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

Barriers and facilitators for successful AED usage during in-situ simulated in-hospital cardiac arrest

Introduction

Methods

Results

Conclusion

Bystander performance using the 2010 vs 2015 ERC guidelines: A post-hoc analysis of two randomised simulation trials

BACKGROUND

The European Resuscitation Council (ERC) basic life support (BLS) 2015 guidelines were simplified compared to the 2010 guidelines. We aimed to compare BLS/automated external defibrillator (AED) skill performance and skill retention following training with the 2010 or 2015 BLS/AED guidelines.

METHODS

Post-hoc analysis of two randomised simulation trials including videorecordings of laypersons skill-tested after ERC BLS/AED training using either the 2010 (n = 70) or 2015 (n = 70) BLS guidelines. Outcomes: (a) correct sequence of the BLS/AED algorithm, (b) correct sequence of the BLS/AED algorithm with all skills performed correctly, and (c) time to EMS call, first chest compression and shock delivery immediately after training and three months later. Groups were compared using multivariate logistic regression.

RESULTS

Mean age (±standard deviation) was 40 (±11) vs. 44 (±11) years and 70% vs. 50% were females for the 2010 and 2015 groups, respectively. Correct sequence of the BLS/AED algorithm for the 2010 vs. 2015 group was 84% vs. 91%, P = 0.08 immediately after training and 16% vs. 41%, adjusted odds ratio (aOR): 5.6 (95% CI: 2.3-14.0, P < 0.001) after three months. Correct sequence with all skills performed correctly was 56% vs. 47%, P = 0.31 immediately after training and 5% vs. 16%, aOR: 4.8 (95% CI: 1.2-19.2), P = 0.03 after three months. Time to EMS call was shorter in the 2015 group immediately after training (P = 0.008) but all other time points did not differ.

CONCLUSION

The simplified 2015 BLS guidelines was associated with better adherence to the sequence of the BLS/AED algorithm when compared to the 2010 BLS guidelines three months after training in a simulated cardiac arrest scenario, without significantly improving skill performance immediately after training.

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

Background

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

Methods

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

Results

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

Conclusion

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

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.