["Kids Save Lives"-resuscitation training for schoolchildren : Systematic review]

Comparison of blended e-learning and face-to-face-only education for resuscitation training in German schools - A cluster randomized-controlled prospective study

Background & Objectives

Cardiopulmonary resuscitation (CPR) is the key for surviving cardiac arrest. Recent recommendations propose that CPR can - and should -be taught to schoolchildren. This e-learning-based study analyzes whether face-to-face CPR training can be partly substituted with e-learning by measuring CPR knowledge and self-efficacy in trainees.

Methods

In this cluster randomized-controlled prospective, students attending grades 5 to 7 of a German secondary school volunteered to participate and were randomly assigned to one of two groups with different methods for CPR training each: a traditional instructor-led group (control) where students received face-to-face teaching by a BLS instructor (45 min), and an e-learning group (intervention) where schoolchildren were able to accomplish their theoretical CPR training using an e-learning module (15 min). CPR knowledge and self-efficacy were measured and compared before (t0) and after (t1) the training using questionnaires. Face-to-face CPR training (45 min) on manikins proceeded in both groups hereafter. The formal hypothesis was that e-learning would result in better CPR knowledge.

Results

Overall, 375 students participated; 33 of which had to be excluded. 342 participants were included in statistical analysis (instructor-led group n = 109; e-learning group n = 233). The study was terminated early due to the Covid19 pandemic, and did not reach the required number of participants. Lacking statistical power, an analysis of the existing datasets failed to show superiority of e-learning vs. conventional training for CPR knowledge (p = 0.306). Both groups improved CPR knowledge (p < 0.001) and self-efficacy (p < 0.001) after CPR training and showed an equal, high level of satisfaction with their perceived training method (face-to-face: 4.1[4.0-4.2] vs. e-learning: 4.0[3.9-4.1]; p = 0.153; maximum 5 points).

Conclusions

This study failed to demonstrate superiority for e-learning but was terminated early and hence underpowered. Further research is necessary to prove the efficiency of e-learning tools for CPR.

Facilitators and Barriers Perceived by German Teachers Considering Basic Life Support Education in School-A Qualitative Study

This qualitative study aims to analyse the personal qualification, attitudes and the pedagogical concepts of German teachers as experts in their profession regarding basic life support (BLS) education in secondary schools. Thirteen (n = 13) secondary school teachers participated in semi-structured expert interviews and were interviewed for at least 20 to 60 min regarding BLS student education. Interviews were semi-structured with guiding questions addressing (1) personal experience, (2) teacher qualification for BLS and (3) implementation factors (e.g., personal, material and organisational). Audio-recorded interviews were analysed by content analysis, generating a coding system. School teachers provided a heterogeneous view on implementation-related processes in BLS education. Many teachers were educated in first aid, acknowledge its importance, but had no experience in teaching BLS. They want to assure being competent for teaching BLS and need tailored trainings, materials, pedagogical information and the incorporation into the curriculum. Also, the management of time constraints, unwilling colleagues, or young students being overwhelmed were commonly mentioned considerations. Concluding, teachers reported to be willing to teach BLS but a stepwise implementation framework incorporating practice-oriented qualification and educational goals is missing.

Teaching Cardiopulmonary Resuscitation to Later Elementary School Students

STUDY OBJECTIVE

Bystander cardiopulmonary resuscitation (CPR) rates remain low in the United States. Training children is a proposed method to increase this rate, but data on the compression efficacy of US elementary school-aged children are scarce. We hypothesized that fourth and fifth graders could learn how to respond to cardiac arrests and provide effective chest compressions.

METHODS

We conducted a nonrandomized before-and-after study with fourth- and fifth-grade elementary students. Two 2-hour CPR educational sessions were held. Two weeks later, skills were assessed using a de novo checklist, and manikin-analyzed compression effectiveness (dichotomized at 50% efficacy) was analyzed using Chi-squared tests. We used paired t tests to evaluate knowledge change on identical pre- and post-tests. Secondary analysis evaluated associations between compression effectiveness and grade, age, sex, and body mass index (BMI) using Chi-squared tests.

RESULTS

Three hundred fifty-six students completed the study. The mean change in test scores measuring CPR knowledge increased from 8.2 to 9.3 (1.1, 95% confidence interval [CI] 0.9 to 1.2). Self-reported adequate CPR knowledge increased from 44% to 97% (odds ratio [OR] 44.17, 95% CI 12.62 to 154.62). Seventy-two percent of students completed >7/11 predefined resuscitation steps, and 76% delivered ≥50% effective compressions. Grade was significantly associated with achieving ≥50% effective compression (OR 2.02, 95% CI, 1.19 to 3.43). Age, BMI, and sex were not significantly associated with greater compression efficacy.

CONCLUSION

Most students were able to learn hands-only CPR, apply their knowledge during a simulated cardiac arrest scenario, and deliver effective chest compressions. Students' confidence and willingness to perform CPR increased after the intervention.

Improving survival after cardiac arrest in Europe: The synergetic effect of rescue chain strategies

Sudden cardiac arrest is a global problem and is considered the third leading cause of death in industrialized countries. Patient survival rates after out-of-hospital cardiac arrest (OHCA) vary significantly between countries and continents. In particular, the 2021 European Resuscitation Council (ERC) Resuscitation Guidelines place a special focus on the chain of survival of patients after OHCA. As a complex, interconnected approach, the focus is on: Raising awareness for cardiac arrest and lay resuscitation, school children's education in resuscitation "KIDS SAVE LIVES", first responder systems - technologies to engage the community, telephone-assisted resuscitation (telephone-CPR; T-CPR) by dispatchers, and cardiac arrest centers (CAC) for further treatment in specialized hospitals. The Systems Saving Lives approach is a comprehensive strategy that emphasizes the interconnectedness of all links in the chain of survival following an OHCA, with a particular focus on the relationship between the community and emergency medical services (EMS). This system-level approach emphasizes the importance of the connection between all those involved in the chain of survival. It has a high potential to improve overall survival after OHCA. Therefore, it is recommended that these strategies be promoted and expanded in all countries.

Education of schoolchildren in cardiopulmonary resuscitation - overview of the current literature

PURPOSE OF REVIEW

Recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) can be learned and adequately replicated by schoolchildren. Regular instruction of schoolchildren in CPR is therefore a core element to increase low bystander CPR rates. Thereby, schoolchildren CPR training evolved as own scientific field within the last decade. Aim was to describe current evidence in terms of epidemiology, teaching approaches and political aspects.

RECENT FINDINGS

Schoolchildren demonstrate a high motivation to be trained in CPR. Teaching approaches that combine theoretical and practical learning sessions guarantee a sustainable learning effect. Schoolchildren can adequately perform chest compressions and mouth-to-mouth ventilation from the age of 12 years. Use of digital media is a highly promising teaching approach. CPR training conducted by teachers from the own school is effective and guarantees continuous development of CPR skills. Integration of schoolchildren CPR training into school curricula is the foundation for a sustainable increase of lay resuscitation rates in the population. Scientific and political promotion of schoolchildren CPR training is needed to sensitize the population and move bystander CPR in the social focus.

SUMMARY

While bystander CPR rates are low in Europe comprehensive establishment of schoolchildren CPR training may sustainably increase survival after cardiac arrest.

A narrative review of European public awareness initiatives for cardiac arrest

A high resuscitation rate can lead to better overall survival after cardiac arrest. In Europe, various campaigns in the field of lay resuscitation are achieving up to a threefold increase in survival. As part of the new Systems Saving Lives (SSL) chapter, the European Resuscitation Council (ERC) guidelines recommend cardiac awareness campaigns to engage the broader community. It has been noted that countries with high survival rates after an out-of-hospital cardiac arrest (OHCA) start education in resuscitation techniques at school age. The ERC 2021 guidelines recommend that all schoolchildren should routinely receive CPR training each year. Since 2015, the KIDS SAVE LIVES statement recommended for two hours of instruction per year in all schools worldwide by age of 12. Cardiac awareness campaigns like World Restart a Heart Day (WRAH) are aimed to raise awareness about resuscitation and to train as many people as possible.

Temporarily Removed

BACKGROUND

Basic life support education for schoolchildren has become a key initiative to increase bystander cardiopulmonary resuscitation rates. Our objective was to review the existing literature on teaching schoolchildren basic life support to identify the best practices to provide basic life support training in schoolchildren.

METHODS

After topics and subgroups were defined, a comprehensive literature search was conducted. Systematic reviews and controlled and uncontrolled prospective and retrospective studies containing data on students <20 years of age were included.

RESULTS

Schoolchildren are highly motivated to learn basic life support. The CHECK-CALL-COMPRESS algorithm is recommended for all schoolchildren. Regular training in basic life support regardless of age consolidates long-term skills. Young children from 4 years of age are able to assess the first links in the chain of survival. By 10 to 12 years of age, effective chest compression depths and ventilation volumes can be achieved on training manikins. A combination of theoretical and practical training is recommended. Schoolteachers serve as effective basic life support instructors. Schoolchildren also serve as multipliers by passing on basic life support skills to others. The use of age-appropriate social media tools for teaching is a promising approach for schoolchildren of all ages.

CONCLUSIONS

Schoolchildren basic life support training has the potential to educate whole generations to respond to cardiac arrest and to increase survival after out-of-hospital cardiac arrest. Comprehensive legislation, curricula, and scientific assessment are crucial to further develop the education of schoolchildren in basic life support.

[The new 2021 resuscitation guidelines and the importance of lay resuscitation]

Lay resuscitation is one of the most important measures to increase the survival rate of patients after out-of-hospital cardiac arrest. While European countries, and especially Scandinavian countries, achieve lay resuscitation rates of over 80%, the rate in Germany is only around 40%. The 2021 Resuscitation Guidelines updated by the European Resuscitation Council give special weight to Systems Saving Lives and focus on resuscitation by laypersons. The Systems Saving Lives emphasize the interplay between all actors involved in the chain of survival and thereby specify the link between the emergency service and the general population.Based on the BIG FIVE survival strategies after cardiac arrest, five key strategies are outlined that can achieve the greatest improvement in survival. These are (1) increasing lay resuscitation rates through campaigns and KIDS SAVE LIVES school-based resuscitation training, (2) implementing telephone resuscitation in dispatch centers, (3) first responder systems, (4) advanced life support, and (5) specialized cardiac arrest centers.

Der aktuelle Umsetzungsstand von Wiederbelebungsunterricht in Schulen in Deutschland – Umfrageergebnisse einer Abfrage der Ministerien aller Bundesländer

Im April 2019 stellte der Bundesgerichtshof in einem Urteil (III ZR 35/18) klar, dass Lehrkräften die Pflicht zur Ersten Hilfe im Sportunterricht obliegt. Schon 2014 hatte der Schulausschuss der Kulturministerkonferenz den Bundesländern empfohlen, Wiederbelebungsunterricht in den Schulunterricht zu implementieren und dafür Lehrkräfte auszubilden. In einer Umfrage wurden jetzt die zuständigen Ministerien aller Bundesländer vom Deutschen Rat für Wiederbelebung (German Resuscitation Council, GRC), gebeten, ihren diesbezüglichen Projektstand mitzuteilen. Nur 2 der 16 Bundesländer (Baden-Württemberg und Mecklenburg-Vorpommern) meldeten hierbei eine weitgehende Flächendeckung. In 75 % der Fälle führen Lehrerinnen und Lehrer den Wiederbelebungsunterricht durch. Jeweils zur Hälfte wurden hierbei größere professionelle Wiederbelebungspuppen und einfache Wiederbelebungspuppen benutzt, die speziell für den Schulunterricht konzipiert wurden. Die Lehrkräfte wurden in der Ausbildung von Ärztinnen und Ärzten, Hilfsorganisationen und Rettungsdienstpersonal ausgebildet, das teilweise auch selbst Unterrichtseinheiten übernahm. Im Ergebnis befinden sich 6 Jahre nach der Publikation der Empfehlungen der Kultusministerkonferenz zum Wiederbelebungsunterricht an deutschen Schulen fast alle Bundesländer noch in der Aufbauphase. Es muss daher nachdrücklich auf eine zeitnahe Umsetzung der Empfehlung zur Implementierung von Wiederbelebungsunterricht bei Schulen und Kultusministerien hingewirkt werden, um so die Überlebensrate nach einem Herz-Kreislauf-Stillstand auch in Deutschland deutlich zu verbessern. Ziel ist es, dass alle Schulen bundesweit Wiederbelebungsunterricht durchführen und Lehrkräfte entsprechend qualifiziert werden.

Addressing the Helper's and Victim's Gender Is Crucial in Schoolchildren Resuscitation Training-A Prospective, Educative Interventional Trial

Background: A victim’s gender is a known factor that influences the willingness of adult bystanders to perform cardiopulmonary resuscitation (CPR) if an out-of-hospital cardiac arrest (OHCA) occurs. This study aims to identify whether gender characteristics of OHCA victims are also relevant to schoolchildren, who are the key target group of CPR trainings worldwide. Methods: A prospective, educative intervention study was performed in schoolchildren (5th−7th grade). Schoolchildren’s willingness to perform CPR was assessed by means of questionnaires before (t0) and after (t1) standardized CPR training. Participants were asked how determined they were to perform CPR in male and female OHCA victims on a 5-point Likert scale (not being determined to being very determined). A data analysis was performed according to the gender characteristics of schoolchildren. Results: Overall, 342 schoolchildren aged 10−15 years were included, and 166 male (MG) and 176 female (FG) schoolchildren served as a comparison group. Before (t0) and after (t1) the intervention, females showed a significantly higher general willingness to perform CPR than males (t0: 97.1% vs. 89.0%; p < 0.003 and t1: 95.7% vs. 98.9%; p = 0.038). The general willingness to perform CPR after training had a stronger increase in males (8.0% vs. 2.3%; p = 0.017). In the case that the OHCA victim was female, male schoolchildren were less willing to perform CPR than females at baseline (MG: n = 101;60.8% vs. FG: n = 147;84.5%; p < 0.001) and after training (MG: n = 97;58.4% vs. FG: n = 138;79.3%; p < 0.001). At t1, CPR willingness for female victims was improved in males (MG: n = 36;21.7% vs. FG: n = 19;10.9%; p = 0.006). Conclusions: The gender characteristics of OHCA victims, as well as schoolchildren themselves, have a relevant impact on the willingness to perform CPR. Training concepts should effectively motivate male schoolchildren to reduce preexisting inhibitions, especially towards female OHCA patients. Trial registration: This study was registered at the German Clinical Trials Register (Registration number: DRKS00017707) on 2 August 2019.

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

Retention of Knowledge and Skills After a Basic Life Support Course for Schoolchildren: A Prospective Study

Courses on basic life support (BLS) and automated external defibrillator (AED) in schools lead to increase in knowledge but its retention is less well explored. We aimed to explore the long-term retention of knowledge and practical skills among schoolchildren after a BLS and AED course to be able to tailor future courses accordingly. Study was conducted in 3 parts and included 823 seventh and ninth graders from different elementary schools in Maribor, Slovenia. In Study 1 (n=611) we assessed students' baseline knowledge and immediate knowledge gain after our BLS and AED course with a validated questionnaire; in Study 2 (n=116) we assessed retention of gained knowledge and skills after 5 months with a modified Cardiff test and Little Anne QCPR manikin; in Study 3 (n=96) we assessed retention of knowledge 2 years after the course. Mean differences in knowledge before and after the course in Study 1 and between studies were analyzed using paired t-tests and independent t-tests. Differences between individual question scores at different time points were compared using Mann – Whitney U test. A two-sided P<0,05 was considered significant. Practical skills retention was presented with descriptive statistics. Knowledge gain was significant immediately after the course with 83% correct answers compared to 60% at baseline. Scores dropped significantly after 5 months (73%) and after 2 years (75%), but remained significantly better than at baseline (P<0.001). Practical skills perfomance score as per Cardiff test after 5 months was 63%. Overall BLS performance score as per QCPR app was 59%, with an overall cardio score of 77% (average compression rate: 124/min and depth: 52 mm) and ventilation score of 44%. This study showed that long term retention of theoretical knowledge was satisfying whereas poor practical skills performance after 5 months calls for a more intense practical training on repeat courses.

Facilitators and barriers for the implementation of resuscitation training programmes for schoolchildren: A systematic review

BACKGROUND

Training schoolchildren in resuscitation seems to improve rates of resuscitation by bystanders. Leading medical societies recommend comprehensive resuscitation education in schools. To date, no widespread implementation within the European Union has happened.

OBJECTIVE

The study aim was to identify facilitators and barriers for the implementation of cardiopulmonary resuscitation training for schoolchildren within the European Union.

DESIGN

Systematic review.

DATA SOURCES

A literature search in PubMed was conducted between 1 January 1999 and 30 June 2020 in accordance with the PRISMA statement. The search terms 'resuscitation', 'children' and 'Europe' were combined with the Boolean Operator 'AND' and 'OR'. Medical subject heading terms were used in order to include relevant articles.

ELIGIBILITY CRITERIA

Articles were included if cardiopulmonary resuscitation training specifically tailored for schoolchildren aged 12 to 18 years was considered in countries of the European Union. Articles that fulfilled the following criteria were excluded: duplicates, training methods only for specific patient groups, articles not accessible in the English language, and articles that did not include original data. Findings were structured by an evidence-based six-level approach to examine barriers and facilitators in healthcare.

RESULTS

Thirty out of 2005 articles were identified. Large variations in cardiopulmonary resuscitation training approaches ranging from conventional to innovative training methods can be observed. Schoolteachers as resuscitation instructors act either as barrier or facilitator depending on their personal attitude and their exposure to training in resuscitation. Cardiopulmonary resuscitation training in schoolchildren is effective. The uncoordinated interplay between the generally motivated schools and the political orientation towards resuscitation training for schoolchildren serve as barrier. The lack of financial support, absent systematic organisation and standardisation of training create major barriers.

CONCLUSION

Training schoolchildren in cardiopulmonary resuscitation is effective. More financial support and political guidance is needed. Until then, local initiatives, motivated teachers, and dedicated principles combined with innovative and low-cost training methods facilitate cardiopulmonary resuscitation training in schools.

KIDS SAVE LIVES: a narrative review of associated scientific production

PURPOSE OF REVIEW

In sudden out-of-hospital cardiac arrest, bystander cardiopulmonary resuscitation (CPR) is one of the most important elements of the chain of survival. Since 2015, international health societies and associations have recognized KIDS SAVE LIVES (KSL) as an essential initiative on CPR principles dissemination among schoolchildren. Children can be potential multipliers of the CPR competencies by teaching families, relatives, and friends. This review aimed to determine the main CPR issues raised in the KSL-associated publications.

RECENT FINDINGS

We found 12 Editorials, 9 Letters, 2 Special Reports, 4 Reviews, 2 Guidelines, 9 Original Articles and 17 Conference Presentations on KSL history, the schoolchildren CPR education, and KSL program implementation in several countries. In nine original studies, the main issues were instructors' and learners' CPR knowledge, skills, and retention, gender and physical aspects affecting CPR performance, types of KSL programs and new technologies to teach CPR.

SUMMARY

The KSL-associated literature is limited to support KSL benefits. However, the KSL could potentially contribute to improve out-of-hospital CPR performed by lay people at earlier age in different countries. Children are an important target group to diffuse CPR principles ('CHECK-CALL-COMPRESS'), as they are curious, motivated and enjoy teaching others.

Die Ausbildung von Lehrerinnen und Lehrern als Multiplikatoren für den Wiederbelebungsunterricht an Schulen

Zielsetzung

Die Einführung des Wiederbelebungsunterrichts an Schulen soll die Reanimationsbereitschaft in der Gesellschaft und das Überleben von Menschen mit einem außerklinischen Herz-Kreislauf-Stillstand nachhaltig verbessern. Ziel der vorliegenden Untersuchung war es zu prüfen, wie Lehrkräfte als qualifizierte Multiplikatoren den Wiederbelebungsunterricht in ihren Schulen eigenständig durchführen.

Methodik

Die Uniklinik Köln qualifizierte in Kooperation mit dem Deutschen Rat für Wiederbelebung e. V. in einem speziell entwickelten Kurs Lehrkräfte von weiterführenden Schulen. Von Juli bis November 2019 erfolgte die Evaluation dieses Lehrermultiplikationskonzepts mittels einer webbasierten Umfrage.

Ergebnisse

An der Befragung nahmen 23 von 26 Schulen teil (88 %). Insgesamt haben 96 % (n = 22) der an der Befragung teilnehmenden Schulen den Wiederbelebungsunterricht eingeführt. Es wurden 229 Lehrkräfte ausgebildet, die in dem 2‑jährigen Beobachtungszeitraum 8612 Schüler trainierten. Im Mittel trainierte eine qualifizierte Lehrkraft in ihrer Schule 38 Schüler in Wiederbelebung. Die Multiplikationsfaktoren (Anzahl der trainierten Schülerinnen und Schüler pro Lehrkraft) waren schulindividuell unterschiedlich (Minimum/Maximum: 10/1747). Die schulintern projektverantwortlichen Lehrkräfte gaben an, sich sehr sicher in der eigenständigen Durchführung des Wiederbelebungsunterrichts zu fühlen.

Zusammenfassung

Speziell qualifizierte Lehrkräfte führen den Wiederbelebungsunterricht an ihren Schulen zuverlässig ein. Um noch mehr Schüler mit dem Wiederbelebungstraining zu erreichen, müssen die Multiplikationsfaktoren durch gezielte Unterstützungsangebote weiter erhöht werden.

[Simulation of video-assisted retrieval of foreign bodies in the airway of children by nonmedical personnel]

BACKGROUND

Complete upper airway obstruction by a foreign body is a dramatic and acute emergency situation, and can result in rapid development of hypoxia, circulatory arrest and death. Special Magill pliers with an adjustable video optical system have been developed for airway inspection to facilitate efforts to remove foreign bodies causing obstruction of the upper airway.

OBJECTIVE

To remove a simulated airway foreign body from a cardiopulmonary resuscitation (CPR) manikin, either with normal Magill pliers or with the newly designed video Magill pliers.

MATERIAL AND METHODS

After a brief introduction, 81 kindergarten teachers, 51 pupils (age 10-14 years) and 52 prospective emergency physicians were asked to remove a 2 × 2 "Lego" brick from the hypopharynx of a CPR manikin using either standard Magill pliers or the newly designed video Magill pliers. The formal hypothesis was that there would be no differences between the methods. Successful removal was defined as when the first removal attempt resulted in the Lego brick passing beyond the teeth of the manikin within 60s.

RESULTS

The use of the video Magill pliers resulted in significantly higher success rates in removal of the simulated foreign airway body within 60 s compared to standard Magill pliers in kindergarten teachers (84% vs. 30%, p < 0.0001), pupils (84% vs. 18%, p < 0.0001) and prospective emergency physicians (92% vs. 40%, p < 0.0001). The time needed for removing the foreign airway body was significantly shorter in groups using the video Magill pliers (kindergarten teachers 29 ± 18s vs. 45 ± 19 s, pupils 29 ± 18s vs. 54 ± 14 s, and prospective emergency physicians 33 ± 18s vs. 45 ± 20 s; p < 0.0001). In an analogue points system (from 1 very simple to 10 extremely complicated), the user friendliness of the video Magill pliers was judged to be significantly higher than the standard Magill pliers (2.8 ± 1.6 vs. 7.8 ± 2.7 kindergarten teachers, 2.0 ± 1.3 vs. 7.2 ± 2.5 pupils and 3.2 ± 2.2 vs. 4.9 ± 3.1 prospective emergency physicians, p < 0.0001). Visibility of the airway foreign body was estimated to be significantly better employing the video Magill pliers compared to the standard Magill pliers (1.9 ± 1.4 vs. 9.8 ± 0.6 kindergarten teachers, pupils 1.3 ± 0.6 vs. 9.2 ± 1.6, prospective emergency physicians 2.3 ± 1.8 vs. 9.1 ± 2.3, p < 0.0001).

CONCLUSION

In this study kindergarten teachers, pupils (aged 10-14 years) and prospective emergency physicians had higher success rates in less time and reported better user friendliness and visibility using video Magill pliers compared to standard Magill pliers for removing a simulated foreign body from a CPR manikin airway.

Basic life support knowledge in Germany and the influences of demographic factors

BACKGROUND

In the developed world, cardiovascular diseases still contribute to mortality and morbidity, leading to significantly increased deaths in recent years. Thus, it is necessary for a layperson to provide the best possible basic life support (BLS) until professional help is available. Since information on current BLS knowledge in Germany is not available, but necessary to be able to make targeted improvements in BLS education, we conducted this study.

METHODS

A cohort survey using convenience sampling (non-probability) method was conducted with questions found in emergency medicine education. People coming to the emergency room of two big university hospitals located in the South (Munich) and western part (Cologne) of Germany were asked to participate in the survey between 2016 and 2017. Primary outcome measures were the proportion of correct answers for each emergency scenario in relationship to age, region, profession and first-aid training.

RESULTS

Altogether 1003 people (504 from Cologne; 499 from Munich) took part in the questionnaire. 54.7% were female and 45.3% were male aging from 19 to 52 with a mean of 37.2 years. Although over 90% had taken part in first aid training, many people were lacking first aid knowledge, with less than 10% choosing the correct frequency for chest compression. Hereby demographic factors had a significant influence (p<0.05) in the given answers (Friedmann-and-Wilcoxon Test).

CONCLUSION

Overall, results of our survey indicate a clear lack of BLS knowledge. With this information, targeted measures for improving BLS knowledge should be conducted. Additionally, further studies on the feasibility and efficiency of teaching methods are needed.

An educational pathway and teaching materials for first aid training of children in sub-Saharan Africa based on the best available evidence

BACKGROUND

First aid training is a cost-effective way to decrease the burden of disease and injury in low- and middle-income countries (LMIC). Since evidence from Western countries has shown that children are able to learn first aid, first aid training of children in LMIC may be a promising way forward. Hence, our project aim was to develop contextualized materials to train sub-Saharan African children in first aid, based on the best available evidence.

METHODS

Systematic literature searches were conducted to identify studies on first aid education to children up to 18 years old (research question one), and studies investigating different teaching approaches (broader than first aid) in LMIC (research question two). A multidisciplinary expert panel translated the evidence to the context of sub-Saharan Africa, and evidence and expert input were used to develop teaching materials.

RESULTS

For question one, we identified 58 studies, measuring the effect of training children in resuscitation, first aid for skin wounds, poisoning etc. For question two, two systematic reviews were included from which we selected 36 studies, revealing the effectiveness of several pedagogical methods, such as problem-solving instruction and small-group instruction. However, the certainty of the evidence was low to very low. Hence expert input was necessary to formulate training objectives and age ranges based on "good practice" whenever the quantity or quality of the evidence was limited. The experts also placed the available evidence against the African context.

CONCLUSIONS

The above approach resulted in an educational pathway (i.e. a scheme with educational goals concerning first aid for different age groups), a list of recommended educational approaches, and first aid teaching materials for children, based on the best available evidence and adapted to the African context.

To strengthen self-confidence as a step in improving prehospital youth laymen basic life support

Background

A rapid emergency care intervention can prevent the cardiac arrest from resulting in death. In order for Cardio Pulmonary Resuscitation (CPR) to have any real significance for the survival of the patient, it requires an educational effort educating the large masses of people of whom the youth is an important part. The aim of this study was to investigate the effect of a two-hour education intervention for youth regarding their self-confidence in performing Adult Basic Life Support (BLS).

Methods

A quantitative approach where data consist of a pre- and post-rating of seven statements by 50 participants during an intervention by means of BLS theoretical and practical education.

Results

The two-hour training resulted in a significant improvement in the participants’ self-confidence in identifying a cardiac arrest (pre 51, post 90), to perform compressions (pre 65, post 91) and ventilations (pre 64, post 86) and use a defibrillator (pre 61, post 81). In addition, to have the self-confidence to be able to perform, and to actually perform, first aid to a person suffering from a traumatic event was significantly improved (pre 54, post 89).

Conclusion

By providing youth with short education sessions in CPR, their self-confidence can be improved. This can lead to an increased will and ability to identify a cardiac arrest and to begin compressions and ventilations. This also includes having the confidence using a defibrillator. Short education sessions in first aid can also lead to increased self-confidence, resulting in young people considering themselves able to perform first aid to a person suffering from a traumatic event. This, in turn, results in young people perceiveing themselves as willing to commence an intervention during a traumatic event. In summary, when the youth believe in their own knowledge, they will dare to intervene.

Self-confidence and level of knowledge after cardiopulmonary resuscitation training in 14 to 18-year-old schoolchildren: A randomised-interventional controlled study in secondary schools in Germany

BACKGROUND

Education of schoolchildren in cardiopulmonary resuscitation (CPR) is a strategic goal for improvement of bystander CPR in society.

OBJECTIVE(S)

The primary objective was to analyse the impact of CPR training on the resuscitation knowledge and self-confidence of secondary schoolchildren. In addition, independent predictors of improved CPR knowledge and self-confidence were investigated.

DESIGN

Randomised-interventional controlled study.

SETTING

Four secondary schools in Germany.

PARTICIPANTS

Four hundred and twenty-four schoolchildren aged from 14 to 18 years were included into the study. Fifty-one percent were female, and 33% had an immigrant background.

INTERVENTION

The intervention group received a 90-min CPR training session, whereas controls had no intervention. Levels of knowledge and self-confidence in initiating CPR were analysed by a study questionnaire before (t0), 90 min after (t1) and 6 months after training (t2).

MAIN OUTCOME MEASURES

Based on the evaluation of study questionnaires, the primary endpoint was to determine the development of resuscitation knowledge and self-confidence in initiating cardiopulmonary resuscitation at survey time-points t0, t1 and t2.

RESULTS

Schoolchildren in the intervention group (n=207) showed a significantly higher level of knowledge (P < 0.001) and self-confidence (P < 0.001) at t1 and t2 compared with controls (n=217). Age was a predictor for long-term self-confidence [odds ratio (OR), 1.20; 95% confidence interval (95% CI), 1.02 to 1.41; P = 0.032]. The long-term benefit in the level of knowledge and self-confidence were significantly higher in native compared with immigrant schoolchildren: (OR, 1.79; 95% CI, 1.14 to 2.82; P = 0.011) and (OR, 1.67; 95% CI, 1.07 to 2.60; P = 0.024), respectively.

CONCLUSION

Guideline compliant (90 min) theoretical and practical CPR training improves the level of knowledge and self-confidence in 14 to 18-year-old schoolchildren. Older schoolchildren are more likely to have increased self-confidence with respect to initiating CPR. Schoolchildren with an immigrant background showed a significantly lower increase in their level of knowledge and self-confidence compared with native children. Adaptation and simplification of teaching materials and further research on educational methods for CPR are urgently needed to enable a sustainable approach to teaching CPR, which also produces a long-lasting effect in the entire population.

Germans learn how to save lives: a nationwide CPR education initiative

Background

Sudden cardiac death is one of the most frequent causes of death in Germany and the third leading cause of death in the industrialized world. Yet, the percentage of people providing first aid in the case of sudden cardiac arrest in Germany is alarmingly low by international comparison. Training Germans or reminding them of the simple but effective steps of resuscitation, so that everybody can save a live in an emergency.

Methods

For the campaign ‘Resuscitation Week’, physicians and paramedics trained passers-by in cardiovascular resuscitation free of charge. Skills were evaluated before and after the instruction by means of a questionnaire.

Results

Three hundred three people aged between 9 and 89 years were trained and evaluated. Forty-nine passers-by had never participated in a resuscitation course, and 46.8% had participated in a course more than 20 years ago. Before the instruction, 41.6% of the passers-by were confident to be capable of resuscitating a person; after the instruction, however, this percentage had risen to 100%!

Conclusions

Saving a life is simple, but one has to know what to do in the case of sudden cardiac arrest. The German population is being gradually trained in resuscitation using campaigns such as ‘Resuscitation Week’ and ‘Kids Save Lives’ to break down barriers in the long term. However, lives are not only saved by training but also by refreshing knowledge and skills; thus, a further effective approach may be training all holders of a driving license in cardiopulmonary resuscitation in intervals of 5 years.

Gender aspects in cardiopulmonary resuscitation by schoolchildren: A systematic review

AIM

Bystander CPR-rates are embarrassingly low in some European countries. To increase bystander CPR-rates, many different approaches are used; one of them is training of schoolchildren in CPR. Multiple authors investigated practical and theoretical CPR performance and demonstrated gender differences related to schoolchildren CPR. The objective was to elaborate gender aspects in practical and theoretical CPR-performance from the current literature to better address female and male students.

METHODS

A systematic search in PubMed-database with different search terms was performed for controlled and uncontrolled prospective investigations. Altogether, n = 2360 articles were identified and checked for aptitude. From n = 97 appropriated articles, n = 24 met the inclusion criteria and were finally included for full review and incorporated in the manuscript.

RESULTS

Female students demonstrated higher motivation to attend CPR-training (p < 0.001), to respond to cardiac arrest (CA) (p < 0.01), scored higher in a CPR-questionnaire (p < 0.025), revealed better remembrance of the national emergency phone-number (p < 0.05) and showed a higher multiplier effect (p < 0.0001). Male students showed higher confidence in CPR-proficiency (p < 0.05), revealed deeper chest compressions (CC) (p < 0.001; p < 0.0015; p < 0.01), a higher CC-fraction (p < 0.01) and a higher arbitrary cardiac output simulated equivalent index (p < 0.05). Male gender could not be detected to be a predictor for higher tidal volume (p = 0.70; p = 0.0212).

CONCLUSION

In context of schoolchildren CPR, gender aspects are underestimated. Female students seem to be more motivated to attend CPR-training, reach more people in the role of a multiplier and need to be individually addressed in intensified practical training. Male students achieve a more sufficient chest compression depth and -fraction and could benefit from individual motivation.