Advanced life support training and assessment: A literature review

Factors associated with willingness to perform basic life support in the community setting in Yogyakarta, Indonesia

BACKGROUND

Cardiac arrest is one of the fatal medical emergencies which need to be treated immediately. Poor survival rates in the community settings are common because of limited and ineffective bystander basic life support (BLS). This study aimed to identify factors that are associated with the willingness to perform BLS in communities in Yogyakarta, Indonesia METHODS: A descriptive study was conducted with a cross-sectional design. Participants (n = 251) were enrolled from the general population consisting of teachers, security personnel, and police officers recruited through cluster random sampling. Data were gathered using both digital or printed questionnaires. Ordinal logistic regression with adjusted odds ratio (AOR) was used to analyze the association between BLS predictors and willingness to perform BLS.

RESULTS

Most participants were willing to perform BLS for all genders (55.55%). The inability to perform BLS and fear of causing harm were the main barriers to performing BLS accounting for 61.35% and 43.82%, respectively. Compared to other independent predictors, ages 40-59 were found to be the highest predictors of willingness to perform BLS (AOR:1.44) followed by experience of seeing real or simulation of the emergency case (AOR:1.38) CONCLUSIONS: More than half of the respondents were eager to perform BLS although some barriers were also found. This study provides some understanding of the predictor factors associated with BLS performance and shows respondents with some training or experience were more likely to perform BLS. The results inform policymakers to develop a strategic plan for increasing willingness to apply BLS in the community. WC:250.

Impact of adult advanced cardiac life support course participation on patient outcomes-A systematic review and meta-analysis

OBJECTIVES

The objective of this study was to evaluate the impact of the prior participation of one or more members of the adult resuscitation team in an accredited advanced life support course on patient outcomes (return of spontaneous circulation, survival to discharge, survival to 30 days, and survival to 1 year).

METHODS

A systematic search of Medline, CINAHL, Embase, ERIC, and Cochrane databases was conducted through 6 March 2018. We included randomised and observational studies in any language. Reviewers independently extracted data on study design and outcomes. The GRADE approach was used to evaluate the overall quality of evidence for each outcome.

RESULTS

Nine hundred and ninety-two articles were identified of which eight observational studies were included. No randomised controlled trials were identified. Meta-analysis showed an association between participation of healthcare personnel in an advanced life support course and return of spontaneous circulation [odds ratio (OR) 1.64; 95% CI 1.12-2.41, risk difference (RD) 0.10 (95% CI 0.03-0.17)]. Life support training showed a significant absolute effect on patient survival to discharge [RD 0.10, 95% CI 0.01-0.18], but non-significant relative effect [OR 2.12; 95% CI 0.98-4.57]. Data from one study showed an association with survival to 30 days [OR 7.15; 95% CI 1.61-31.69, RD 0.18 (95% CI 0.08-0.27)].

CONCLUSION

The inference of this review is that the advanced life support courses have a positive impact upon return of spontaneous circulation and survival to hospital discharge. The data also implies a positive impact upon survival to 30 days of adult cardiac arrest patients.

Development of an instrument for the evaluation of advanced life support performance

BACKGROUND

Assessing advanced life support (ALS) competence requires validated instruments. Existing instruments include aspects of technical skills (TS), non-technical skills (NTS) or both, but one instrument for detailed assessment that suits all resuscitation situations is lacking. This study aimed to develop an instrument for the evaluation of the overall ALS performance of the whole team.

METHODS

This instrument development study had four phases. First, we reviewed literature and resuscitation guidelines to explore items to include in the instrument. Thereafter, we interviewed resuscitation team professionals (n = 66), using the critical incident technique, to determine possible additional aspects associated with the performance of ALS. Second, we developed an instrument based on the findings. Third, we used an expert panel (n = 20) to assess the validity of the developed instrument. Finally, we revised the instrument based on the experts' comments and tested it with six experts who evaluated 22 video recorded resuscitations.

RESULTS

The final version of the developed instrument had 69 items divided into adherence to guidelines (28 items), clinical decision-making (5 items), workload management (12 items), team behaviour (8 items), information management (6 items), patient integrity and consideration of laymen (4 items) and work routines (6 items). The Cronbach's α values were good, and strong correlations between the overall performance and the instrument were observed.

CONCLUSION

The instrument may be useful for detailed assessment of the team's overall performance, but the numerous items make the use demanding. The instrument is still under development, and more research is needed to determine its psychometric properties.

Evaluating team-based inter-professional advanced life support training in intensive care-a prospective observational study

Recent focus on national standards within Australian hospitals has prompted a focus on the training of our staff in advanced life support (ALS). Research in critical care nursing has questioned the traditional annual certification of ALS competence as the best method of delivering this training. Simulation and team-based training may provide better ALS education to intensive care unit (ICU) staff. Our new inter-professional team-based advanced life support program involved ICU staff in a large private metropolitan ICU. A prospective observational study using three standardised questionnaires and two multiple choice questionnaire assessments was conducted. Ninety-nine staff demonstrated a 17.8% (95% confidence interval 4.2-31, P=0.01) increase in overall ICU nursing attendance at training sessions. Questionnaire response rates were 93 (94%), 99 (100%) and 60 (61%) respectively; 51 (52%) staff returned all three. Criteria were assessed by scores from 0 to 10. Nurses reported improved satisfaction with the education program (9.4 to 7.1, P <0.001), as well as improvement in role understanding (8.7 and 9.1 versus 7.9 and 8.2, P <0.001) and confidence (8.4 and 8.8 versus 7.4 and 7.8, P <0.001) during ALS provision (outside ICU and inside ICU) following the course when compared to before the program. Doctors' only statistically significant improvement was in their confidence in ALS provision outside ICU (8.7 versus 8.1, P=0.04). The new program cost approximately an extra $16,500 in nursing salaries. We concluded that team-based, inter-professional ALS training produced statistically significant improvements in nursing attendance, satisfaction with ALS education, confidence and role understanding compared to traditional ALS training.

Assessment of long-term impact of formal certified cardiopulmonary resuscitation training program among nurses

CONTEXT

Cardiopulmonary resuscitation (CPR) and emergency cardiovascular care guidelines are periodically renewed and published by the American Heart Association. Formal training programs are conducted based on these guidelines. Despite widespread training CPR is often poorly performed. Hospital educators spend a significant amount of time and money in training health professionals and maintaining basic life support (BLS) and advanced cardiac life support (ACLS) skills among them. However, very little data are available in the literature highlighting the long-term impact of these training.

AIMS

To evaluate the impact of formal certified CPR training program on the knowledge and skill of CPR among nurses, to identify self-reported outcomes of attempted CPR and training needs of nurses.

SETTING AND DESIGN

Tertiary care hospital, Prospective, repeated-measures design.

SUBJECTS AND METHODS

A series of certified BLS and ACLS training programs were conducted during 2010 and 2011. Written and practical performance tests were done. Final testing was undertaken 3-4 years after training. The sample included all available, willing CPR certified nurses and experience matched CPR noncertified nurses.

STATISTICAL ANALYSIS USED

SPSS for Windows version 21.0.

RESULTS

The majority of the 206 nurses (93 CPR certified and 113 noncertified) were females. There was a statistically significant increase in mean knowledge level and overall performance before and after the formal certified CPR training program (P = 0.000). However, the mean knowledge scores were equivalent among the CPR certified and noncertified nurses, although the certified nurses scored a higher mean score (P = 0.140).

CONCLUSIONS

Formal certified CPR training program increases CPR knowledge and skill. However, significant long-term effects could not be found. There is a need for regular and periodic recertification.

Advanced life support (ALS) instructors experience of ALS education in Western Australia: a qualitative exploratory research study

BACKGROUND

When cardiac arrest occurs, timely competent advanced life support (ALS) interventions by nursing staff can influence patient outcomes. Ongoing ALS education influences maintenance of competency and avoids skill decay.

OBJECTIVES

To explore the methods of ALS education delivery for nurses in the workplace; describe the issues relating to maintaining ALS competency; explore ALS competency decay for nurses and develop recommendations for the provision of continuing ALS education.

DESIGN

A qualitative exploratory design was used to study ALS education provision in the workplace.

PARTICIPANTS

Data were collected from ALS nurse experts in Western Australia by face-to-face and phone interviews.

METHODS

Semi-structured interviews were conducted and organised around a set of predetermined questions.

RESULTS

Two major themes were identified; the first theme Demand and Supply describes the increasing demand for ALS education for nurses and the challenges with providing timely cost effective traditional face-to-face ALS education. The second theme, Choosing The Best Education Options describes new ways to provide ALS education using emerging technologies.

CONCLUSIONS

The study suggested that using e-learning methods would assist with educating the maximum amount of nurses in a timely manner and e-learning and teleconferencing offer opportunities to reach nurses in distant locations. Delivering ALS education more frequently than annually would increase skills maintenance and lessen skill decay. Further research is required to explore which blended e-learning model is best suited to ALS education.