Visual assessment of CPR quality during pediatric cardiac arrest: does point of view matter?

Initial implementation of the resuscitation quality improvement program in emergency department of a teaching hospital in China

Background

Cardiopulmonary resuscitation (CPR) skills may decay over time after conventional instructor-led BLS training. The Resuscitation Quality Improvement® (RQI®) program, unlike a conventional basic life support (BLS) course, is implemented through mastery learning and low-dose, high-frequency training strategies to improve CPR competence. We facilitated the RQI program to compare the performance of novices vs those with previous BLS training experience before RQI implementation and to obtain their confidence and attitude of the RQI program.

Methods

A single-center observational study was conducted from May 9, 2021 to June 25, 2021 in an emergency department of a tertiary hospital. The performance assessment data of both trainees with a previous training experience in conventional BLS course (BLS group) and the novice ones with no prior experience with any BLS training (Non-BLS group) was collected by RQI cart and other outcome variables were rated by online questionnaire. Outcome measurements included chest compression and ventilation in both adult-sized and infant-sized manikins.

Results

A total of 149 participants were enrolled. Among them, 103 participants were in BLS group and 46 participants in Non-BLS group. Post RQI training, all the trainees achieved a passing score of 75 or more, and obtained an improvement in CPR performance. The number of attempts to pass RQI for compression and ventilation practice was lower in the BLS group in both adult and infant training sessions (P < 0.05). Although the BLS group had a poor baseline, it had fewer trials and the same learning outcomes, and the BLS group had better self-confidence. Trainees were well adapted to the innovative training modality, and satisfaction among all of the participants was high. Only the respondents for non-instructor led training, the satisfaction was low in both groups (72.8% in BLS group vs 65.2% in No-BLS group, strongly agreed).

Conclusion

Among novices, RQI can provide excellent CPR core skills performance. But for those who had previous BLS training experience, it was able to enhance the efficiency of the skills training with less time consumption. Most trainees obtained good confidence and satisfaction with RQI program, which might be an option for the broad prevalence of BLS training in China.

A novel retraining strategy of chest compression skills for infant CPR results in high skill retention for longer

Infant cardiopulmonary resuscitation (iCPR) is often poorly performed, predominantly because of ineffective learning, poor retention and decay of skills over time. The aim of this study was to investigate whether an individualized, competence-based approach to simulated iCPR retraining could result in high skill retention of infant chest compressions (iCC) at follow-up. An observational study with 118 healthcare students was conducted over 12 months from November 2019. Participants completed pediatric resuscitation training and a 2-min assessment on an infant mannequin. Participants returned for monthly assessment until iCC competence was achieved. Competence was determined by passing assessments in two consecutive months. After achieving competence, participants returned just at follow-up. For each 'FAIL' during assessment, up to six minutes of practice using real-time feedback was completed and the participant returned the following month. This continued until two consecutive monthly 'PASSES' were achieved, following which, the participant was deemed competent and returned just at follow-up. Primary outcome was retention of competence at follow-up. Descriptive statistics were used to analyze demographic data. Independent t-test or Mann-Whitney U test were used to analyze the baseline characteristics of those who dropped out compared to those remaining in the study. Differences between groups retaining competence at follow-up were determined using the Fisher exact test. On completion of training, 32 of 118 participants passed the assessment. Of those achieving iCC competence at month 1, 96% retained competence at 9-10 months; of those achieving competence at month 2, 86% demonstrated competence at 8-9 months; of those participants achieving competence at month 3, 67% retained competence at 7-8 months; for those achieving competence at month 4, 80% demonstrated retention at 6-7 months.   Conclusion: Becoming iCC competent after initial training results in high levels of skill retention at follow-up, regardless of how long it takes to achieve competence. What is Known: • Infant cardiopulmonary resuscitation (iCPR) is often poorly performed and skills decay within months after training. • Regular iCPR skills updates are important, but the optimal retraining interval considering individual training needs has yet to be established. What is New: • Infant chest compression (iCC) competence can be achieved within one to four months after training and once achieved, it can be retained for many months. • With skill reinforcement of up to 28 minutes after initial training, 90% of individuals were able to achieve competence in iCC and 86% retained this competence at follow-up.

Validation of an Assessment Instrument for Pediatric Basic Life Support

OBJECTIVES

To develop a valid and reliable instrument for the assessment of pediatric basic life support (PBLS).

METHODS

An assessment instrument for PBLS was developed, based on 3 existing scoring systems and the European Resuscitation Council PBLS guideline. We tested if experienced PBLS instructors performed better than medical students on a standard PBLS examination on a low-fidelity pediatric manikin (construct validity). To pass the examination, 15 penalty points or less were required. The examinations were videotaped. One researcher assessed all videos once, and approximately half of them twice (intrarater reliability). A second researcher independently assessed part of the videos (interrater reliability). The time needed to assess 1 examination was determined.

RESULTS

Face and content validity were established, because PBLS experts reached consensus on the instrument and because the instrument incorporated all items of the European Resuscitation Council algorithm. Of the 157 medical students that were scored, 98 (62.4%) passed the examination. Fourteen PBLS instructors were scored; all passed (100%). Pass rate (62.4% vs 100%) and median penalty points (15 [interquartile range, 10-22.5] vs 7.5 [interquartile range, 1.25-10]) were significantly different between students and instructors (P = 0.005 and <0.001, respectively). Reassessment demonstrated a κ for intrarater reliability of 0.62 (95% confidence interval, 0.45-0.81) (substantial agreement); κ for interrater reliability was 0.51 (95% confidence interval, 0.09-0.93) (moderate agreement). It took approximately 3 minutes to assess 1 videotaped examination.

CONCLUSIONS

Our instrument for the (video-based) assessment of PBLS is valid and sufficiently reliable. It is also designed to be practical, time-efficient, and applicable in various settings, including resource limited.

Teaching Infant Cardiopulmonary Resuscitation to Caregivers in the Emergency Department

OBJECTIVES

Infant cardiopulmonary resuscitation (CPR) has been taught to caregivers of infants in inpatient settings. There are no studies to date that look at teaching infant CPR in the emergency department (ED). Using a framework of cognitive load theory, we compared teaching infant CPR to caregivers in a pediatric ED versus an inpatient setting.

METHODS

Knowledge tests, 1-minute infant CPR performances on a Resusci Baby QCPR (Laerdal) manikin, and self-reported questionnaires were completed before and after caregivers were self-taught infant CPR using Infant CPR Anytime kits. The proportions of chest compression depth and rate that met quality standards from the American Heart Association's Basic Life Support program were measured.

RESULTS

Seventy-four caregivers participated. Mean knowledge scores (out of a total score of 15) increased in both settings (ED preintervention: Mean (M) = 4.53 [SD = 1.97]; ED postintervention: M = 10.47 [SD = 2.90], P < 0.001; inpatient preintervention: M = 4.83 (SD = 2.08); inpatient postintervention: M = 10.61 [SD = 2.79], P < 0.001). Improvement in the proportion of chest compression that met high quality standards for depth increased in the inpatient group only. Neither groups had improvements in compression rates. There were no statistically significant differences in the difficulty of learning CPR, frequency of interruptions/distractions, or difficulty staying concentrated in learning CPR between the 2 settings.

CONCLUSIONS

Caregivers in the ED and inpatient settings after a self-instructional infant CPR kit did not demonstrate adequate infant CPR performance. However, both groups gained infant CPR knowledge. Differences in cognitive loads between the 2 settings were not significant.

Code Team Structure and Training in the Pediatric Resuscitation Quality International Collaborative

OBJECTIVES

Code team structure and training for pediatric in-hospital cardiac arrest are variable. There are no data on the optimal structure of a resuscitation team. The objective of this study is to characterize the structure and training of pediatric code teams in sites participating in the Pediatric Resuscitation Quality Collaborative.

METHODS

From May to July 2017, an anonymous voluntary survey was distributed to 18 sites in the international Pediatric Resuscitation Quality Collaborative. The survey content was developed by the study investigators and iteratively adapted by consensus. Descriptive statistics were calculated.

RESULTS

All sites have a designated code team and hospital-wide code team activation system. Code team composition varies greatly across sites, with teams consisting of 3 to 17 members. Preassigned roles for code team members before the event occur at 78% of sites. A step stool and backboard are used during resuscitations in 89% of surveyed sites. Cardiopulmonary resuscitation (CPR) feedback is used by 72% of the sites. Of those sites that use CPR feedback, all use an audiovisual feedback device incorporated into the defibrillator and 54% use a CPR coach. Multidisciplinary and simulation-based code team training is conducted by 67% of institutions.

CONCLUSIONS

Code team structure, equipment, and training vary widely in a survey of international children's hospitals. The variations in team composition, role assignments, equipment, and training described in this article will be used to facilitate future studies regarding the impact of structure and training of code teams on team performance and patient outcomes.

The assessment of a manikin-based low-dose, high-frequency cardiac resuscitation quality improvement program in early UK adopter hospitals

BACKGROUND

Adult and paediatric basic life support (BLS) training are often conducted via group training with an accredited instructor every 24 months. Multiple studies have demonstrated a decline in the quality of cardio-pulmonary resuscitation (CPR) performed as soon as 3-month post-training. The 'Resuscitation Quality Improvement' (RQI) programme is a quarterly low-dose, high-frequency training, based around the use of manikins connected to a cart providing real-time and summative feedback. We aimed to evaluate the effects of the RQI Programme on CPR psychomotor skills in UK hospitals that had adopted this as a method of BLS training, and establish whether this program leads to increased compliance in CPR training.

METHODS

The study took place across three adopter sites and one control site. Participants completed a baseline assessment without live feedback. Following this, participants at the adopter sites followed the RQI curriculum for adult CPR, or adult and infant CPR. The curriculum was split into quarterly training blocks, and live feedback was given on technique during the training session via the RQI cart. After following the curriculum for 12/24 months, participants completed a second assessment without live feedback.

RESULTS

At the adopter sites, there was a significant improvement in the overall score between baseline and assessment for infant ventilations (N = 167, p < 0.001), adult ventilations (n = 129, p < 0.001), infant compressions (n = 163, p < 0.001) adult compressions (n = 205, p < 0.001), and adult CPR (n = 249, p < 0.001). There was no significant improvement in the overall score for infant CPR (n = 206, p = 0.08). Data from the control site demonstrated a statistically significant improvement in mean score for adult CPR (n = 22, p = 0.02), but not for adult compressions (N = 18, p = 0.39) or ventilations (n = 17, p = 0.08). No statistically significant difference in improvement of mean scores was found between the grouped adopter sites and the control site. The effect of the duration of the RQI curriculum on CPR performance appeared to be minimal in this data set. Compliance with the RQI curriculum varied by site, one site maintained hospital compliance at 90% over a 1 year period, however compliance reduced over time at all sites.

CONCLUSIONS

This data demonstrated an increased adherence with guidelines for high-quality CPR post-training with the RQI cart, for all adult and most infant measures, but not infant CPR. However, the relationship between a formalised quarterly RQI curriculum and improvements in resuscitation skills is not clear. It is also unclear whether the RQI approach is superior to the current classroom-based BLS training for CPR skill acquisition in the UK. Further research is required to establish how to optimally implement the RQI system in the UK and how to optimally improve hospital wide compliance with CPR training to improve the outcomes of in-hospital cardiac arrests.

Guess it (SVUAL): An app designed to help nursing students acquire and retain knowledge about basic and advanced life support techniques

To design an app that helps nursing students to acquire and retain knowledge of Basic and Advanced Life Support techniques, as well as analyze the students' gamification experience. The study had two phases: 1) App design and development and 2) experimental study. A total of 184 students participated, with 92 in the experimental group and 92 in the control group. The instruments used were the Guess it (SVUAL) app, a test on knowledge and the Gameful Experience Scale. The app was deemed to have a suitable level of content and user-friendliness of 97%. The experimental group obtained a higher average score on the knowledge test than the control group (U = 2835.500; Z = -3.968; p < 0.05). On the re-test, the experimental group also obtained a higher average score than the control group. As for the experience within the game, all the dimensions scored higher than average, except the absence of negative effects dimension, which indicates that the app had very few negative consequences on the participants. The developed app has proven to have a good level of content and to be user-friendly, improving knowledge levels and retention of information in nursing students.

Impact of an untrained CPR Coach in simulated pediatric cardiopulmonary arrest: A pilot study

Aim

To determine if an untrained cardiopulmonary resuscitation (CPR) Coach, with no access to real-time CPR feedback technology, improves CPR quality.

Methods

This was a prospective randomized pilot study at a tertiary care children's hospital that aimed to integrate an untrained CPR Coach into resuscitation teams during simulated pediatric cardiac arrest. Simulation events were randomized to two arms: control (no CPR Coach) or intervention (CPR Coach). Simulations were run by pediatric intensive care unit (PICU) providers and video recorded. Scenarios focused on full cardiopulmonary arrest; neither team had access to real-time CPR feedback technology. The primary outcome was CPR quality. Secondary outcomes included workload assessments of the team leader and CPR Coach using the NASA Task Load Index and perceptions of CPR quality.

Results

Thirteen simulations were performed; 5 were randomized to include a CPR Coach. There was a significantly shorter duration to backboard placement in the intervention group (median 20 s [IQR 0–27 s] vs. 52 s [IQR 38–65 s], p = 0.02). There was no self-reported change in the team leader's workload between scenarios using a CPR Coach compared to those without a CPR Coach. There were no significant changes in subjective CPR quality measures.

Conclusions

In this pilot study, inclusion of an untrained CPR Coach during simulated CPR shortened time to backboard placement but did not improve most metrics of CPR quality or significantly affect team leader workload. More research is needed to better assess the value of a CPR Coach and its potential impact in real-world resuscitation.

Validating peer-led assessments of CPR performance

BACKGROUND

A patient's survival from cardiac arrest is improved if they receive good quality chest compressions as soon as possible. During cardiopulmonary resuscitation (CPR) training subjective assessments of chest compression quality is still common. Recently manikins allowing objective assessment have demonstrated a degree of variance with Instructor assessment. The aim of this study was to compare peer-led subjective assessment of chest compressions in three groups of participants with objective data from a manikin.

METHOD

This was a quantitative multi-center study using data from simulated CPR scenarios. Seventy-eight Instructors were recruited, from different backgrounds; lay persons, hospital staff and emergency services personnel. Each group consisted of 13 pairs and all performed 2 ​min of chest compressions contemporaneously by peers and manikin (Brayden PRO®). The primary hypothesis was subjective and objective assessment methods would produce different test outcomes.

RESULTS

13,227 chest compressions were assessed. The overall median score given by the manikin was 88.5% (interquartile range 71.75-95), versus 92% (interquartile range 86.75-98) by observers. There was poor correlation in scores between assessment methods (Kappa -0.051 - +0.07). Individual assessment of components within the manikin scores demonstrated good internal consistency (alpha ​= ​0.789) compared to observer scores (alpha ​= ​0.011).

CONCLUSION

Observers from all backgrounds were consistently more generous in their assessment when compared to the manikin. Chest compressions quality influences outcome following cardiac arrest, the findings of this study support increased use of objective assessment at the earliest opportunity, irrespective of background.

Certified Basic Life Support Instructors Identify Improper Cardiopulmonary Resuscitation Skills Poorly: Instructor Assessments Versus Resuscitation Manikin Data

INTRODUCTION

During basic life support (BLS) training, instructors assess learners' cardiopulmonary resuscitation (CPR) skills and correct errors to ensure high-quality performance. This study aimed to investigate certified BLS instructors' assessments of CPR skills.

METHODS

Data were collected at BLS courses for medical students at Aarhus University, Aarhus, Denmark. Two certified BLS instructors evaluated each learner with a cardiac arrest test scenario, where learners demonstrated CPR on a resuscitation manikin for 3.5 minutes. Instructors' assessments were compared with manikin data as reference for correct performance. The first 3 CPR cycles were analyzed. Correct chest compressions were defined as 2 or more of 3 CPR cycles with 30 ± 2 chest compressions, 50 to 60 mm depth, and 100 to 120 min rate. Correct rescue breaths were defined as 50% or more efficient breaths with visible, but not excessive manikin chest inflation (for instructors) or 500 to 600mL air (manikin data).

RESULTS

Overall, 90 CPR assessments were performed by 16 instructor pairs. Instructors passed 81 (90%) learners, whereas manikin pass rate was 2%. Instructors identified correct chest compressions with a sensitivity of 0.96 [95% confidence interval (CI) = 0.79-1) and a specificity of 0.05 (95% CI = 0.01-0.14), as well as correct rescue breaths with a sensitivity of 1 (95% CI = 0.40-1) and a specificity of 0.07 (95% CI = 0.03-0.15). Instructors mistakenly failed 1 learner with adequate chest compression depth, while passing 53 (59%) learners with improper depth. Moreover, 80 (89%) improper rescue breath performances were not identified.

CONCLUSIONS

Certified BLS instructors assess CPR skills poorly. Particularly, improper chest compression depth and rescue breaths are not identified.

Improving the position of resuscitation team leader with simulation (IMPORTS); a pilot cross-sectional randomized intervention study

BACKGROUND

Leadership and teamwork are important contributory factors in determining cardiac resuscitation performance and clinical outcome. We aimed to determine whether fixed positioning of the resuscitation team leader (RTL) relative to the patient influences leadership qualities during cardiac resuscitation using simulation.

METHODS

A cross-sectional randomized intervention study over 12 months' duration was conducted in university hospital simulation lab. ACLS-certified medical doctors were assigned to run 2 standardized simulated resuscitation code as RTL from a head-end position (HEP) and leg-end position (LEP). They were evaluated on leadership qualities including situational attentiveness (SA), errors detection (ED), and decision making (DM) using a standardized validated resuscitation-code-checklist (RCC). Performance was assessed live by 2 independent raters and was simultaneously recorded. RTL self-perceived performance was compared to measured performance.

RESULTS

Thirty-four participants completed the study. Mean marks for SA were 3.74 (SD ± 0.96) at HEP and 3.54 (SD ± 0.92) at LEP, P = .48. Mean marks for ED were 2.43 (SD ± 1.24) at HEP and 2.21 (SD ± 1.14) at LEP, P = .40. Mean marks for DM were 4.53 (SD ± 0.98) at HEP and 4.47 (SD ± 0.73) at LEP, P = .70. The mean total marks were 10.69 (SD ± 1.82) versus 10.22 (SD ± 1.93) at HEP and LEP respectively, P = .29 which shows no significance difference in all parameters. Twenty-four participants (71%) preferred LEP for the following reasons, better visualization (75% of participants); more room for movement (12.5% of participants); and better communication (12.5% of participants). RTL's perceived performance did not correlate with actual performance CONCLUSION:: The physical position either HEP or LEP appears to have no influence on performance of RTL in simulated cardiac resuscitation. RTL should be aware of the advantages and limitations of each position.

How is quality of cardiopulmonary resuscitation being assessed? A national survey of Canadian emergency medicine physicians

Background

High-quality cardiopulmonary resuscitation (CPR) is a fundamental intervention for cardiac arrest, yet health care providers rarely adhere to recommended guidelines. Real-time feedback improves CPR performance. It is currently unknown how Canadian emergency physicians assess CPR quality during cardiac arrest and if they use feedback devices. Our aim was to describe how emergency physicians assess CPR quality and to describe eventual barriers to implementation of feedback technology.

Methods

This was a cross-sectional survey that was distributed to attending and resident emergency physicians through the Canadian Association of Emergency Physicians. Responses were summarized and analyzed using descriptive statistics.

Results

The response rate was 19% (323/1735). Visual observation was the most common method of assessing CPR quality (41.2%), with leaders standing at the foot of the bed (67.4%). This was followed by real-time pulse check (29.7%) and end-tidal CO2 values (21.7%). Only 12% of physicians utilized CPR feedback technology. The most common perceived barrier to utilization was unavailability, inexperience with devices and lack of guidelines/evidence for their use.

Conclusion

Most Canadian emergency physicians that responded to our survey, assess quality of CPR by standing at the foot of the bed and utilize visual observation and palpation methods which are known to be inaccurate. A minority utilize objective measurements such as ETCO2 or feedback devices, with the greatest barrier being lack of availability.

Comparison between synchronized and non-synchronized ventilation and between guided and non-guided chest compressions during resuscitation in a pediatric animal model after asphyxial cardiac arrest

Introduction

There are no studies comparing synchronized and non-synchronized ventilation with bag-valve mask ventilation (BVMV) during cardiopulmonary resuscitation (CPR) in pediatric patients. The main aim is to compare between synchronized and non-synchronized BVMV with chest compressions (CC), and between guided and non-guided CC with a real-time feedback-device in a pediatric animal model of asphyxial cardiac arrest (CA). The secondary aim is to analyze the quality of CC during resuscitation.

Methods

60 piglets were randomized for CPR into four groups: Group A: guided-CC and synchronized ventilation; Group B: guided-CC and non-synchronized ventilation; Group C: non-guided CC and synchronized ventilation; Group D: non-guided CC and non-synchronized ventilation. Return of spontaneous circulation (ROSC), hemodynamic and respiratory parameters, and quality of CC were compared between all groups.

Results

60 piglets were included. Twenty-six (46.5%) achieved ROSC: A (46.7%), B (66.7%), C (26.7%) and D (33.3%). Survival rates were higher in group B than in groups A+C+D (66.7% vs 35.6%, p = 0.035). ROSC was higher with guided-CC (A+B 56.7% vs C+D 30%, p = 0.037). Piglets receiving non-synchronized ventilation did not show different rates of ROSC than synchronized ventilation (B+D 50% vs A+C 36.7%, p = 0.297). Non-synchronized groups showed lower arterial pCO₂ after 3 minutes of CPR than synchronized groups: 57 vs 71 mmHg, p = 0.019. No differences were found in arterial pH and pO₂, mean arterial pressure (MAP) or cerebral blood flow between groups. Chest compressions were shallower in surviving than in non-surviving piglets (4.7 vs 5.1 cm, p = 0.047). There was a negative correlation between time without CC and MAP (r = -0.35, p = 0.038).

Conclusions

The group receiving non-synchronized ventilation and guided-CC obtained significantly higher ROSC rates than the other modalities of resuscitation. Guided-CC achieved higher ROSC rates than non-guided CC. Non-synchronized ventilation was associated with better ventilation parameters, with no differences in hemodynamics or cerebral flow.

Influence of Cardiopulmonary Resuscitation Coaching and Provider Role on Perception of Cardiopulmonary Resuscitation Quality During Simulated Pediatric Cardiac Arrest

OBJECTIVES

We aimed to describe the impact of a cardiopulmonary resuscitation coach on healthcare provider perception of cardiopulmonary resuscitation quality during simulated pediatric cardiac arrest.

DESIGN

Prospective, observational study.

SETTING

We conducted secondary analysis of data collected from a multicenter, randomized trial of providers who participated in a simulated pediatric cardiac arrest.

SUBJECTS

Two-hundred pediatric acute care providers.

INTERVENTIONS

Participants were randomized to having a cardiopulmonary resuscitation coach versus no cardiopulmonary resuscitation coach. Cardiopulmonary resuscitation coaches provided feedback on cardiopulmonary resuscitation performance and helped to coordinate key tasks. All teams used cardiopulmonary resuscitation feedback technology.

MEASUREMENTS AND MAIN RESULTS

Cardiopulmonary resuscitation quality was collected by the defibrillator, and perceived cardiopulmonary resuscitation quality was collected by surveying participants after the scenario. We calculated the difference between perceived and measured quality of cardiopulmonary resuscitation and defined accurate perception as no more than 10% deviation from measured quality of cardiopulmonary resuscitation. Teams with a cardiopulmonary resuscitation coach were more likely to accurately estimate chest compressions depth in comparison to teams without a cardiopulmonary resuscitation coach (odds ratio, 2.97; 95% CI, 1.61-5.46; p < 0.001). There was no significant difference detected in accurate perception of chest compressions rate between groups (odds ratio, 1.33; 95% CI, 0.77-2.32; p = 0.32). Among teams with a cardiopulmonary resuscitation coach, the cardiopulmonary resuscitation coach had the best chest compressions depth perception (80%) compared with the rest of the team (team leader 40%, airway 55%, cardiopulmonary resuscitation provider 30%) (p = 0.003). No differences were found in perception of chest compressions rate between roles (p = 0.86).

CONCLUSIONS

Healthcare providers improved their perception of cardiopulmonary resuscitation depth with a cardiopulmonary resuscitation coach present. The cardiopulmonary resuscitation coach had the best perception of chest compressions depth.

Interventions to improve the quality of bystander cardiopulmonary resuscitation: A systematic review

Background

Performing high-quality bystander cardiopulmonary resuscitation (CPR) improves the clinical outcomes of victims with sudden cardiac arrest. Thus far, no systematic review has been performed to identify interventions associated with improved bystander CPR quality.

Methods

We searched Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, Ovid PsycInfo, Thomson Reuters SCI-EXPANDED, and the Cochrane Central Register of Controlled Trials to retrieve studies published from 1 January 1966 to 5 October 2018 associated with interventions that could improve the quality of bystander CPR. Data regarding participant characteristics, interventions, and design and outcomes of included studies were extracted.

Results

Of the initially identified 2,703 studies, 42 were included. Of these, 32 were randomized controlled trials. Participants included adults, high school students, and university students with non-medical professional majors. Interventions improving bystander CPR quality included telephone dispatcher-assisted CPR (DA-CPR) with simplified or more concrete instructions, compression-only CPR, and other on-scene interventions, such as four-hand CPR for elderly rescuers, kneel on opposite sides for two-person CPR, and CPR with heels for a tired rescuer. Devices providing real-time feedback and mobile devices containing CPR applications or software were also found to be beneficial in improving the quality of bystander CPR. However, using mobile devices for improving CPR quality or for assisting DA-CPR might cause rescuers to delay starting CPR.

Conclusions

To further improve the clinical outcomes of victims with cardiac arrest, these effective interventions may be included in the guidelines for bystander CPR.

The Effects of the 5-step Method for Infant Cardiopulmonary Resuscitation Training on Nursing Students' Knowledge, Attitude, and Performance Ability

PURPOSE

The purpose of this study was to examine the effects of an infant cardiopulmonary resuscitation (CPR) training program that applied the 5-step method on the knowledge, attitudes, and performance ability of nursing students in terms of enhancement and sustainability.

METHODS

Sixty-one nursing students (28 in the experimental group and 33 in the control group) from D city participated in this study. Data were collected from April 25 to December 15, 2016. The experimental group and control group received infant CPR education using the 5-step method and the traditional method, respectively. The outcome variables were measured 3 times (pretest and posttest at 1 week and 6 months after training).

RESULTS

There were significant differences in attitude (t=2.68, p=.009) and performance ability (t=4.56, p<.001) between the groups at 1 week after training, as well as in sustained performance ability at 6 months after training (F=6.76, p=.012).

CONCLUSION

The 5-step method of infant CPR training was effective for improving performance ability in a sustained manner and promoting a positive attitude. Therefore, it is recommended that nursing students, as infant CPR novices, receive training using this effective method.

Competence-based training needs assessment for basic life support instructors

Basic life support instructors play an important role in the planning, implementation, and evaluation of basic life support education. However, little is known about basic life support instructors' competence. The aim of the present study was to identify basic life support instructors' competence attributes and assess their competence-based training needs according to their expertise. This was a descriptive survey study to identify the educational needs of basic life support instructors using importance and performance analysis. A Web-based survey with a 29 item Competence Importance-Performance scale was undertaken with a convenience sample of 213 Korean instructors. Factor analysis identified several important factors for the competence of instructors: assessment, professional foundations, planning and preparation, educational method and strategies and evaluation. The importance and performance analysis matrix showed that training priorities for novice instructors were communication with learners and instructors, learner motivation, educational design, and qualifications of instructors, whereas checking equipment status and educational environment had the highest training priority for experienced instructors. Assessment was the most important factor in basic life support instructor's competence. A competence-based training program is needed according to basic life support instructors' expertise.

Optimal training frequency for acquisition and retention of high-quality CPR skills: A randomized trial

AIM

Spaced training programs employ short, frequent CPR training sessions to improve provider skills. The optimum training frequency for CPR skill acquisition and retention has not been determined. We aimed to determine the training interval associated with the highest quality CPR performance at one year.

METHODS

Participants were randomized to 1-month, 3-month, 6-month, and 12-month CPR training intervals over the course of a 12-month study period. Practice sessions included repeated two-minute CPR practice sessions with visual feedback and verbal coaching until Excellent CPR was achieved, to a maximum of three attempts. Excellent CPR was defined as a two-minute CPR session with ≥90% of compressions with a depth of 50-60 millimeters, a rate of 100-120 per minute, and with complete chest recoil. CPR performance was assessed in all groups at 12 months. The primary outcome was the proportion of participants able to perform Excellent CPR in each group.

RESULTS

A total of 167 participants were included in the analysis. Baseline assessment showed no difference in CPR performance (p = 0.38). Participants who were trained monthly had a significantly higher proportion of Excellent CPR performance (58%) than those in all other groups (26% in the 3-month group, p = 0.008; 21% in the 6-month group, p = 0.002; and 15% in the 12-month group, p < 0.001).

CONCLUSION

Short-duration, distributed CPR training on a manikin with real-time visual feedback is effective in improving CPR performance, with monthly training more effective than training every 3, 6, or 12 months.

Improving CPR quality with distributed practice and real-time feedback in pediatric healthcare providers - A randomized controlled trial

OBJECTIVES

Guideline compliant CPR is associated with improved survival for patients with cardiac arrest. Conventional Basic Life Support (BLS) training results in suboptimal CPR competency and skill retention. We aimed to compare the effectiveness of distributed CPR training with real-time feedback to conventional BLS training for CPR skills in pediatric healthcare providers.

METHODS

Healthcare providers were randomized into receiving annual BLS training (control) or distributed training with real-time feedback (intervention). The intervention group was asked to practice CPR for 2 min on mannequins while receiving real-time CPR feedback, at least once per month. Control group participants were not asked to practice CPR during the study period. Excellent CPR was defined as 90% guideline-compliance for depth, rate and recoil of chest compressions. CPR performance of participants was assessed (on infant and adult-sized mannequins) every 3 months for a duration of 12 months. CPR performance was compared between the 2 groups.

RESULTS

A total of 87 healthcare providers were included in the analyses (control n = 41, intervention n = 46). Baseline assessment showed no significant difference in CPR performance across the 2 groups. The intervention group has a significantly greater proportion of participants with excellent CPR compared with the control group on an adult sized mannequin (14.6% vs. 54.3%, p < 0.001) and infant-sized mannequin (19.5% vs. 71.7%, p < 0.001) at the end of the study. In the intervention group, all CPR metrics except infant depth were improved and retained over the course of the study.

CONCLUSION

Distributed CPR training with real-time feedback improves the compliance of AHA guidelines of quality of CPR.

Retention of knowledge and skills in pediatric basic life support amongst pediatricians

Retention of resuscitation skills is usually assessed at a predefined moment, which enables participants to prepare themselves, possibly introducing bias. In this multicenter study, we evaluated the retention of knowledge and skills in pediatric basic life support (PBLS) amongst 58 pediatricians and pediatric residents with an unannounced examination. Practical PBLS skills were assessed with a validated scoring instrument, theoretical knowledge with a 10-item multiple-choice test (MCQ). Participants self-assessed their PBLS capabilities using five-point Likert scales. Background data were collected with a questionnaire. Of our participants, 21% passed the practical PBLS exam: 29% failed on compressions/ventilations, 31% on other parts of the algorithm, 19% on both. Sixty-nine percent passed the theoretical test. Participants who more recently completed a PBLS course performed significantly better on the MCQ (p = 0.03). This association was less clear-cut for performance on the practical exam (p = 0.11). Older, attending pediatricians with more years of experience in pediatrics performed less well than their younger colleagues (p < 0.05). Fifty-one percent of the participants considered themselves competent in PBLS. No correlation was found between self-assessed PBLS capabilities and actual performance on the practical exam (p = 0.25).

CONCLUSION

Retention of PBLS skills appears to be poor amongst pediatricians and residents, whereas PBLS knowledge is retained somewhat better. What is Known: • Pediatricians and pediatric residents are not always competent in pediatric basic life support (PBLS) in daily practice. Poor retention of skills supposedly accounts for this incompetence. Without regular exposure, resuscitation skills usually deteriorate within 3 to 6 months after training. • Examination of resuscitation skills usually takes place after training. Also, in most studies evaluating retention of skills, participants are tested at a predefined moment. Inasmuch as participants are able to prepare themselves, these assessments do not reflect the ad hoc resuscitation capabilities of pediatricians and residents. What is New: • In this study, pediatricians and pediatric residents had to complete an unannounced PBLS exam at variable time intervals from last certification. Retention of PBLS skills was rather poor (pass rate 21%). • The PBLS skills of older, attending pediatricians with many working years in pediatrics appeared to be inferior to those of their younger colleagues.