Minimal instructions improve the performance of laypersons in the use of semiautomatic and automatic external defibrillators

The general public's ability to operate automated external defibrillator: A controlled simulation study

BACKGROUND

Automated external defibrillators (AEDs) enable laypeople to provide early defibrillations to patients undergoing cardiac arrest, but scant information is available on the general public's ability to use AEDs. This study assessed the ability of laypeople to operate AEDs, the effect of a 15-minute training, and whether skills differed by age.

METHODS

From May 1 to December 31, 2018, a prospective simulation study was conducted with 94 laypeople aged 18-65 years (32 aged 18-24 years, 34 aged 25-54 years, and 28 aged 55-65 years) with no prior AED training. The participants' AED skills were assessed individually pre-training, post-training, and at a three-month follow-up using a simulated cardiac arrest scenario. The critical actions and time intervals were evaluated during the AED operating process.

RESULTS

Only 14 (14.9%) participants (eight aged 18-24 years, four aged 25-54 years, and two aged 55-65 years) successfully delivered defibrillations before training. AED operation errors were more likely to occur among the participants aged 55-65 years than among other age groups. After training, the proportion of successful defibrillations increased significantly (18-24 years old: 25.0% vs. 71.9%, P<0.01; 25-54 years old: 11.8% vs. 70.6%, P<0.01; 55-65 years old: 7.1% vs. 67.9%, P<0.01). After three months, 26.1% of the participants aged 55-65 years successfully delivered defibrillations, which was significantly lower than that of participants aged 18-24 years (54.8%) and 25-54 years (64.3%) (P=0.02). There were no differences in time measures among three age groups in each test.

CONCLUSIONS

The majority of untrained laypeople cannot effectively operate AEDs. More frequent training and refresher courses are crucial to improve AED skills.

Automated external defibrillation training on the left or the right side - a randomized simulation study

Background

Correct placement of the left automated external defibrillator (AED) electrode is rarely achieved. AED electrode placement is predominantly illustrated and trained with the rescuer sitting on the right side of the patient. Placement of the AED electrodes from the left side of the patient may result in a better overview of and access to the left lateral side of the thorax. This study aimed to investigate if training in automated external defibrillation on the left side compared to the right side of a manikin improves left AED electrode placement.

Methods

Laypeople attending basic life support training were randomized to learn automated external defibrillation from the left or right side of a manikin. After course completion, participants used an AED and placed AED electrodes in a simulated cardiac arrest scenario.

Results

In total, 40 laypersons were randomized to AED training on the left (n=19 [missing data =1], 63% female, mean age: 47.3 years) and right (n=20, 75% female, mean age: 48.7 years) sides of a manikin. There was no difference in left AED electrode placement when trained on the left or right side: the mean (SD) distances to the recommended left AED electrode position were 5.9 (2.1) cm vs 6.9 (2.2) cm (p=0.15) and to the recommended right AED electrode position were 2.6 (1.5) cm vs 1.8 (0.8) cm (p=0.06), respectively.

Conclusion

Training in automated external defibrillation on the left side of a manikin does not improve left AED electrode placement compared to training on the right side.

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.

Long-term retention of cardiopulmonary resuscitation skills after shortened chest compression-only training and conventional training: a randomized controlled trial

OBJECTIVES

It is unclear how much the length of a cardiopulmonary resuscitation (CPR) training program can be reduced without ruining its effectiveness. The authors aimed to compare CPR skills 6 months and 1 year after training between shortened chest compression-only CPR training and conventional CPR training.

METHODS

Participants were randomly assigned to either the compression-only CPR group, which underwent a 45-minute training program consisting of chest compressions and automated external defibrillator (AED) use with personal training manikins, or the conventional CPR group, which underwent a 180-minute training program with chest compressions, rescue breathing, and AED use. Participants' resuscitation skills were evaluated 6 months and 1 year after the training. The primary outcome measure was the proportion of appropriate chest compressions 1 year after the training.

RESULTS

A total of 146 persons were enrolled, and 63 (87.5%) in the compression-only CPR group and 56 (75.7%) in the conventional CPR group completed the 1-year evaluation. The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression (mean ± SD = 59.8% ± 40.0% vs. 46.3% ± 28.6%; p = 0.036) and the number of appropriate chest compressions (mean ± SD = 119.5 ± 80.0 vs. 77.2 ± 47.8; p = 0.001). Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group (mean ± SD = 11.8 ± 21.1 seconds vs. 52.9 ± 14.9 seconds; p < 0.001).

CONCLUSIONS

The shortened compression-only CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program.

CLINICAL TRIAL REGISTRATION

UMIN-CTR UMIN000001675.

Simplified dispatcher instructions improve bystander chest compression quality during simulated pediatric resuscitation

AIM

Cardiopulmonary resuscitation (CPR) quality is associated with survival outcomes after out-of-hospital cardiac arrest. The objective of this study was to evaluate the effectiveness of simplified dispatcher CPR instructions to improve the chest compression (CC) quality during simulated pediatric cardiac arrest in public places.

METHODS

Adult bystanders recruited in public places were randomized to receive one of two scripted dispatcher CPR instructions: (1) "Push as hard as you can" (PUSH HARD) or (2) "Push approximately 2 inches" (TWO INCHES). A pediatric manikin with realistic CC characteristics (similar to a 6-year-old child), and a CPR recording defibrillator was used for quantitative CC data collection during a 2-min simulated pediatric scenario. The primary outcome was average CC depth treated as a continuous variable. Secondary outcomes included compliance with American Heart Association (AHA) CPR targets. Analysis was by two-sided unpaired t-test and Chi-square test, as appropriate.

RESULTS

128 out of 140 providers screened met inclusion/exclusion criteria and all 128 consented. The average CC depth (mean (SEM)) was greater in PUSH HARD compared to TWO INCHES (43 (1) vs. 36 (1) mm, p<0.01) and met AHA targets more often (39% (25/64) vs. 20% (13/64), p=0.02). CC rates trended higher in the PUSH HARD group (93 (4) vs. 82 (4) CC/min, p=0.06). More providers did not achieve full chest recoil with PUSH HARD compared to TWO INCHES (53% (34/64) vs. 75% (48/64), p=0.01).

CONCLUSIONS

Simplified dispatcher assisted pediatric CPR instructions: "Push as hard as you can" was associated with lay bystanders providing deeper and faster CCs on a simulated, 6-year-old pediatric manikin. However, percentage of providers leaning between CC increased. The potential effect of these simplified instructions in younger children remains unanswered.

Can mass education and a television campaign change the attitudes towards cardiopulmonary resuscitation in a rural community?

BACKGROUND

Survival after out-of-hospital cardiac arrest (OHCA) is improved when bystanders provide Basic Life Support (BLS). However, bystander BLS does not occur frequently. The aim of this study was to assess the effects on attitudes regarding different aspects of resuscitation of a one-year targeted media campaign and widespread education in a rural Danish community. Specifically, we investigated if the proportion willing to provide BLS and deploy an automated external defibrillator (AED) increased.

METHODS

BLS and AED courses were offered and the local television station had broadcasts about resuscitation in this study community. A telephone enquiry assessed the attitudes towards different aspects of resuscitation among randomly selected citizens before (2008) and after the project (2009).

RESULTS

For responses from 2008 (n = 824) to 2009 (n = 815), there was a significant increase in the proportions who had participated in a BLS course within the past 5 years, from 34% to 49% (p = 0.0001), the number willing to use an AED on a stranger (p < 0.0001), confident at providing chest compressions (p = 0.03), and confident at providing mouth-to-mouth ventilations (MMV) (p = 0.048). There was no significant change in the proportions willing to provide chest compressions (p = 0.15), MMV (p = 0.23) or confident at recognizing a cardiac arrest (p = 0.09). The most frequently reported reason for not being willing to provide chest compressions, MMV and use an AED was insecurity about how to perform the task.

CONCLUSION

A targeted media campaign and widespread education can significantly increase the willingness to use an AED, and the confidence in providing chest compressions and MMV. The willingness to provide chest compressions and MMV may be less influenced by a targeted campaign.

Effectiveness of current teaching methods in Cardiology: the SKILLS (medical Students Knowledge Integration of Lower Level clinical Skills) study

INTRODUCTION

The aim of the study is to assess reported changes in medical students' capacity to attain five basic cardiological clinical skills, following a one-month intensive cardiology course provisioned in the core curriculum.

MATERIALS AND METHODS

An anonymous questionnaire comprising self reported performance in the five skills, namely 1) arterial blood pressure measurement, 2) cardiac auscultation, 3) electrocardiogram (ECG) carry out, 4) ECG interpretation and 5) defibrillation, was distributed to 177 fifth year students of the Athens Medical School upon initiating the cardiology course (pre-training group) and to 59 students matched for sex, age, year of study and training centre, following completion of the course (post training group). Comparison of pre- and post- training performance was evaluated using the χ(2) test.

RESULTS

No change was noted with regards to blood pressure measurement, cardiac auscultation or defibrillation. By contrast, a statistically significant improvement was reported for ECG execution (54.3 versus 81.4%; p<0.001) and interpretation (from 33.1 to 89.8%; p<0.001).

CONCLUSIONS

Improvement in the execution and interpretation of ECGs seems to be among the strengths of the cardiology training program. Further studies including larger samples from multiple medical schools and objective assessment of skill execution might facilitate accurate training evaluation and define opportunities for improvement.

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.

Evaluation of a newly developed media-supported 4-step approach for basic life support training

Objective

The quality of external chest compressions (ECC) is of primary importance within basic life support (BLS). Recent guidelines delineate the so-called 4“-step approach” for teaching practical skills within resuscitation training guided by a certified instructor. The objective of this study was to evaluate whether a “media-supported 4-step approach” for BLS training leads to equal practical performance compared to the standard 4-step approach.

Materials and methods

After baseline testing, 220 laypersons were either trained using the widely accepted method for resuscitation training (4-step approach) or using a newly created “media-supported 4-step approach”, both of equal duration. In this approach, steps 1 and 2 were ensured via a standardised self-produced podcast, which included all of the information regarding the BLS algorithm and resuscitation skills. Participants were tested on manikins in the same mock cardiac arrest single-rescuer scenario prior to intervention, after one week and after six months with respect to ECC-performance, and participants were surveyed about the approach.

Results

Participants (age 23 ± 11, 69% female) reached comparable practical ECC performances in both groups, with no statistical difference. Even after six months, there was no difference detected in the quality of the initial assessment algorithm or delay concerning initiation of CPR. Overall, at least 99% of the intervention group (n = 99; mean 1.5 ± 0.8; 6-point Likert scale: 1 = completely agree, 6 = completely disagree) agreed that the video provided an adequate introduction to BLS skills.

Conclusions

The “media-supported 4-step approach” leads to comparable practical ECC-performance compared to standard teaching, even with respect to retention of skills. Therefore, this approach could be useful in special educational settings where, for example, instructors’ resources are sparse or large-group sessions have to be prepared.

Effect of a reminder video using a mobile phone on the retention of CPR and AED skills in lay responders

BACKGROUND

Skills related to cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use by lay responders decay rapidly after training, and efforts are required to maintain competence among trainees. We examined whether repeated viewing of a reminder video on a mobile phone would be an effective means of maintaining CPR and AED skills in lay responders.

METHODS

In a single-blind case-control study, 75 male students received training in CPR and AED use. They were allocated either to the control or to the video-reminded group, who received a memory card containing a video clip about CPR and AED use for their mobile phone, which they were repeatedly encouraged to watch by SMS text message. CPR and AED skills were assessed in scenario format by examiners immediately and 3 months after initial training.

RESULTS

Three months after initial training, the video-reminded group showed more accurate airway opening (P<0.001), breathing check (P<0.001), first rescue breathing (P=0.004), hand positioning (P=0.004), AED electrode positioning (P<0.001), pre-shock safety check (P<0.001), defibrillation within 90s (P=0.010), and resuming CPR after defibrillation (P<0.001) than controls. They also showed significantly higher self-assessed CPR confidence scores and increased willingness to perform bystander CPR in cardiac arrest than the controls at 3 months (P<0.001, P=0.024, respectively).

CONCLUSION

Repeated viewing of a reminder video clip on a mobile phone increases retention of CPR and AED skills in lay responders.

Implementation of automated external defibrillators on merchant ships

BACKGROUND

In contrast to cruise ships, ferries and merchant ships are rarely equipped with automated external defibrillators (AEDs). Germany is the first flag state worldwide that legally requires to carry AEDs on seagoing merchant vessels by September 2012 at the latest.

OBJECTIVES

The aim of this study was to investigate the effect of training ship officers in the handling of AEDs and to explore their perceptions concerning the user-friendliness of currently available defibrillators.

METHODS

Using four different AEDs, 130 nautical officers performed a total of 400 resuscitation drills. One group (n = 60) used only one device before and after resuscitation training; the other group (n = 70) used all four AEDs in comparison after training. The officers' performances were timed and they were asked by questionnaire about the user-friendliness of each AED.

RESULTS

Without resuscitation training, 81.7% of the first mentioned group delivered an effective defibrillation shock. After a 7-hour resuscitation training with special regard to defibrillation, all ship officers (n = 130) used the AED correctly. Among all AEDs, the mean time until start of analysis decreased from 72.4 seconds before to 60.4 seconds after resuscitation training (Wilcoxon test; p < 0.001). The results of the questionnaire and the differences in time to first shock indicated a different user-friendliness of the AEDs. The voice prompts and the screen messages of all AEDs were well understood by all participants. In the second mentioned group, 57.1% regarded feedback information related to depths and frequency of thorax compression as helpful.

CONCLUSION

Nautical officers are able to use AEDs in a timely and effective way with proper training. However, to take advantage of all wanted features of the device (monitoring and resuscitation), the ship management has to observe practical questions of storage, maintenance, signing, training, data management, and transmission. Thus, implementation of the regulations requires proper instructions for the maritime industry by responsible bodies.

AED training and its impact on skill acquisition, retention and performance--a systematic review of alternative training methods

INTRODUCTION

The most popular method of training in basic life support and AED use remains instructor-led training courses. This systematic review examines the evidence for different training methods of basic life support providers (laypersons and healthcare providers) using standard instructor-led courses as comparators, to assess whether alternative method of training can lead to effective skill acquisition, skill retention and actual performance whilst using the AED.

METHOD

OVID Medline (including Medline 1950-November 2010; EMBASE 1988-November 2010) was searched using "training" OR "teaching" OR "education" as text words. Search was then combined by using AND "AED" OR "automatic external defibrillator" as MESH words. Additionally, the American Heart Association Endnote library was searched with the terms "AED" and "automatic external defibrillator". Resuscitation journal was hand searched for relevant articles.

RESULTS

285 articles were identified. After duplicates were removed, 172 references were reviewed for relevance. From this 22 papers were scrutinized and 18 were included. All were manikin studies. Four LOE 1 studies, seven LOE 2 studies and three LOE 4 studies were supportive of alternative AED training methods. One LOE 2 study was neutral. Three LOE 1 studies provided opposing evidence.

CONCLUSION

There is good evidence to support alternative methods of AED training including lay instructors, self directed learning and brief training. There is also evidence to support that no training is needed but even brief training can improve speed of shock delivery and electrode pad placement. Features of AED can have an impact on its use and further research should be directed to making devices user-friendly and robust to untrained layperson.

Pharmacy students' retention of knowledge and skills following training in automated external defibrillator use

OBJECTIVES

To assess pharmacy students' retention of knowledge about appropriate automated external defibrillator use and counseling points following didactic training and simulated experience.

DESIGN

Following a lecture on sudden cardiac arrest and automated external defibrillator use, second-year doctor of pharmacy (PharmD) students were assessed on their ability to perform basic life support and deliver a shock at baseline, 3 weeks, and 4 months. Students completed a questionnaire to evaluate recall of counseling points for laypeople/the public.

ASSESSMENT

Mean time to shock delivery at baseline was 74 ± 25 seconds, which improved significantly at 3 weeks (50 ± 17 seconds, p < 0.001) and was maintained at 4 months (47 ± 18 seconds, p < 0.001). Recall of all signs and symptoms of sudden cardiac arrest and automated external defibrillator counseling points was diminished after 4 months.

CONCLUSION

Pharmacy students can use automated external defibrillators to quickly deliver a shock and are able to retain this ability after 4 months. Refresher training/courses will be required to improve students' retention of automated external defibrillator counseling points to ensure their ability to deliver appropriate patient education.

The intuitive use of laryngeal airway tools by first year medical students

Background

Providing a secured airway is of paramount importance in cardiopulmonary resuscitation. Although intubating the trachea is yet seen as gold standard, this technique is still reserved to experienced healthcare professionals. Compared to bag-valve facemask ventilation, however, the insertion of a laryngeal mask airway offers the opportunity to ventilate the patient effectively and can also be placed easily by lay responders. Obviously, it might be inserted without detailed background knowledge.

The purpose of the study was to investigate the intuitive use of airway devices by first-year medical students as well as the effect of a simple, but well-directed training programme. Retention of skills was re-evaluated six months thereafter.

Methods

The insertion of a LMA-Classic and a LMA-Fastrach performed by inexperienced medical students was compared in an airway model. The improvement on their performance after a training programme of overall two hours was examined afterwards.

Results

Prior to any instruction, mean time to correct placement was 55.5 ± 29.6 s for the LMA-Classic and 38.1 ± 24.9 s for the LMA-Fastrach. Following training, time to correct placement decreased significantly with 22.9 ± 13.5 s for the LMA-Classic and 22.9 ± 19.0 s for the LMA-Fastrach, respectively (p < 0.05). After six months, the results are comparable prior (55.6 ± 29.9 vs 43.1 ± 34.7 s) and after a further training period (23.5 ± 13.2 vs 26.6 ± 21.6, p < 0.05).

Conclusion

Untrained laypersons are able to use different airway devices in a manikin and may therefore provide a secured airway even without having any detailed background knowledge about the tool. Minimal theoretical instruction and practical skill training can improve their performance significantly. However, refreshment of knowledge seems justified after six months.

Effects of AED device features on performance by untrained laypersons

OBJECTIVE

Our study evaluates the impact of features of automated external defibrillators (AEDs) on the performance and speed of untrained laypersons to deliver a shock and initiate CPR after a shock.

METHODS

This was a randomized trial of volunteer laypersons without AED or advanced medical training. Subjects were assigned to use one of six different models of AEDs on a manikin in simulated cardiac arrest. No instructions on AED operation were provided. Primary endpoints were shock delivery and elapsed time from start to shock. Secondary endpoints included time to power-on, initiation of CPR, adequacy of pad placement and subjects' ratings of ease of use (1=very easy, 5=very difficult).

RESULTS

Most subjects (109/120; 91%) were able to deliver a shock. Median time from start of scenario to shock delivery was 79 s (IQR: 67-99). Of the 11 participants who did not deliver shock, eight never powered on the device. Time to power-on was shorter in devices with open lid (median 12s, IQR 8-27 s) and pull handle (17s, IQR 9-20s) mechanisms than with a push button (37s, IQR 18-69 s; p=0.000). Pad position on the manikin was judged adequate for 86 (77%) of the 111 subjects who placed pads. Devices which gave more detailed voice instruction for pad placement had higher rates of adequate pad position [38/39 (97%) versus 50/73 (68%), p=0.001]. With AEDs that provided step-by-step CPR instruction, 49/58 (84%) subjects began CPR compared to 26/51 (51%) with AEDs that only prompted to start CPR (p=0.01). Participants rated all the models easy to use (overall mean 1.48; individual device means 1.28-1.71).

CONCLUSIONS

Most untrained laypersons were successful in delivering a shock. Device features had the most impact on these functions: ability and time to power-on device, adequacy of pad position and initiation of CPR.

Improving the outcome of in-hospital cardiac arrest: the importance of being EARNEST

Cardiopulmonary resuscitation techniques were introduced more than 50 years ago, yet the rate of survival from cardiac arrest, particularly in the hospital setting, remains dismally low. This article reviews the prevalence, etiology, and outcome of in-hospital cardiac arrest, with a focus on the determinants of outcome that are amenable to improvement. These include principally components of basic life support that may be supported by either prompting or mechanical assistance (eg, chest compression, ventilation, and defibrillation). Also reviewed are preevent and postevent effectors such as medical staff skills and recognition of impending arrest, induction of mild hypothermia, and stabilization after return of spontaneous circulation.

Retention of skills in medical students following minimal theoretical instructions on semi and fully automated external defibrillators

AIM OF THE STUDY

There is consent that the use of automated external defibrillators (AED) by laypersons improves survival rates in case of cardiac arrest, but no evident consensus exists on the content and duration of training for this purpose. Acceptance of the implementation of Public Access Defibrillation programmes will depend on practical and target-oriented training concepts. The aim of this prospective randomised interventional study was to evaluate long-term effects of a specific, minimal training programme on using semiautomatic and fully automatic AEDs in simulated cardiac arrest.

MATERIALS AND METHODS

In a mock cardiac arrest scenario 59 medical students with no specific previous medical education were tested during their first semester at medical school. Students who passed any medical emergency training were excluded. The subjects were evaluated before and after attending specified instructions of 15 min duration and after a period of 6 months. Main end points were time to first shock, electrode-positioning and safety throughout the procedure.

RESULTS

Mean time to first shock without prior instructions was 77.7+/-17.05 s. After instruction there was a significant improvement to 56.5+/-9.5 s (p<or=0.01) and after 6 months this time had only slightly elongated (59.9+/-8.9 s; p<or=0.01). Initially, correct electrode placement was observed in 84.4%. No difference was found immediately and 6 months after instructions (93.2% and 98.3%). All individuals performed safely.

CONCLUSION

First year medical students with minimal instruction are able to use semiautomatic as well as fully automatic AED sufficiently fast and safe without prior training. A significant improvement in time to first shock can be detected up to 6 months after receiving non-specific instructions of 15 min duration.

CPREzy™ improves performance of external chest compressions in simulated cardiac arrest

AIM OF THE STUDY

External chest compression (ECC) is an essential part of cardiopulmonary resuscitation and usually performed without any adjuncts. Although different supportive devices have been developed, none have yet been implemented as a standard procedure to guide rescuers in resuscitation. This study investigates the effects of the CPREzy-pad on ECC performed by first year medical students during simulated cardiac arrest.

MATERIALS AND METHODS

Two hundred and two subjects were randomised and asked to perform 5 min of single-rescuer-CPR. Group 1 (n = 111) was taught classic ECC, followed by ECC with the CPREzy and was tested in ECC with the CPREzy. Group 2 (n = 91) was taught and tested in classic ECC only. One week later each group was divided: Group 1A was tested in ECC with the CPREzy again; Group 1B was tested in classic ECC. Group 2A was taught and tested in ECC with CPREzy; Group 2B was tested in classic ECC again. Primary endpoints were compression rate (90-110/min) and compression depth (40-50mm).

RESULTS

Comparing groups 1 and 2, ECC was significantly superior with CPREzy (correct rate: 93.7% versus 19.8%, p < or = 0.01; depth: 71.2% versus 34.1%, p < or = 0.01). The group tested with CPREzy initially 1 week later (2A; n = 36) improved significantly in correct compression rate (19.8% versus 88.9%, p < or = 0.01) and compression depth (34.1% versus 75.0%, p < or = 0.02). The control-group (2B; n = 55) without CPREzy demonstrated poor performance in both evaluations (correct rate: 19.8% versus 25.5%, depth: 34.1% versus 43.6%).

CONCLUSION

CPREzy as a simple portable and re-usable device is able to improve performance of ECC in simulated cardiac arrest.

In-hospital cardiac arrest

To review the current management of in-hospital cardiac arrest and to identify variables that influence outcomes, OLDMEDLINE from 1950 to 1966 and MEDLINE from 1966 to March 2005 were searched using the keywords cardiopulmonary resuscitation, cardiac arrest, in hospital, and adult. Secondary sources were derived from review publications and personal communications by one of the authors. There is no secure evidence that the ultimate outcomes after cardiopulmonary resuscitation in settings of in-hospital cardiac arrest have improved in the >40 yrs that followed the landmark report by Kouwenhoven, Jude, and Knickerbocker, which launched the modern era of cardiopulmonary resuscitation. A paucity of objective measurements preclude secure protocols for sequencing of interventions and, even more, when to initiate and discontinue cardiopulmonary resuscitation. The preparedness of both physicians and nursing professionals to implement the published guidelines has itself been questioned. Whereas early access defibrillation with automated external defibrillators may be of benefit in out-of-hospital settings, there has as yet been no secure evidence that automated external defibrillators have had a favorable impact on in-hospital cardiopulmonary resuscitation when used on infrequent occasions by first responders. This contrasts with the much greater success of advanced life support providers and especially when electrical defibrillation is promptly performed by expertly trained personnel after onset of cardiac arrest. Outcomes are therefore improved in critical care settings and especially in coronary care units in which patients are continuously monitored.

Charging up the public for automated external defibrillators

Public training in the use of automated external defibrillators to treat out-of-hospital cardiac arrests has been receiving increased attention. The implementation of public access defibrillation programs has been the most significant intervention to improve survival in decades. Dramatic success came when we placed automated external defibrillators in the hands of the public to be utilized without an Emergency Medical Services response having to occur. The device is simple to operate – sixth-grade children have demonstrated safe and effective operation. Training should be taken to its elemental level. Cardiopulmonary resuscitation training should not be forgotten; it too should be taken to its simplest form.