Poor quality teaching in lay person CPR courses

A six-year teaching life supportive first aid program to eventually generate peer trainer pupils: a prospective case control study

BACKGROUND

Out of hospital cardiac arrest is a life-threatening condition. To improve the chances of survival, lay-person cardio-pulmonary-resuscitation (CPR) is a crucial factor. Many bystanders fail to react appropriately, even if life supporting first aid (LSFA) programs and campaigns including CPR tried to increase the handling of basic cardiac life support. To achieve an enhanced learning of CPR a pupil's grade after grade teaching program was established in a school with medical students.

METHODS

The learning of CPR was investigated in a prospective, case-controlled study at an international school. Pupils (12 ± 3 years old) joining our LSFA courses (n = 538, female: 243, attendance for evaluation: 476) were compared to a control group (n = 129, female: 52, attendance for evaluation: 102). Surveys and quality of CPR (QCPR%) through a computer linked "Resusci Anne" dummy were compared with Chi-squared tests, t-tests pair wisely, and by one-way ANOVA.

RESULTS

Knowledge and skills on the "Resusci Anne" were significantly better in trained grade 9 pupils compared to the control group (QCPR, 59 vs. 25%). The number of LSFA courses each grade 9 student had, correlated with improved practical performance (r² = 0.21, p < 0.001). The willingness to deliver CPR to strangers increased with improved practical performance. Attitudes towards performing CPR were high in all participating grades.

CONCLUSION

Repetitive teaching LSFA to grade 5-9 pupil's grade after grade by medical students has been successfully established. Pupils who finish the program will eventually be able to teach LSFA to younger students. This is furthermore a good way of sharing a "learning by teaching" role and it enables to have more pupils as trainers who can provide instruction to a larger number of pupils with the purpose of having a better-trained population in LSFA.

[Education for resuscitation]

Diese Leitlinien des European Resuscitation Council basieren auf dem internationalen wissenschaftlichen Konsens 2020 zur kardiopulmonalen Reanimation mit Behandlungsempfehlungen (International Liaison Committee on Resuscitation 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations [ILCOR] 2020 CoSTR). Dieser Abschnitt bietet Bürgern und Angehörigen der Gesundheitsberufe Anleitungen zum Lehren und Lernen der Kenntnisse, der Fertigkeiten und der Einstellungen zur Reanimation mit dem Ziel, das Überleben von Patienten nach Kreislaufstillstand zu verbessern.

Basic life support skills can be improved among certified basic life support instructors

Background

A correct visual skill demonstration is important when learning cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED). Basic life support (BLS) instructors are expected to master and demonstrate CPR/AED skills correctly. The aim of this study was to evaluate certified BLS instructors’ competencies in demonstrating CPR and the use of an AED.

Methods

Certified BLS instructors demonstrated CPR and the use of an AED on a resuscitation manikin. Skills were evaluated using data collected from the manikin and video recordings and compared to resuscitation guidelines. Further, instructors completed questionnaires on resuscitation guidelines and rating of their own CPR/AED skills.

Results

Overall, we analyzed data from 125 instructors. Of all chest compressions, only 22% were within guideline recommendations regarding depth. Instructors performed chest compressions with excessive depth (mean depth 64 mm (7.3)) and a mean rate of 115 min⁻¹ (10.8). Only 25% of instructors placed the left AED electrode correctly (median distance 7.6 cm (5.0;10.5)), while the right AED electrode usually was placed correctly (median distance 2.9 cm (1.5;4.0), 85% placed correctly). Nearly half of the instructors failed to state correct answers regarding how to diagnose a cardiac arrest and where to place the AED electrodes. Despite their performance, instructors rated their BLS skills as good.

Conclusion

Certified BLS instructors’ have poor CPR/AED skills and several important knowledge gaps on CPR/AED guidelines in contrast to instructors’ self-reported skills. This highlights a need for improving BLS instructor education, including continuous faculty development to ensure optimal learning conditions for BLS course participants.

European Resuscitation Council Guidelines 2021: Education for resuscitation

These European Resuscitation Council education guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidance to citizens and healthcare professionals with regard to teaching and learning the knowledge, skills and attitudes of resuscitation with the ultimate aim of improving patient survival after cardiac arrest.

Factors influencing the willingness to perform bystander cardiopulmonary resuscitation on the workplace: a study from North-Eastern Italy

Background:

Early bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. However, few data are available regarding the willingness to perform CPR among First Aid Attendants on the Workplace (FAAWs) in Italy. The present study was performed in order to identify current attitudes of Italian FAAWs towards CPR.

Methods:

Between February and June 2017, FAAWs from the Autonomous Province of Trento were asked about their willingness to perform CPR through a structured questionnaire assessing their knowledge about CPR, and the reasons for hesitancy. A cumulative knowledge score (KS) was eventually calculated.

Results:

A total of 123 FAAWs (male 57.7%, mean age 45.2 years ± 10.1) completed the questionnaire. About 1/3 of participants (32.5%) had previously performed First Aid procedures. Overall, 77.2% exhibited willingness to perform CPR, and such attitude was more frequently reported by subjects younger than 40 years (29.5% vs. 10.7% in older subjects; p=0.045), perceiving First Aid training as useful (98.9% vs. 84.7%, p=0.002), and exhibiting a better knowledge of CPR (KS≥75%: 47.4% vs. 15.3%). The reasons for the unwillingness were inadequate knowledge and doubt regarding whether they could perform the techniques effectively. Eventually, KS was identified as the main predictor for willingness to perform CPR (OR 4.450, 95%CI 1.442-14.350).

Conclusions:

Willingness to perform CPR was seemingly high, and knowledge of CPR techniques was its main predictor. These findings emphasize the importance for an accurate CPR training, as well as for the surveillance of the quality of qualification courses.(www.actabiomedica.it)

In out-of-hospital cardiac arrest, is the positioning of victims by bystanders adequate for CPR? A cohort study

OBJECTIVES

Outcome from out-of-hospital cardiac arrest (OHCA) highly depends on bystander cardiopulmonary resuscitation (CPR) with high-quality chest compressions (CCs). Precondition is a supine position of the victim on a firm surface. Until now, no study has systematically analysed whether bystanders of OHCA apply appropriate positions to victims and whether the position is associated with a particular outcome.

DESIGN

Prospective observational cohort study.

SETTING

Metropolitan emergency medical services (EMS) serving a population of 400 000; dispatcher-assisted CPR was implemented. We obtained information from the first EMS vehicle arriving on scene and matched this with data from semi-structured interviews with witnesses of the arrest.

PARTICIPANTS

Bystanders of all OHCAs occurring during a 12-month period (July 2006-July 2007). From 201 eligible missions, 200 missions were fully reported by EMS. Data from 138 bystander interviews were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Proportion of positions suitable for effective CCs; related survival with favourable neurological outcome at 3 months.

RESULTS

Positioning of victims at EMS arrival was 'supine on firm surface' in 64 cases (32.0%), 'recovery position (RP)' in 37 cases (18.5%) and other positions unsuitable for CCs in 99 cases (49.5%). Survival with favourable outcome at 3 months was 17.2% when 'supine position' had been applied, 13.5% with 'RP' and 6.1% with 'other positions unsuitable for CCs'; a statistically significant association could not be shown (p=0.740, Fisher's exact test). However, after 'effective CCs' favourable outcome at 3 months was 32.0% compared with 5.3% if no actions were taken. The OR was 5.87 (p=0.02).

CONCLUSION

In OHCA, two-thirds of all victims were found in positions not suitable for effective CCs. This was associated with inferior outcomes. A substantial proportion of the victims was placed in RP. More attention should be paid to the correct positioning of victims in OHCA. This applies to CPR training for laypersons and dispatcher-assisted CPR.

A pilot study of Practice While Watch based 50 min school quality cardiopulmonary resuscitation classroom training: a cluster randomized control trial

Aim

Cardiopulmonary resuscitation (CPR) training in schools can increase the rate of bystander CPR. We assessed whether a "Quality CPR (QCPR) Classroom" can support CPR performance by students trained by a teacher who is not a CPR instructor.

Methods

A cluster randomized trial was undertaken to assess the effectiveness of a 50-min Practice While Watch CPR training program enhanced by QCPR Classroom, which used 42 manikins connected by Bluetooth to real-time feedback monitoring. Fifty-seven students were divided into Group 1, taught by a non-CPR-instructor, and Group 2, taught by a CPR instructor. Psychomotor and cognitive tests were administered before and after training. Primary outcomes were post-training compression depth and rate and percent of improvement in adequate depth, recoil, and overall score. The secondary outcome was risk improvement.

Results

Post-training, Group 1 achieved 62.1 ± 7.7 mm and 118.0 ± 3.6 compressions/min whereas Group 2 achieved 57.4 ± 9.8 mm and 119.8 ± 5.4 compressions/min. The overall score improvement in percentage points was 36.4 ± 25.9% and 27.0 ± 27.7%, respectively (P ≤ 0.001 for both). The adequate depth improvement in percentage points was 22.4 ± 35.4% and 32.5 ± 40.0%, respectively (P = 0.33). Teaching by a non-CPR instructor improved student cognitive knowledge.

Conclusions

Using a QCPR Classroom to enhance CPR teaching by a non-CPR-instructor results in similar or better outcomes compared to using a CPR instructor. Use of a Practice While Watch QCPR Classroom will provide adequate quality in preparing students for CPR.

The changes in cardiopulmonary resuscitation guidelines: from 2000 to the present

This review aims to determine the changes made in the cardiopulmonary resuscitation (CPR) guidelines from 2000 to the present. The study was mainly undertaken by using International Guidelines from American Heart Association. The main change of CPR was chest compression skill. The guidelines have improved high-quality CPR through the change of chest compression skill. The latest adult CPR guidelines are as follows: (a) push chest quickly (100-120/min), (b) compress appropriately (5-6 cm), (c) relax chest fully (complete chest recoil), (d) avoid interruption of compression, and (e) avoid hyperventilation. The understanding of the latest CPR skills will be helpful in improving survival rate from sudden cardiac death.

The effect of automatic external defibrillator with a real-time feedback on quality of bystander cardiopulmonary resuscitation: A before-and-after simulation study

High-quality bystander cardiopulmonary resuscitation (CPR) and early defibrillation in the community are important for survival in out-of hospital-cardiac-arrest, but maintaining the quality of CPR in bystanders is difficult. We aimed to determine the effect of an automated external defibrillator (AED) with real-time feedback on the quality of bystander CPR in a community setting. A before-and-after simulation study was designed. Trainees of basic life support education were recruited for the simulation experiment. Each team consisted of two bystanders with different roles (initial witness and CPR supporter). 82 teams performed simulation scenarios with the real-time feedback function of AED disabled initially, and then repeated it with feedback function enabled. Quality measures of chest compression depth and no-flow fraction were compared between each of the two simulation scenarios. CPR quality data from 82 teams were analysed. The mean percentage of chest compressions with adequate depth was significantly higher in simulations with real-time feedback (78.1% vs. 89.3%, p < 0.01). Similarly, no-flow fractions were lower in simulation scenarios with real-time feedback (32.0% vs. 30.3% p = 0.05). In a subgroup with the lowest percentage of adequate depth performance in the initial simulation without real-time feedback, a mean increase of 47.7% (95% CI 31.3-64.0) in the fraction of chest compressions with adequate depth was seen with real-time feedback. Use of an AED with real-time feedback improves the quality of bystander CPR in a simulated community setting. The positive effect of real-time feedback is greatest among people with a low level of CPR skill.

Effect of real-time visual feedback device 'Quality Cardiopulmonary Resuscitation (QCPR) Classroom' with a metronome sound on layperson CPR training in Japan: a cluster randomized control trial

OBJECTIVES

'Quality Cardiopulmonary Resuscitation (QCPR) Classroom' was recently introduced to provide higher-quality Cardiopulmonary Resuscitation (CPR) training. This study aimed to examine whether novel QCPR Classroom training can lead to higher chest-compression quality than standard CPR training.

DESIGN

A cluster randomised controlled trial was conducted to compare standard CPR training (control) and QCPR Classroom (intervention).

SETTING

Layperson CPR training in Japan.

PARTICIPANTS

Six hundred forty-two people aged over 15 years were recruited from among CPR trainees.

INTERVENTIONS

CPR performance data were registered without feedback on instrumented Little Anne prototypes for 1 min pretraining and post-training. A large classroom was used in which QCPR Classroom participants could see their CPR performance on a big screen at the front; the control group only received instructor's subjective feedback.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes were compression depth (mm), rate (compressions per minute (cpm)), percentage of adequate depth (%) and recoil (%). Survey scores were a secondary outcome. The survey included participants' confidence regarding CPR parameters and ease of understanding instructor feedback.

RESULTS

In total, 259 and 238 people in the control and QCPR Classroom groups, respectively, were eligible for analysis. After training, the mean compression depth and rate were 56.1±9.8 mm and 119.2±7.3 cpm in the control group and 59.5±7.9 mm and 116.8±5.5 cpm in the QCPR Classroom group. The QCPR Classroom group showed significantly more adequate depth than the control group (p=0.001). There were 39.0% (95% CI 33.8 to 44.2; p<0.0001) and 20.0% improvements (95% CI 15.4 to 24.7; P<0.0001) in the QCPR Classroom and control groups, respectively. The difference in adequate recoil between pretraining and post-training was 2.7% (95% CI -1.7 to 7.1; pre 64.2±36.5% vs post 66.9%±34.6%; p=0.23) and 22.6% in the control and QCPR Classroom groups (95% CI 17.8 to 27.3; pre 64.8±37.5% vs post 87.4%±22.9%; p<0.0001), respectively.

CONCLUSIONS

QCPR Classroom helped students achieve high-quality CPR training, especially for proper compression depth and full recoil. For good educational achievement, a novel QCPR Classroom with a metronome sound is recommended.

Chest Compression Depth and Rate - Effect on Instructor Visual Assessment of Chest Compression Quality

BACKGROUND

The aim of the present study was to determine whether instructors could accurately assess chest compression quality visually, considering the association between chest compression depth and rate. Methods and Results: In this prospective, observational study, the quality of chest compressions performed by a simulated actor in a video was visually assessed by certified instructors. The film consisted of 14 case scenarios, each including a combination of depth (2 patterns: adequate, 5-6 cm; and inadequate, <5 cm) and rate (7 categories: compressions 90-150 times/min in increments of 10 times/min). The participants evaluated whether the compression depth was adequate, deep, or inadequate; and whether the compression rate was appropriate, fast, or slow. Of 198 instructors, 56% of participants misidentified adequate depth as deep at a chest compression rate of 120/min (the tendency toward this response increased as chest compression rate increased), and 64.1% of participants incorrectly determined 130/min to be appropriate. On generalized linear mixed-effects model analysis, perceived chest compression depth and rate were significant factors for a correct response (P<0.01, both). A significant interaction between chest compression depth and rate was observed (P<0.01).

CONCLUSIONS

In the visual assessment of chest compression quality, recognition of chest compression depth was closely associated with compression rate. Misidentification of adequate chest compression depth as deep increased as the compression rate increased.

In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM)

By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.

Teaching basic life support with an automated external defibrillator using the two-stage or the four-stage teaching technique

INTRODUCTION

Laypersons often hesitate to perform basic life support (BLS) and use an automated external defibrillator (AED) because of self-perceived lack of knowledge and skills. Training may reduce the barrier to intervene. Reduced training time and costs may allow training of more laypersons. The aim of this study was to compare BLS/AED skills' acquisition and self-evaluated BLS/AED skills after instructor-led training with a two-stage versus a four-stage teaching technique.

METHODS

Laypersons were randomized to either two-stage or four-stage teaching technique courses. Immediately after training, the participants were tested in a simulated cardiac arrest scenario to assess their BLS/AED skills. Skills were assessed using the European Resuscitation Council BLS/AED assessment form. The primary endpoint was passing the test (17 of 17 skills adequately performed). A prespecified noninferiority margin of 20% was used.

RESULTS

The two-stage teaching technique (n=72, pass rate 57%) was noninferior to the four-stage technique (n=70, pass rate 59%), with a difference in pass rates of -2%; 95% confidence interval: -18 to 15%. Neither were there significant differences between the two-stage and four-stage groups in the chest compression rate (114±12 vs. 115±14/min), chest compression depth (47±9 vs. 48±9 mm) and number of sufficient rescue breaths between compression cycles (1.7±0.5 vs. 1.6±0.7). In both groups, all participants believed that their training had improved their skills.

CONCLUSION

Teaching laypersons BLS/AED using the two-stage teaching technique was noninferior to the four-stage teaching technique, although the pass rate was -2% (95% confidence interval: -18 to 15%) lower with the two-stage teaching technique.

Initial neonatal resuscitation: skill retention after the implementation of the novel 24/7 HybridLab® learning system

BACKGROUND

Ensuring long-term retention of the acquired practical skills is one of the major aims of a medical school. This depends on the application of training techniques and their combinations. In order to standardize the teaching process, to acquire and maintain a broad array of technical, professional, and interpersonal skills and competencies, and to improve the retention of practical skills, we developed a new training technique - the HybridLab^® learning method. It consists of an e-learning platform, hands-on simulation, carefully elaborated learning algorithms (DRAKON), peer-to-peer teaching, and assessment and feedback by peers, and later - by a remote instructor. Summary of the work: The subjects of the study were fifth-year students of the Lithuanian University of Health Sciences Medical Academy who during 2014-2015 were studying the obstetrics and gynecology module in the neonatology cycle. We analyzed the retention of practical skills in the initial neonatal resuscitation among students who were training with the use of our developed HybridLab^® technique at 6 and 12 months after the completion of the cycle.

SUMMARY OF RESULTS

After 6 and 12 months, mean changes in the subjects' evaluation scores (percentage drop-off between the first and the second total score) dropped by, respectively, 31.8% (SD: 27.5) and 7.7% (SD: 25.6), and did not differ statistically significantly (p = .2). In the group of subjects who were not given a possibility to remember the skills and the course of initial neonatal resuscitation, the mean change between the first and the second total evaluation scores was 42.5% (SD: 26.7). In students who were given such possibility, the mean change between the first and the second total evaluation scores was significantly smaller -12.7% (SD: 13.8) (p < .001). Changes in the evaluation scores of individual skills (first steps, mouth-to-mouth ventilation, and chest compressions) between the first and the second evaluation also differed statistically significantly and were smaller in the group of students who were given a possibility to remember their skills (p < .001).

DISCUSSION

The HybridLab^® learning method is a novel technique, and thus more studies are required to evaluate the significance of the HybridLab^® technique for long-time retention of practical skills.

CONCLUSION

As a result of the application of the HybridLab^® training technique, practical skill retention among medical students after 6 and 12 months dropped by only about 13%. A recall system significantly improved practical skill retention.

Accuracy of instructor assessment of chest compression quality during simulated resuscitation

Objectives

The 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario.

Methods

This is a prospective observational study in which objective chest compression quality data (rate, depth, and fraction) were collected from the simulation manikin and compared to subjective instructor assessment. Data were collected during weekly simulation training sessions for residents, medical students, and nursing students.

Results

We included data from 24 simulated resuscitation scenarios assessed by 1 of 15 instructors. Subjective assessment of chest compression quality identified an adequate compression rate (100–120 compressions per minute) with a sensitivity of 0.17 (confidence interval [CI] 0.02–0.32) and specificity of 0.06 (CI −0.04–0.15), adequate depth (>50 mm) with a sensitivity of 0 and specificity of 0.38 (CI 0.18–0.57), and adequate fraction (>80%) with a sensitivity of 1 and a specificity of 0.25 (CI 0.08–0.42).

Conclusion

Instructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators.

Are Canadians more willing to provide chest-compression-only cardiopulmonary resuscitation (CPR)?-a nation-wide public survey

BACKGROUND

Bystander cardiopulmonary resuscitation (CPR) improves the likelihood of survival from out-of-hospital cardiac arrest (OHCA), yet it is performed in only 30% of cases. The 2010 guidelines promote chest-compression-only bystander CPR-a change intended to increase willingness to provide CPR.

OBJECTIVES

1) To determine whether the Canadian general public is more willing to perform chest-compression-only CPR compared to traditional CPR; 2) to characterize public knowledge of OHCA; and 3) to identify barriers and facilitators to bystander CPR.

METHODS

A 32-item survey assessing resuscitation knowledge, and willingness to provide CPR were disseminated in five Canadian regions. Descriptive statistics were used to characterize response distribution. Logistic regression analysis was applied to assess shifts in intention to provide CPR.

RESULTS

A total of 428 completed surveys were analysed. When presented with a scenario of being a bystander in an OHCA, a greater proportion of respondents were willing to provide chest-compression-only CPR compared to traditional CPR for all victims (61.5% v. 39.7%, p<0.001), when the victim was a stranger (55.1% v. 38.8%, p<0.001), or when the victim was an unkempt individual (47.9% v. 28.5%, p<0.001). When asked to describe an OHCA, 41.4% said the heart stopped beating, and 20.8% said it was a heart attack. Identified barriers and facilitators included fear of litigation and lack of skill confidence.

CONCLUSIONS

This study identified gaps in knowledge, which may impair the ability of bystanders to act in OHCA. Most respondents expressed greater willingness to provide chest-compression-only CPR, but this was mediated by victim characteristics, skill confidence, and recognition of a cardiac arrest.

[Resuscitation training for lay persons in first aid courses: Transfer of knowledge, skills and attitude]

BACKGROUND

Bystander cardiopulmonary resuscitation (CPR) is the most effective intervention for out of hospital sudden cardiac arrest; therefore, basic life support (BLS) courses for lay persons have become well established in industrialized countries, often since decades. Despite this favorable situation bystander CPR rates still remain low in some countries (e.g. in Germany), indicating serious implementation problems. The quality of instruction in these courses could be one reason for low bystander CPR rates. We therefore analyzed official lay BLS courses in terms of the teaching quality in the domains of knowledge, skills and attitudes (according to Bloom's taxonomy).

MATERIAL AND METHODS

A total of 20 officially accredited lay BLS courses in Berlin, Germany, were analyzed by a participating observer, who remained blinded to the instructor and course participants until the end of the course. Courses were offered by German rescue organizations and private providers according to European Resuscitation Council (ERC) guidelines. Teaching quality was rated by a standardized checklist including 21 observable criteria of teaching quality for transfer of knowledge (n = 10), skills (n = 8) and attitudes (n = 3). In order to achieve comparability between items the results of each criterion were quantified by Likert scales ranging from +2 (very good) to -2 (very poor).

RESULTS

The average score of all courses was +0.47 (SD ±0.46) for transfer of knowledge, +0.03 (SD ±0.61) for skills and -1.08 (SD ±0.73) for attitudes. In the domain of knowledge transfer, learning atmosphere and course structure were rated to be generally good, whilst marked deficits were found with respect to correctness of content. In the domain of skills the more positive ratings were given for teaching of single BLS elements (e.g. compressions and ventilation), in contrast to the training of BLS context, where e.g. realistic scenarios were only used by 3 out of 20 instructors. The domain of attitude transfer had the worst rating. Detailed ratings were -0.90 for "reducing fear of doing harm to the victim", -1.25 for "positive attribution of practical training" and -1.10 for "explaining course relevance from the learners' perspective".

CONCLUSION

Within the observed BLS courses the teaching quality revealed significant deficits, especially for the transfer of positive attitudes to learners. Also, the use of meaningful realistic scenario teaching was very scarce. These findings can significantly contribute to low bystander CPR rates because transfer of learned content into practice may be hampered.

Official lay basic life support courses in Germany: is delivered content up to date with the guidelines? An observational study

BACKGROUND AND OBJECTIVES

Educating the lay public in basic life support (BLS) is a cornerstone to improving bystander cardiopulmonary resuscitation (CPR) rates. In Germany, the official rescue organisations deliver accredited courses based on International Liaison Committee on Resuscitation (ILCOR) guidelines to up to 1 million participants every year. However, it is unknown how these courses are delivered in reality. We hypothesised that delivered content might not follow the proposed curriculum, and miss recent guideline updates.

METHODS

We analysed 20 official lay BLS courses of 240 min (which in Germany are always embedded into either a 1-day or a 2-day first aid course). One expert rated all courses as a participating observer, remaining incognito throughout the course. Teaching times for specific BLS elements were recorded on a standardised checklist. Quality of content was rated by 5-point Likert scales, ranging from -2 (not mentioned) to +2 (well explained).

RESULTS

Median total course time was 101 min (range 48-138) for BLS courses if part of a 1-day first aid course, and 123 min (53-244) if part of a 2-day course. Median teaching time for CPR was 51 min (range 20-70) and 60 min (16-138), respectively. Teaching times for recovery position were 44 min (range 24-66) and 55 min (24-114). Quality of content was rated worst for 'agonal gasping' (-1.35) and 'minimising chest compression interruptions' (-1.70).

CONCLUSIONS

Observed lay BLS courses lasted only half of the assigned curricular time. Substantial teaching time was spent on non-evidence-based interventions (eg, recovery position), and several important elements of BLS were not included. The findings call for curriculum revision, improved instructor training and systematic quality management.

Knowledge about basic life support in European students

Introduction: Better knowledge and skills of basic life support can save millions of lives each year in Europe. Aim: The aim of this study was to measure the knowledge about basic life support in European students. Method: From 13 European countries 1527 volunteer participated in the survey. The questionnaire consisted of socio-demographic questions and knowledge regarding basic life support. The maximum possible score was 18. Results: Those participants who had basic life support training earned 11.91 points, while those who had not participated in lifesaving education had 9.6 points (p<0.001). Participants from former socialist Eastern European countries reached 10.13 points, while Western Europeans had average 10.85 points (p<0.001). The best results were detected among the Swedish students, and the worst among the Belgians. Conclusions: Based on the results, there are significant differences in the knowledge about basic life support between students from different European countries. Western European youth, and those who were trained had better performance. Orv. Hetil., 2014, 155(21), 833–837.

Basic life support knowledge, self-reported skills and fears in Danish high school students and effect of a single 45-min training session run by junior doctors; a prospective cohort study

Background

Early recognition and immediate bystander cardiopulmonary resuscitation are critical determinants of survival after out-of-hospital cardiac arrest (OHCA). Our aim was to evaluate current knowledge on basic life support (BLS) in Danish high school students and benefits of a single training session run by junior doctors.

Methods

Six-hundred-fifty-one students were included. They underwent one 45-minute BLS training session including theoretical aspects and hands-on training with mannequins. The students completed a baseline questionnaire before the training session and a follow-up questionnaire one week later. The questionnaire consisted of an eight item multiple-choice test on BLS knowledge, a four-level evaluation of self-assessed BLS skills and evaluation of fear based on a qualitative description and visual analog scale from 0 to 10 for being first responder.

Results

Sixty-three percent of the students (413/651) had participated in prior BLS training. Only 28% (179/651) knew how to correctly recognize normal breathing. The majority was afraid of exacerbating the condition or causing death by intervening as first responder. The response rate at follow-up was 61% (399/651). There was a significant improvement in correct answers on the multiple-choice test (p < .001). The proportion of students feeling well prepared to perform BLS increased from 30% to 90% (p < .001), and the level of fear of being first responder was decreased 6.8 ± 2.2 to 5.5 ± 2.4 (p < .001).

Conclusion

Knowledge of key areas of BLS is poor among high school students. One hands-on training session run by junior doctors seems to be efficient to empower the students to be first responders to OHCA.

Functions of standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival

Background

Cardiopulmonary resuscitation (CPR) is a sudden emergency procedure that requires a rapid and efficient response, and personnel training in lifesaving procedures. Regular practice and training are necessary to improve resuscitation skills and reduce anxiety among the staff. As one of the most important skills mastered by medical volunteers serving for Mt. Taishan International Mounting Festival, we randomly selected some of them to evaluate the quality of CPR operation and compared the result with that of the untrained doctors and nurses. In order to evaluate the functions of repeating standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival, their performance qualities of CPR were compared with those of the untrained medical workers working in emergency departments of hospitals in Taian.

Methods

The CPR performance qualities of 52 medical volunteers (Standard Training Group), who had continually taken part in standard CPR technical training for six months, were tested at random and were compared with those of 68 medical workers (Compared Group) working in emergency departments of hospitals in Taian who hadn’t attended CPR training within a year. The QCPR 3535 monitor (provided by Philips Company) was used to measure the standard degree of single simulated CPR performance, including the chest compression depth, frequency, released pressure between compressions and performance time of compression and ventilation, the results of which were recorded in the table and the number of practical compression per minute was calculated. The data were analyzed by x2 Test and t Test. The factors which would influence CPR performance, including gender, age, placement, hand skill, posture of compression and frequency of training, were classified and given parameters, and were put to Logistic repression analysis.

Results

The CPR performance qualities of volunteers were much higher than those of the compared group. The overall pass rates were respectively 86.4% and 31.9%; the pass rates of medical volunteers in terms of the chest compression depth, frequency, released pressure between compressions were higher than those of the compared group, which were 89.6%, 94.2%, 95.8% vs 50.3%, 53.0%, 83.1%, P<0.01; there were few differences in overall performance time, which were (118.4±13.5s) vs (116.0±10.4s), P>0.05; the duration time of ventilation in each performance section was much shorter than that in the compared group, which were (6.38±1.2) vs (7.47±1.7), P<0.01; there were few differences in the number of practical compression per minute, which were (78.2±3.5) vs (78.8±12.2), P>0.05); the time proportion of compression and ventilation was 2.6:1 vs 2.1:1. The Logistic repression analysis showed that CPR performance qualities were clearly related to hand skill, posture of compression and repeating standard training, which were respectively OR 13.12 and 95%CI (2.35~73.2); OR 30.89, 95%CI (3.62~263.5); OR 4.07,95%CI (1.16~14.2).

Conclusion

The CPR performance qualities of volunteers who had had repeating standard training were much higher than those of untrained medical workers, which proved that standard training helped improve CPR performance qualities.

Four-stage teaching technique and chest compression performance of medical students compared to conventional technique

AIM

To compare the 2-stage and 4-stage basic life support teaching technique. The second aim was to test if students' self-evaluated knowledge was in accordance with their actual knowledge.

METHODS

A total of 126 first-year students of the Faculty of Medicine in Ljubljana were involved in this parallel study conducted in the academic year 2009/2010. They were divided into ten groups. Five groups were taught the 2-stage model and five the 4-stage model. The students were tested in a scenario immediately after the course. Questionnaires were filled in before and after the course. We assessed the absolute values of the chest compression variables and the proportions of students whose performance was evaluated as correct according to our criteria. The results were analyzed with independent samples t test or Mann-Whitney-U test. Proportions were compared with χ(2) test. The correlation was calculated with the Pearson coefficient.

RESULTS

There was no difference between the 2-stage (2S) and the 4-stage approach (4S) in the compression rate (126±13 min-1 vs 124±16 min -1, P=0.180, independent samples t test), compression depth (43±7 mm vs 44±8 mm, P=0.368, independent samples t test), and the number of compressions with correct hand placement (79±32% vs 78±12, P=0.765, Mann-Whitney U-test). However, students from the 4-stage group had a significantly higher average number of compressions per minute (70±13 min -1 2S, 78±12 min-1 4S, P=0.02, independent samples t test). The percentage of students with all the variables correct was the same (13% 2S, 15% 4S, P=0.741, χ2 test). There was no correlation between the students' actual and self-evaluated knowledge (P=0.158, Pearson coefficient=0.127).

CONCLUSIONS

The 4-stage teaching technique does not significantly improve the quality of chest compressions. The students' self-evaluation of their performance after the course was too high.

CPR Skill Retention of First Aid Attendants within the Workplace

Introduction

Immediate resuscitation is necessary in order to achieve conscious survival for persons who have lost airways or pulses. However, current literature suggests that even in medically-trained personnel, CPR skills are forgotten shortly after certification.

Hypothesis/Problem

The purpose of this study was to determine the CPR skill and knowledge decay in those who are paid to respond to emergency situations within the workplace.

Methods

Using an unconscious victim scenario, the sequence and accuracy of CPR events were observed and recorded in 244 participants paid to act as first responders in large industrial or service industry settings.

Results

A significant negative correlation was observed between days since training and a pre-CPR safety check variable, periodic checks for breathing and positioning. Many of the knowledge-related assessment skills (e.g., scene safety, emergency medical system (EMS) activation) appeared to deteriorate with time, although they could be contaminated by the repetition of training in those who had recertified one or more times. Skill-based components such as landmarking for chest compressions and controlling the airway declined in a more predictable fashion.

Conclusion

The results of this study suggest that repetition may be more important than days since last trained for skill and knowledge retention, and methods of “refreshing” skills should be examined. While skills deteriorate rapidly, changing frequency of certification is not necessarily the best way to increase retention of skill and knowledge.

Anderson GS, Gaetz M, Statz C. CPR skill retention of first aid attendants within the workplace. Prehosp Disaster Med. 2012;27(4):1-7.

Poor chest compression quality with mechanical compressions in simulated cardiopulmonary resuscitation: a randomized, cross-over manikin study

INTRODUCTION

Mechanical chest compression devices are being implemented as an aid in cardiopulmonary resuscitation (CPR), despite lack of evidence of improved outcome. This manikin study evaluates the CPR-performance of ambulance crews, who had a mechanical chest compression device implemented in their routine clinical practice 8 months previously. The objectives were to evaluate time to first defibrillation, no-flow time, and estimate the quality of compressions.

METHODS

The performance of 21 ambulance crews (ambulance nurse and emergency medical technician) with the authorization to perform advanced life support was studied in an experimental, randomized cross-over study in a manikin setup. Each crew performed two identical CPR scenarios, with and without the aid of the mechanical compression device LUCAS. A computerized manikin was used for data sampling.

RESULTS

There were no substantial differences in time to first defibrillation or no-flow time until first defibrillation. However, the fraction of adequate compressions in relation to total compressions was remarkably low in LUCAS-CPR (58%) compared to manual CPR (88%) (95% confidence interval for the difference: 13-50%). Only 12 out of the 21 ambulance crews (57%) applied the mandatory stabilization strap on the LUCAS device.

CONCLUSIONS

The use of a mechanical compression aid was not associated with substantial differences in time to first defibrillation or no-flow time in the early phase of CPR. However, constant but poor chest compressions due to failure in recognizing and correcting a malposition of the device may counteract a potential benefit of mechanical chest compressions.

Impact of additional module training on the level of basic life support knowledge of first year students at the University of Maribor

AIM

The aim of this study was to investigate the impact of additional (two versus one session) basic life support (BLS) training of university students on knowledge and attitude concerning the performance of cardiopulmonary resuscitation.

METHODS

A total of 439 students in three separate groups were tested: those with no prior BLS training; BLS training in high school (part of the driver's education course); and BLS training in high school (in the driver's education course) and additional BLS training at the university.

RESULTS

Our study showed the best results of BLS education in a group of university students who took an additional BLS module approximately half a year after the driver's education BLS course. In our study we observed equal levels of knowledge between the group with BLS training in high school and the group without any formal BLS education. The questionnaire revealed a disappointing level of knowledge about BLS in both groups.

CONCLUSION

Additional basic life support training (two BLS training sessions: high school and university) improves retention of knowledge and attitudes concerning performing CPR in first year university students.

First aid skill retention of first responders within the workplace

Background

Recent literature states that many necessary skills of CPR and first aid are forgotten shortly after certification. The purpose of this study was to determine the skill and knowledge decay in first aid in those who are paid to respond to emergency situations within a workplace.

Methods

Using a choking victim scenario, the sequence and accuracy of events were observed and recorded in 257 participants paid to act as first responders in large industrial or service industry settings. A multiple choice exam was also written to determine knowledge retention.

Results

First aid knowledge was higher in those who were trained at a higher level, and did not significantly decline over time. Those who had renewed their certificate one or more times performed better than those who had learned the information only once. During the choking scenario many skills were performed poorly, regardless of days since last training, such as hand placement and abdominal thrusts. Compressions following the victim becoming unconscious also showed classic signs of skill deterioration after 30 days.

Conclusions

As many skills deteriorate rapidly over the course of the first 90 days, changing frequency of certification is not necessarily the most obvious choice to increase retention of skill and knowledge. Alternatively, methods of regularly "refreshing" a skill should be explored that could be delivered at a high frequency - such as every 90 days.

A randomized controlled trial comparing traditional training in cardiopulmonary resuscitation (CPR) to self-directed CPR learning in first year medical students: The two-person CPR study

STUDY AIM

The primary purpose of this study was to compare two, shorter, self-directed methods of cardiopulmonary resuscitation (CPR) education for healthcare professionals (HCP) to traditional training with a focus on the trainee's ability to perform two-person CPR.

METHODS

First-year medical students with either no prior CPR for HCP experience or prior training greater than 5 years were randomized to complete one of three courses: 1) HeartCode BLS System, 2) BLS Anytime, or 3) Traditional training. Only data from the adult CPR skills testing station was reviewed via video recording by certified CPR instructors and the Laerdal PC Skill Reporter software program (Laerdal Medical, Stavanger, Norway).

RESULTS

There were 180 first-year medical students who met inclusion criteria: 68 were HeartCode BLS System, 53 BLS Anytime group, and 59 traditional group Regarding two-person CPR, 57 (84%) of Heartcode BLS students and 43 (81%) of BLS Anytime students were able to initiate the switch compared to 39 (66%) of traditional course students (p = 0.04). There were no significant differences in the quality of chest compressions or ventilations between the three groups. There was a trend for a much higher CPR skills testing pass rate for the traditional course students. However, failure to "clear to analyze or shock" while using the AED was the most common reason for failure in all groups.

CONCLUSION

The self-directed learning groups not only had a high level of success in initiating the "switch" to two-person CPR, but were not significantly different from students who completed traditional training.

Visual-aided directions are superior to verbal instruction only in obtaining hand position for cardiopulmonary resuscitation

OBJECTIVE

The aim of the study was to test if instruction without visual directions is sufficient to obtain the recommended hand position for cardiopulmonary resuscitation (CPR).

METHOD

Group A (n = 12) was verbally instructed to "place the heel of the hand in the center of the chest." Group B (n = 10) was verbally instructed to "place the heel of the hand in the middle of the lower half of the breastbone." Subsequently, both groups again received the same verbal instruction aided by visual directions. The distance from the recommended hand position was compared before and after visual directions.

MAIN RESULTS

Five participants in Group A (42%) and 1 in Group B (10%) placed their hands in the epigastrium. In both groups, hand position significantly improved after visual directions (Group A: 5.7 ± 2.4 vs 2.1 ± 0.8 cm, P < .001, and Group B: 4.5 ± 2.5 vs 2.0 ± 1.2 cm, P = .005).

CONCLUSIONS

Instruction including visual direction was superior to verbal instruction only in obtaining hand position for CPR.

Practical examination of bystanders performing Basic Life Support in Germany: a prospective manikin study

BACKGROUND

In an out-of-hospital emergency situation bystander intervention is essential for a sufficient functioning of the chain of rescue. The basic measures of cardiopulmonary resuscitation (Basic Life Support - BLS) by lay people are therefore definitely part of an effective emergency service of a patient needing resuscitation. Relevant knowledge is provided to the public by various course conceptions. The learning success concerning a one day first aid course ("LSM" course in Germany) has not been much investigated in the past. We investigated to what extent lay people could perform BLS correctly in a standardised manikin scenario. An aim of this study was to show how course repetitions affected success in performing BLS.

METHODS

The "LSM course" was carried out in a standardised manner. We tested prospectively 100 participants in two groups (Group 1: Participants with previous attendance of a BLS course; Group 2: Participants with no previous attendance of a BLS course) in their practical abilities in BLS after the course. Success parameter was the correct performance of BLS in accordance with the current ERC guidelines.

RESULTS

Twenty-two (22%) of the 100 investigated participants obtained satisfactory results in the practical performance of BLS. Participants with repeated participation in BLS obtained significantly better results (Group 1: 32.7% vs. Group 2: 10.4%; p < 0.01) than course participants with no relevant previous knowledge.

CONCLUSION

Only 22% of the investigated participants at the end of a "LSM course" were able to perform BLS satisfactorily according to the ERC guidelines. Participants who had previously attended comparable courses obtained significantly better results in the practical test. Through regular repetitions it seems to be possible to achieve, at least on the manikin, an improvement of the results in bystander resuscitation and, consequently, a better patient outcome. To validate this hypothesis further investigations are recommended by specialised societies.

Basic life support

PURPOSE OF REVIEW

Bystander cardiopulmonary resuscitation increases the chances of survival after out-of-hospital cardiac arrest. Existing bystander cardiopulmonary resuscitation rates are poor. There are several strategies for increasing the frequency and effectiveness of bystander cardiopulmonary resuscitation. These include simplifying the technique for basic life support, emphasizing the importance of compressions over ventilation, reducing the length of training by using video-based self-instruction and widening the range of those trained to include school children.

RECENT FINDINGS

A change in compression-ventilation ratio from 15: 2 to 30: 2 increases the number of compressions delivered. There is some evidence that compression-only cardiopulmonary resuscitation may increase survival rates from out-of-hospital cardiac arrest. Video-based self-instruction enables laypeople to be trained in basic life support in a fraction of the time of traditional courses. School children can be taught basic life support and can be used to help disseminate the skill.

SUMMARY

The optimal basic life support technique that will generate the highest survival rates from out-of-hospital cardiac arrest has not been determined, but there is increasing evidence that the existing technique needs to be simplified. Bystander cardiopulmonary resuscitation increases survival but it needs to be undertaken more frequently if overall survival rates are to be improved significantly.

Teaching children basic life support skills

Can improve outcomes but implementation needs to be earlier and more widespread