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

The Effect of Cardiopulmonary Resuscitation (CPR) Education on the CPR Knowledge, Attitudes, Self-Efficacy, and Confidence in Performing CPR among Elementary School Students in Korea

Cardiopulmonary resuscitation (CPR) education for schoolchildren is emphasized, as bystander CPR is a vital key to increasing the survival rate of out-of-hospital cardiac arrest (OHCA) victims. This study was conducted to verify the effect of CPR education on knowledge, attitudes, self-efficacy, and confidence of Korean elementary school students in performing CPR. Data were collected through structured questionnaires before and after CPR education and analyzed using descriptive statistics, T-tests, and hierarchical regression. Significant improvements in CPR knowledge, attitudes, self-efficacy, and confidence in performing CPR were found after CPR education, with the greatest increase observed in confidence (p = 0.000). The influencing factors on confidence in performing CPR were school grade, attitude, and self-efficacy. Although a significant increase in schoolchildren's CPR knowledge after education was shown, knowledge did not affect confidence in performing CPR. Therefore, early CPR education which focuses on improving confidence in performing CPR is recommended. CPR education might raise attitude and self-efficacy leading to increased confidence in performing bystander CPR. In conclusion, early and regular CPR education for elementary school students is crucial and should be conducted repeatedly.

Temporarily Removed

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The psychological and behavioural factors associated with laypeople initiating CPR for out-of-hospital cardiac arrest: a systematic review

BACKGROUND

Prompt, effective CPR greatly increases the chances of survival in out-of-hospital c ardiac arrest. However, it is often not provided, even by people who have previously undertaken training. Psychological and behavioural factors are likely to be important in relation to CPR initiation by lay-people but have not yet been systematically identified.

METHODS

Aim: to identify the psychological and behavioural factors associated with CPR initiation amongst lay-people.

DESIGN

Systematic review Data sources: Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo and Google Scholar.

STUDY ELIGIBILITY CRITERIA

Primary studies reporting psychological or behavioural factors and data on CPR initiation involving lay-people published (inception to 31 Dec 2021).

STUDY APPRAISAL AND SYNTHESIS METHODS

Potential studies were screened independently by two reviewers. Study characteristics, psychological and behavioural factors associated with CPR initiation were extracted from included studies, categorised by study type and synthesised narratively.

RESULTS

One hundred and five studies (150,820 participants) comprising various designs, populations and of mostly weak quality were identified. The strongest and most ecologically valid studies identified factors associated with CPR initiation: the overwhelming emotion of the situation, perceptions of capability, uncertainty about when CPR is appropriate, feeling unprepared and fear of doing harm. Current evidence comprises mainly atheoretical cross-sectional surveys using unvalidated measures with relatively little formal testing of relationships between proposed variables and CPR initiation.

CONCLUSIONS

Preparing people to manage strong emotions and increasing their perceptions of capability are likely important foci for interventions aiming to increase CPR initiation. The literature in this area would benefit from more robust study designs.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42018117438.

Increasing lay-people's intentions to initiate CPR in out of hospital cardiac arrest: Results of a mixed-methods 'before and after' pilot study of a behavioural text-message intervention (BICeP)

Background

Prompt, effective cardio-pulmonary resuscitation (CPR) increases survival in out-of-hospital cardiac arrest. However, CPR is often not provided, even by people with training. Low confidence, perceptions of risks and high emotion can prevent initiation of CPR. Behaviour-change techniques may be helpful in increasing CPR rates.

Aim

To pilot a text-message behavioural intervention designed to increase intentions to initiate CPR, explore participant responses and pilot methods for future randomised controlled trial of effectiveness.

Methods

A 'before and after' pilot study plus qualitative interviews was undertaken. Participants were lay-people who had undertaken CPR training in previous 2 years.Participants were sent an intervention, comprising 35 text-messages containing 14 behaviour-change techniques, to their mobile phone over 4-6 weeks.Primary outcome: intentions to initiate CPR assessed in response to 4 different scenarios.Secondary outcomes: theory-based determinants of intention (attitudes, subjective norms, perceived behavioural control and self-efficacy) and self-rated competence.

Results

20 participants (6 female, 14 male), aged 20-84 provided baseline data. 17 received the full suite of 35 text messages.15 provided follow-up data. Intentions to perform CPR in scenarios where CPR was indicated were high at baseline and increased (18.1 ± 3.2-19.5 ± 1.8/21) after the intervention, as did self-efficacy and self-rated competency. Self-efficacy, attitudes, perceived behavioural control and subjective norms were positively correlated with intentions. Qualitative data suggest the intervention was perceived as useful. Additional options for delivery format and pace were suggested.

Conclusions

Pilot-testing suggests a text-message intervention delivered after CPR training is acceptable and may be helpful in increasing/maintaining intentions to perform CPR.

Knowledge Level of Medan City Resident about Cardiac Lung Brain Resuscitation in Basic Life Support

BACKGROUND: In 2015, approximately 350,000 adults in the United States experienced nontraumatic out-of-hospital cardiac arrest and were treated by the emergency medical services (EMS) personnel. Despite recent increases, <40% of adults receive layman-initiated cardiopulmonary resuscitation (CPR), and <12% apply an automated external defibrillator before EMS personnel. AIM: To know the ability of the Medan city community in handling cardiac arrest for the first time and implementing the 2020 AHA basic life support (BLS). METHODS: This study used a descriptive method with a cross-sectional approach and was conducted in the city of Medan in the period July–October 2021. Sampling used cluster sampling and purposive sampling with inclusion and exclusion criteria. RESULTS: In this study, it was found that the majority of the people of Medan City had less knowledge about CPR in BLS. In this study, only respondents from Medan Marelan District were dominated by good knowledge by 80%. It was found that the people of Medan City have a good level of knowledge about these cardiac events, and the people of Medan City have a low level of knowledge about BLS and CPR. CONCLUSION: The ability of the people of Medan City in implementing BLS and CPR in BLS for cardiac events outside the hospital is still lacking.

High school basic life support training: Is the trainer's experience of cardiopulmonary resuscitation in the actual setting important? A randomized control trial

BACKGROUND

Although basic life support (BLS) has been taught in school by a variety of professionals, it is still unclear that, whether the instructor's previous cardiopulmonary resuscitation (CPR) experience is an important factor. This study aimed to compare the effect of BLS training, based on trainer experience in actual situations, on knowledge and skills of secondary high school students.

MATERIALS AND METHODS

In this randomized controlled trial, 150 high school students were selected based on the inclusion criteria and then assigned into two groups, (76 in Group A), and (74 in Group B) randomly. Both groups were trained according to adult BLS: 2020 American Heart Association guidelines on mannequins in three 60 min in-person training sessions. The knowledge and skill scores were measured for both groups before, immediately, and 1 month after intervention by a questionnaire. Data were analyzed by the SPSS software version 22, using Chi-square, Mann-Whitney U, repeated-measure ANOVA tests, and statistically modeling at a significance level of 0.05.

RESULTS

There were no significant differences between groups regarding demographic characteristics. The knowledge and skill scores in both groups increased significantly compared to baseline immediately and 1 month after the intervention (P = 0.001). However, there was no significant difference in knowledge scores between groups (P = 0.076(. However, at the immediacy and 1 month after the intervention, the skill score in "Group A" was significantly higher than the "Group B" (P = 0.001).

CONCLUSIONS

The trainer's experience of CPR in the actual setting in the transfer of BLS knowledge is not important, but it improved Student's BSL skill acquisition score.

Basic life support training in schools

Older children and adolescents are able to learn and perform cardiopulmonary resuscitation maneuvers in a satisfactory manner. Schools are places where training in basic life support can be carried out. This narrative review was carried out to assess the effectiveness of training in basic life support in schools, analyzing different learning methodology, age groups, and gaining confidence in performing cardiopulmonary resuscitation in a real situation. The search was conducted in the MEDLINE database. Articles published from 01/01/2014 to 12/31/2019, with children under 18 years of age, published in English, Portuguese and Spanish, were selected. Three hundred and nine articles were found, of which 15 met the inclusion criteria in the study. There was great heterogeneity in the methodologies evaluated, making it difficult to compare some studies. Cardiopulmonary resuscitation taught to school children has resulted in the retention of skills and knowledge. There was a direct relationship between age group and quality of cardiopulmonary resuscitation. Learning cardiopulmonary resuscitation can also change the stigma and fear associated with procedures. We conclude that the teaching of cardiopulmonary resuscitation by different methodologies is effective in the learning of children and adolescents and improves their confidence in doing it. Although older than 12 years of age have a greater ability for depth of compression, other points of basic life support can be developed in younger children.

Awareness of Secondary School Students regarding Basic Life Support in Abha City, Southern Saudi Arabia: A Cross-Sectional Survey

BACKGROUND

Basic life support (BLS) is a level of medical care that is used for individuals with life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians and paramedics, and by qualified bystanders. Vital areas of adult BLS include immediate identification of sudden cardiac arrest and activation of the emergency response system, early performance of high-quality cardiopulmonary resuscitation (CPR), and rapid defibrillation, when appropriate.

AIM

To assess the awareness of secondary school students regarding BLS in Abha City, Saudi Arabia. Methodology. A descriptive cross-sectional survey was conducted targeting all accessible secondary school students in Abha City during the academic years 2018-2019. After explaining the objectives and importance of the research topic, all students in the three grades were invited to complete the study questionnaire. The questionnaire was developed by the researchers after reviewing the literature for related topics and consulting an expert for any additions or modifications.

RESULTS

The study included 761 students with ages ranging from 15 to 20 years and a mean age of 17 ± 1 years old. Male students accounted for 53.6% of the participants, and 96.7% of the participants were Saudi. Exactly 31% of the students had had a BLS training course, among which 79.2% had had training that lasted for only one day. Regarding awareness, 65% of the students had heard about BLS, and 44% knew about CPR. Exactly 52% of the students indicated that they should call the ER if there was a case with fainting. A total of 45.3% of the students reported that airway checking was the first step in CPR, and 16.7% reported that the chest compression to oral breathing ratio should be 30 to 2. Conclusions and Recommendations. In conclusion, the study revealed that poor awareness regarding BLS was present among the students. The researchers concluded that less than one-third of the students had BLS training. BLS should be taught, theoretically and practically (with simulations), to middle and high school students as BLS involves relatively simple concepts and methods.

Evaluation of Awareness, Knowledge, and Attitudes Towards Basic Life Support Among Non-Medical Students at Two Academic Institutions in Jeddah, Saudi Arabia

BACKGROUND

Cardiac arrests are a leading cause of mortality in Saudi Arabia. Prompt and quick intervention using early cardiopulmonary resuscitation (CPR) can be a life-saving strategy. Sufficient knowledge and awareness regarding CPR are important in initial care, particularly during an out-of-hospital cardiac arrest. We aim to assess the knowledge, awareness, and attitude toward CPR among the students of King Abdulaziz University and Jeddah University.

MATERIALS AND METHODS

A descriptive, cross-sectional study design with a sample of 1053 non-medical students, regardless of their academic year, was conducted from May to July 2019 at both universities. Data were analyzed through chi-square and analysis of variance where a P-value <0.05 was considered statistically significant.

RESULTS

Out of 1053 students, 28.7% received CPR training. Also, the majority of the subjects were female 71%. The science department provided the largest response. Results showed that chest pain was the most observed early sign of cardiac arrest among participants by a percentage of 84.6. Majority of the participants (90.9%) felt no hesitation in performing early CPR on a family member. Additionally, committing a mistake was the most feared factor that deterred students from performing CPR.

CONCLUSION

Knowledge and awareness of CPR among non-medical university students were poor, despite positive attitudes toward it. Integrating mandatory CPR courses in the orientation and in the first year of the undergraduate curriculum could increase awareness and improve the outcomes of out-of-hospital cardiac arrest (OHCA).

Training of Basic Life Support Among Lay Undergraduates: Development and Implementation of an Evidence-Based Protocol

Background

Cardiopulmonary resuscitation (CPR) is an important method to improve the prognosis of patients with prehospital cardiac arrest (CA). Basic life support (BLS) is the first step in CPR and is usually performed by the first witness. However, the general population has poor BLS skills due to the lack of efficient and practical training strategy. Several training initiatives could be used to improve this situation, and the challenge is to find the most efficient one in detail according to the actual setting. Repeated and effective BLS training increase bystander’s confidence and willingness to perform BLS. Evidence-based instructional design is essential to improve the training of lay providers and ultimately improve resuscitation performance and patient outcomes.

Objective

1) To develop an evidence-based BLS training protocol for lay undergraduates; 2) to implement the protocol and 3) to evaluate the process of implementation.

Methods

Nine databases were searched to synthesize the best evidence. A protocol was formed by ranking evidence and considering university setting and students’ preferences. We implemented this training protocol and evaluated its effects.

Results

We achieved the three aims above. A total of 120 lay undergraduates received BLS training and retraining within 3 months. The students and teaching staff were satisfied with the training protocol and effect. The BLS training process was more clearly defined. The role of teaching assistants and the strategies to sustain training quality was proven to be crucial to the project’s success.

Conclusion

The development and implementation of an evidence-based protocol could elevate undergraduates’ BLS skill and confidence.

Barriers to bystander CPR in deprived communities: Findings from a qualitative study

STUDY AIM

Rates of out of hospital cardiac arrest are higher in deprived communities. Bystander Cardiopulmonary Resuscitation (BCPR) can double the chance of survival but occurs less often in these communities in comparison to more affluent communities. People living in deprived communities are, therefore, doubly disadvantaged and there is limited evidence to explain why BCPR rates are lower. The aim of this paper is to examine the barriers to administering BCPR in deprived communities.

METHOD

Mixed method qualitative study with ten single sex focus groups (n = 61) conducted in deprived communities across central Scotland and 18 semi-structured interviews with stakeholders from the UK, Europe and the USA.

RESULTS

Two key themes related to confidence and environmental factors were identified to summarise the perceived barriers to administering BCPR in deprived communities. Barriers related to confidence included: self-efficacy; knowledge and awareness of how, and when, to administer CPR; accessing CPR training; having previous experience of administering BCPR; who required CPR; and whether the bystander was physically fit to give CPR. Environmental barriers focused on the safety of the physical environment in which people lived, and fear of reprisal from gangs or the police.

CONCLUSIONS

Barriers to administering BCPR identified in the general population are relevant to people living in deprived communities but are exacerbated by a range of contextual, individual and environmental factors. A one-size-fits-all approach is not sufficient to promote 'CPR readiness' in deprived communities. Future approaches to working with disadvantaged communities should be tailored to the local community.

Awareness and willingness to perform CPR: a survey amongst Flemish schoolchildren, teachers and principals

OBJECTIVES

Training children in cardiopulmonary resuscitation (CPR) is one of the strategies to increase bystander CPR in society. Reinforcing knowledge and awareness and increasing willingness to perform bystander CPR contributes to a better outcome after cardiac arrest. We questioned schoolchildren, teachers and principals about their awareness of the importance of CPR and about their willingness to perform CPR.

METHODS

During a four-month period, Flemish schoolchildren aged 10-18 years, teachers and principals were invited to complete a survey consisting of three parts: (1) demographics, (2) CPR (training) experience and (3) attitude towards CPR teaching and training.

RESULT

In total, 390 schoolchildren, 439 teachers and 100 principals completed the survey. Previous CPR training was reported by 33% of the schoolchildren (in 82% as part of the curriculum) and by 81% teachers and 82% principals. Willingness to participate in CPR training was 77% in schoolchildren, 79% in teachers and 86% in principals with 88% of the principals convinced that schoolchildren should learn how to perform CPR. Willingness to perform CPR in a real-life situation was 68% in schoolchildren, 84% in teachers and 92% in principals.

CONCLUSION

Schoolchildren are well aware of the importance of CPR and are willing to acquire the related knowledge and skills. Noteworthy is the larger awareness among principals and teachers, establishing a strong base for increasing implementation of CPR training in schools. However, a majority of children indicated a lack of training opportunities, highlighting the need for a stronger implementation.

What Do Adolescents Learn from a 50 Minute Cardiopulmonary Resuscitation/Automated External Defibrillator Education in a Rural Area: A Pre-Post Design

Background: Literature indicates that patients who receive cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) from bystanders have a greater chance of surviving out-of-hospital cardiac arrest (OHCA). A few evaluative studies involving CPR/AED education programs for rural adolescents have been initiated. This study aimed to examine the impact of a 50 min education program that combined CPR with AED training in two rural campuses. Methods: A quasi-experimental pre-post design was used. The 50 min CPR/AED training and individual performance using a Resusci Anne manikin was implemented with seventh grade students between August and December 2018. Results: A total of 336 participants were included in this study. The findings indicated that the 50 min CPR/AED education program significantly improved participant knowledge of emergency responses (p < 0.001), correct actions at home (p < 0.01) and outside (p < 0.001) during an emergency, and willingness to perform CPR if necessary (p < 0.001). Many participants described that “I felt more confident to perform CPR/AED,” and that “It reduces my anxiety and saves the valuable rescue time.” Conclusions: The brief education program significantly improved the immediate knowledge of cardiac emergency in participants and empowered them to act as first responders when they witnessed someone experiencing a cardiac arrest. Further studies should consider the study design and explore the effectiveness of such brief programs.

Awareness of basic life support and cardiopulmonary resuscitation among female secondary school students in government schools in Riyadh city, KSA

Background and Objective

Basic life support (BLS) and cardiopulmonary resuscitation (CPR) are urgently required and must be performed when cardiac arrest occurs. These lifesaving procedures must be learned by healthcare professionals. In developed countries, members of the public, academics, and students learn how to carry out these emergency procedures. Knowledge of these simple procedures determines successful outcome. This study was conducted to determine the level of awareness of BLS and CPR among female secondary students at governmental schools in Riyadh city, Saudi Arabia (SA).

Methods

This cross-sectional study was conducted in five governmental secondary schools in Riyadh city, SA, between June 2015 and June 2016. Total of 1224 female students were selected randomly, and data were collected using a self-reported structured questionnaire.

Results

A total of 1170 participants completed the questionnaire. Most of the participants (81.5%) were Saudis. More than 50% of the students (54.8%) did not have information about BLS, and 82.6% felt their knowledge about BLS was insufficient. Only 10.8% of the participants had taken a BLS course, and only 38.5% believe BLS courses should be mandatory.

Conclusion

The level of awareness regarding BLS among female secondary school students in governmental schools in Riyadh was found to be insufficient. The introduction of BLS and CPR courses in the curriculum of governmental secondary schools in Riyadh city is highly recommended.

The effectiveness of traditional Basic Life Support training and alternative technology-enhanced methods in high schools

Background:

Implementation of resuscitation training in school programs is a promising approach to improve rates of cardiopulmonary resuscitation use by trained bystanders. Unfortunately, theoretical cardiopulmonary resuscitation instruction alone is not sufficiently effective in developing practical skills.

Objectives:

This study aimed to investigate the effectiveness of traditional Basic Life Support training and alternative instructional methods to achieve learning objectives of Basic Life Support education.

Methods:

This quasi-experimental study was conducted in a secondary school in Ankara, Turkey. Eighty-three voluntary students were randomly allocated to theoretical (Group A), video-based (Group B), and mobile-assisted video-based instructions (Group C). All groups were led by the course teacher. Assessments were conducted in training and again 1 week later. Assessments were based on Basic Life Support knowledge and confidence performance scores.

Results:

Statistically significant difference was found for the groups’ Confidence Scale scores (F(2, 73) = 3.513, p = 0.035, ηp2 = 0.088); Group C (6.76 ± 1.70) scored higher than Group A. The groups’ Basic Life Support checklist scores were statistically significant (F(2, 73) = 28.050, p = 0.000, ηp2 = 0.435); Group C (32.32 ± 3.84) scored higher than the other groups. Statistically significant difference was found for the groups’ measurable Basic Life Support scores (F(2, 73) = 13.527, p = 0.000, ηp2 = 0.270); and Group C (23.76 ± 3.98) scored higher than the other groups.

Conclusion:

Our findings showed that all instruction methods led to increased Basic Life Support knowledge scores. The mobile-assisted program significantly increased knowledge scores. Same-group high-quality cardiopulmonary resuscitation parameters were more positive than the other instruction groups except for hand position. Group C students expressed higher confidence in their ability to act in an emergency when witnessing a victim collapse.

Attitudes towards bystander cardiopulmonary resuscitation: Results from a cross-sectional general population survey

Survival from out-of-hospital cardiac arrest (OHCA) varies across the developed world. Although not all OHCA are recoverable, the survival rate in Scotland is lower than in comparable countries, with higher average survival rates of 7.9% in England and 9% across Europe. The purpose of this paper is to explore the barriers, facilitators and public attitudes to administering bystander cardiopulmonary resuscitation (CPR) which could inform future policy and initiatives to improve the rate of bystander CPR. Data was collected via a cross-sectional general population survey of 1027 adults in Scotland. 52% of respondents had been trained in CPR. Of those who were not trained, two fifths (42%) expressed a willingness to receive CPR training. Fewer than half (49%) felt confident administering CPR, rising to 82% if they were talked through it by a call handler. Multivariate analyses identified that people in social grade C2DE were less likely than those in social grade ABC1 to be CPR trained and less confident to administer CPR if talked through by a call handler. The older a person was, the less likely they were to be CPR trained, show willingness to be CPR trained or be confident to administer bystander CPR with or without instruction from an emergency call handler. These findings are particularly relevant considering that most OHCA happen in the homes of older people. In a developed country such as Scotland with widely available CPR training, only half of the adult population reported feeling confident about administering bystander CPR. Further efforts tailored specifically for people who are older, unemployed and have a lower social grade are required to increase knowledge, confidence and uptake of training in bystander CPR.

Emotional Impact of Cardiopulmonary Resuscitation Training on High School Students

Background

The American Heart Association (AHA) has implemented several programs to educate the public about cardiopulmonary resuscitation (CPR). A common issue in bystander CPR is the fear of hurting the victim. As a result, the victim may not receive CPR in time. The purpose of this study was to measure the emotional impact of CPR training on high school students using two approved AHA courses.

Methods

A total of 60 students participated in this study. These students had a mean age of 15.4 ± 1.2 years old and were selected from a high school in Southern California. Subjects were divided into two groups, Basic Life Support (BLS) (n₁ = 31) and Hands-Only™ CPR (n₂ = 29). Emotional impacts were assessed by having each subject answer a questionnaire based on given scenarios before and after their training session.

Results

There was a significant difference in both groups when comparing positive-emotion scores before and after the training (BLS: 30.3 ± 6.0 vs. 34.5 ± 6.7, p < 0.001; Hands-Only 27.9 ± 5.0 vs. 32.1 ± 6.5, p < 0.001). In addition, both groups showed significant reductions in negative-emotion scores (BLS: 29.2 ± 6.7 vs. 23.7 ± 6.5, p < 0.001 and Hands-Only: 26.8 ± 6.1vs. 24.8 ± 7.7, p = 0.05).

Conclusion

Our results indicate that the AHA programs have positive effects on students’ emotional response. We recommend that future studies include an in-depth study design that probes the complexity of students’ emotions after completing an AHA session.

The effect of a national web course "Help-Brain-Heart" as a supplemental learning tool before CPR training: a cluster randomised trial

BACKGROUND

The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation.

METHODS

Classes with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention). Data were collected (practical test and a questionnaire) directly after training and at 6 months. CPR skills were evaluated using a modified Cardiff test (12-48 points). Knowledge on stroke symptoms (0-7 points), AMI symptoms (0-9 points) and lifestyle factors (0-6 points), and willingness to act were assessed by the questionnaire. The primary endpoint was CPR skills at 6 months. CPR skills directly after training, willingness to act and theoretical knowledge were secondary endpoints. Training and measurements were performed from December 2013 to October 2014.

RESULTS

Four hundred and thirty-two students were included in the analysis of practical skills and self-reported confidence. The mean score for CPR skills was 34 points after training (control, standard deviation [SD] 4.4; intervention, SD 4.0; not significant [NS]); and 32 points at 6 months for controls (SD 3.9) and 33 points for intervention (SD 4.2; NS). At 6 months, 73% (control) versus 80% (intervention; P = 0.05) stated they would do compressions and ventilation if a friend had a cardiac arrest, whereas 31% versus 34% (NS) would perform both if the victim was a stranger. One thousand, two hundred and thirty-two students were included in the analysis of theoretical knowledge; the mean scores at 6 months for the control and intervention groups were 2.8 (SD 1.6) and 3.2 (SD 1.4) points (P < 0.001) for stroke symptoms, 2.6 (SD 2.0) and 2.9 (SD 1.9) points (P = 0.008) for AMI symptoms and 3.2 (SD 1.2) and 3.4 (SD 1.0) points (P < 0.001) for lifestyle factors, respectively.

DISCUSSION

Use of online learning platforms is a fast growing technology that increases the flexibility of learning in terms of location, time and is available before and after practical training.

CONCLUSIONS

A web course before CPR training did not influence practical CPR skills or willingness to act, but improved the students' theoretical knowledge of AMI, stroke and lifestyle factors.

"You can also save a life!": children's drawings as a non-verbal assessment of the impact of cardiopulmonary resuscitation training

Drawings made by training children into cardiopulmonary resuscitation (CPR) during the special education week called "School otherwise" can be used as non-verbal means of expression and communication to assess the impact of such training. We analyzed the questionnaires and drawings completed by 327 schoolchildren in different stages of education. After a brief overview of the basic life support (BLS) steps and after watching a video presenting the dynamic performance of the BLS sequence, subjects were asked to complete a questionnaire and make a drawing to express main CPR messages. Questionnaires were filled completely in 97.6 % and drawings were done in 90.2 % cases. Half of the subjects had already witnessed a kind of medical emergency and 96.94 % knew the correct "112" emergency phone number. The drawings were single images (83.81 %) and less cartoon strips (16.18 %). Main themes of the slogans were "Save a life!", "Help!", "Call 112!", "Do not be indifferent/insensible/apathic!" through the use of drawings interpretation, CPR trainers can use art as a way to build a better relation with schoolchildren, to connect to their thoughts and feelings and obtain the highest quality education.

Lay Bystanders' Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests

Background

Many patients who suffer an out‐of‐hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what factors encourage lay bystanders to initiate CPR and AED use in a cohort of bystanders previously trained in CPR techniques who were present at an out‐of‐hospital cardiac arrest.

Methods and Results

One‐hundred and twenty‐eight semistructured qualitative interviews with CPR‐trained lay bystanders to consecutive out‐of‐hospital cardiac arrest, where an AED was present were conducted (from January 2012 to April 2015, in Denmark). Purposive maximum variation sampling was used to establish the breadth of the bystander perspective. Twenty‐six of the 128 interviews were chosen for further in‐depth analyses, until data saturation. We used cross‐sectional indexing (using software), and inductive in‐depth thematic analyses, to identify those factors that facilitated CPR and AED use. In addition to prior hands‐on CPR training, the following were described as facilitators: prior knowledge that intervention is crucial in improving survival, cannot cause substantial harm, and that the AED will provide guidance through CPR; prior hands‐on training in AED use; during CPR performance, teamwork (ie, support), using the AED voice prompt and a ventilation mask, as well as demonstrating leadership and feeling a moral obligation to act.

Conclusions

Several factors other than previous hands‐on CPR training facilitate lay bystander instigation of CPR and AED use. The recognition and modification of these factors may increase lay bystander CPR rates and patient survival following an out‐of‐hospital cardiac arrest.

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study

OBJECTIVE

Cardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims.

METHODS, PARTICIPANTS

This is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims. We used a semistructured interview guide focusing on their experiences after providing CPR.

SETTING

The study was conducted in the Stavanger region of Norway, an area with very high bystander CPR rates.

RESULTS

Three themes emerged from the interview analysis: concern, uncertainty and coping strategies. Providing CPR had been emotionally challenging for all lay rescuers and, for some, had consequences in terms of family and work life. Several lay rescuers experienced persistent mental recurrences of the OHCA incident and had concerns about the outcome for the cardiac arrest victim. Unknown or fatal outcomes often caused feelings of guilt and were particularly difficult to handle. Several reported the need to be acknowledged for their CPR attempts. Health-educated lay rescuers seemed to be less affected than others. A common coping strategy was confiding in close relations, preferably the health educated. However, some required professional help to cope with the OHCA incident.

CONCLUSIONS

Lay rescuers experience emotional and social challenges, and some struggle to cope in life after providing CPR in OHCA incidents. Experiencing a positive patient outcome and being a health-educated lay rescuer seem to mitigate concerns. Common coping strategies are attempts to reduce uncertainty towards patient outcome and own CPR quality. Further studies are needed to determine whether an organised professional follow-up can mitigate the concerns and uncertainty of lay rescuers.

Knowledge of the Portuguese population on Basic Life Support and availability to attend training

OBJECTIVETo evaluate the level of knowledge and the availability of the Portuguese population to attend training in Basic Life Support (BLS) and identify factors related to their level of knowledge about BLS.METHODObservational study including 1,700 people who responded to a questionnaire containing data on demography, profession, training, interest in training and knowledge about BLS.RESULTSAmong 754 men and 943 women, only 17.8% (303) attended a course on BLS, but 95.6% expressed willingness to carry out the training. On average, they did not show good levels of knowledge on basic life support (correct answers in 25.9 ± 11.5 of the 64 indicators). Male, older respondents who had the training and those who performed BLS gave more correct answers, on average (p<0.01).CONCLUSIONThe skill levels of the Portuguese population are low, but people are available for training, hence it is important to develop training courses and practice to improve their knowledge.