15; 95% CI, −0.05 to 0.34).(Owen 2006, 204; Cherry 2007, 229; Campbell 2009, 19; Hoadley 2009, 91; King 2011, 62; Settles 2011, 271; Cheng 2013, e1; Conlon 2014, 135) This was supported by very-low-quality evidence (downgraded for inconsistency and imprecision) from 1 non-RCT enrolling a total of 34 participants showing no benefit for high-fidelity training (SMD, 0.26; 95% CI, −0.42 to 0.93).(Rodgers 2009, 200) |
We suggest the use of high-fidelity manikins when training centers/organizations have the infrastructure, trained personnel, and resources to maintain the program (weak recommendations based on very-low-quality evidence).
If high-fidelity manikins are not available, we suggest that the use of low-fidelity manikins is acceptable for standard ALS training in an educational setting (weak recommendations based on low-quality evidence).
Values, Preferences, and Task Force Insights
In making these recommendations, we took into account the well-documented, self-reported participant preference for high-fidelity manikins (versus low-fidelity manikins) and the likely impact of this preference on willingness to train.(Mancini 2010, S539) We considered the positive impact of skill acquisition at course completion, as well as the lack of evidence of sustained impact on the learner. We also considered the relative costs of high- versus low-fidelity manikins.
High-fidelity manikins can provide physical findings, display vital signs, physiologically respond to interventions (via computer interface), and enable procedures to be performed on them (eg, bag-mask ventilation, intubation, intravenous cannulation).(Cheng 2014, e1313) When considering physical realism, these high-fidelity manikins are more expensive but are increasingly more popular with candidates and faculty.
Determining the treatment recommendation for this PICO question was challenging because of the marginal benefits for the intervention. In reviewing the science, it was clear that there was a benefit to high-fidelity manikins but less clear whether the incremental costs justified the added expenses. |
