Effect of low-dose, high-frequency advanced life support training versus annual full-day training on simulation-based resuscitation performance: a randomized controlled trial

Background Skill decay in advanced life support (ALS) is well documented, yet optimal training frequency remains unclear. This trial compared low-dose, high-frequency ALS training with annual full-day training regarding simulation-based resuscitation performance after one year. Methods In this randomized, controlled, simulation-based trial, 35 emergency medical services (EMS) professionals were allocated to either low-dose, high-frequency ALS training (intervention group, n = 18) or a single annual full-day ALS training (control group, n = 17). Performance was assessed at baseline and after 12 months using a validated 29-item rating instrument covering technical and non-technical skills (NTS), with items rated on a 5-point Likert scale (1 = poor performance, 5 = excellent performance). The primary endpoint was the overall performance score for resuscitation management, defined as the mean across all items. Secondary endpoints included domain-specific performance scores (NTS, defibrillation-related, and cardio-pulmonary resuscitation [CPR] items), calculated as the mean scores for each domain, as well as time to key interventions. Results After 12 months, the intervention group showed significantly higher overall performance scores than the control group (4.7 ± 0.2 vs. 4.2 ± 0.3; p < 0.001). The largest between-group difference was observed for NTS (4.8 ± 0.2 vs. 3.9 ± 0.5; p < 0.001). Scores for defibrillation-related and CPR-related items were also significantly higher in the intervention group. Time to CPR initiation (13 ± 2 s vs. 18 ± 7 s; p = 0.015), rhythm analysis (29 ± 9 s vs. 45 ± 24 s; p = 0.015), supraglottic airway insertion (51 ± 13 s vs. 68 ± 30 s; p = 0.013), as well as hands-off time (4 ± 1 s vs. 6 ± 3 s; p = 0.002) were significantly shorter in the intervention group. The rating instrument demonstrated good reliability (Cronbach’s alpha 0.793; intraclass correlation coefficient 0.794, 95% confidence interval 0.718–0.854). Conclusion Low-dose, high-frequency ALS training resulted in higher simulation-based resuscitation performance scores than annual full-day training, particularly for non-technical skills and time-critical processes. Trial registration The study is registered in the German Register of Clinical Studies under the ID DRKS00024822.