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Resuscitation skills of lay public after recent training
Abstract
To investigate the ability of laypeople to apply basic CPR techniques after recent training.
Cross-sectional assessment of practical CPR skills.
151 laypeople who were trained twice in the preceding 20 to 24 months.
Practical skills were tested using six primary recorded variables that describe the quality of CPR techniques in a training situation. A total score on the skills of each participant was computed on the basis of a predefined scoring system. Thirty-three percent of the participants were able to perform adequate CPR. The compression:relaxation ratio, the breathing volume, and the breathing interval were points of concern.
Practical skills in basic CPR after a 12-month training interval, though better in this study than in many previous studies, are insufficient in the majority of laypeople. The results of this study could be used to design a better tailored (re)instruction program, with an emphasis on regular, frequent refresher courses.
... Frequency of training opportunities may also have an impact on remembering of skills. One study which examined participants whom received two training sessions within twenty-four months found 33% of participants could perform CPR skills adequately, a higher percentage than many other studies measuring retention after one training session (Berden et al., 1994). ...
... The literature examining retention of CPR skills states several additional limitations of studies conducted thus far. Initial training is often not standardized and achievement of competence is not always assured during initial training (Berden et al., 1994;McKenna and Glendon, 1985). Much of the variance in CPR skill retention is left unexplained (Glendon et al., 1988;Magura et al., 2012), providing impetus for future research. ...
... Learners who had exposure to multiple training opportunities tended to perform better on retention tests than those participating in a course for the first time (Anderson et al., 2011;Berden et al., 1994). Both long-term (i.e. ...
... In contrast to earlier meta analyses, the odds ratios for coronary artery disease, cerebrovascular disease and peripheral disease were not different. More recent meta-analysis demonstrated that stronger associations were observed in retrospective studies where homocysteine was measured in blood collected after the onset of disease than in prospective studies among individuals who had no history of cardiovascular disease when blood was collected [7]. With regard to the consistency of the finding of a positive association between hyperhomocysteinemia and premature vascular disease, it is important to note that to date, more than 20 prospective studies of the topic have been published. ...
... With regard to the consistency of the finding of a positive association between hyperhomocysteinemia and premature vascular disease, it is important to note that to date, more than 20 prospective studies of the topic have been published. Among these, the population-based, nested, case-control studies showed that a 5 µmol/L increment in total plasma homocysteine results in a 20–30% increase in cardiovascular risk, which is substantially lower than the 60–90% risk enhancement shown in the retrospective case-control studies[7]. The prospective studies also suggested that the risk is highest during short-term follow-up and is attenuated after 3–4 years. ...
... MS requires the co-factor cobalamin (vitamin B12) for the methyl transport from 5- methyltetrahydrofolate to homocysteine. MS is activated by S- adenosylmethionine [7]. The MTHFR dependant methionine synthase remethylation pathway is located in almost all tissues. ...
... However, extensive research in first aid training has shown retention of theoretical knowledge and practical skills following first aid training, for both lay people and health professionals, declines with time. 28,29 Similarly, the level of skills retention after a 12 month interval since training is insufficient for the majority of lay persons. 25 Schumann et al. 29 conducted a detailed analysis of wilderness first aid knowledge, self-efficacy and skills retention at varying intervals following training. ...
... 28,29 Similarly, the level of skills retention after a 12 month interval since training is insufficient for the majority of lay persons. 25 Schumann et al. 29 conducted a detailed analysis of wilderness first aid knowledge, self-efficacy and skills retention at varying intervals following training. The work showed that without repeated practice, skills and knowledge degraded over time and demonstrated the more complex a skill the greater the deterioration in performance. ...
... Bennet et al. (2017) recognized the need to allow wilderness first aid courses to evolve with evidence-based practices to ensure a "better understanding of what first aid practices are safe and effective in the hands of a lay provider and how best to teach these skills" (p. 233), and further recommended continued examination of how well the lay public learns and retains first aid skills and performs first aid techniques (Berden et al., 1994). Current and past studies point to poor skill retention, suggesting the need for reduced course complexity in first aid education and training programs while increasing the frequency of re-certification (Berden et al., 1994;Schumann et al., 2012). ...
... 233), and further recommended continued examination of how well the lay public learns and retains first aid skills and performs first aid techniques (Berden et al., 1994). Current and past studies point to poor skill retention, suggesting the need for reduced course complexity in first aid education and training programs while increasing the frequency of re-certification (Berden et al., 1994;Schumann et al., 2012). The complexity of first aid training and outdoor education skill proficiency required for the teacher to lead outdoors compels us to continue to use the 7 Rights. ...
... However for compiling the results in order to compare results between different groups, and to given guidelines, additionally instruments were needed. Berden et al. [109] introduced a scoring system with penalty points ranging from five to twenty depending on the seriousness of the mistakes made. Only mistakes regarding ventilations and chest compressions were assessed. ...
... Those who had taken part in a course had done this on average 22 years ago [80]. As we know that skills of performance in CPR deteriorate rapidly with time following education [97,109], and that ineffective CPR has no influence on survival [87,88], one can speculate as to whether or not those who were trained a long time ago will manage to perform any effective CPR at all. ...
... Retention of CPR skills is problematic with poor performance 3-6 months posttraining. [16][17][18] Inadequate time to practice skills on a manikin has been implicated as a specific cause of poor skill acquisition. 18 Recent modifications of defibrillator technology using a force sensor and accelerometer (Philips MRx/Q-CPR) can provide realtime audiovisual feedback on the rate, depth, and quality of chest compressions (CC) during CPR. ...
... Nonetheless, multiple studies suggest that chest compression quality continues to be sub-optimal after CPR training and could be contributing to the poor performance in clinical practice. [16][17][18]22 The quality of actual CPR has been shown to be poor in adult cardiac arrest resuscitation attempts and the importance of high quality CPR for improved survival suggests a critical need for novel methods to improve the quality of CPR. Two possible targets for improving CPR psychomotor skill delivery are (1) directive and corrective audiovisual feedback and monitoring of CPR quality during resuscitation attempts, and (2) novel bedside educational programs that bring the teaching to the bedside where the care is provided in a frequent, just-in-time manner. ...
High quality CPR skill retention is poor. We hypothesized that "just-in-time" and "just-in-place" training programs would be effective and well-accepted to maintain CPR skills among PICU staff.
"Rolling Refreshers", a portable manikin/defibrillator system with chest compression sensor providing automated corrective feedback to optimize CPR skills, were conducted daily in the PICU with multidisciplinary healthcare providers. Providers practiced CPR until skill success was attained, prospectively defined as <3 corrective prompts within 30s targeting chest compression (CC) rate 90-120/min, CC depth > 38 mm during continuous CPR. Providers completing > or =2 refreshers/month (Frequent Refreshers [FR]) were compared to providers completing < 2 refreshers/month (Infrequent Refreshers [IR]) for time to achieve CPR skill success. Univariate analysis performed using non-parametric methods. Following actual cardiac arrests, CPR providers were surveyed for subjective feedback on training approach efficacy (5-point Likert scale; 1=poor to 5=excellent).
Over 15 weeks, 420 PICU staff were "refreshed": 340 nurses, 34 physicians, 46 respiratory therapists. A consecutive sample of 20 PICU staff was assessed before subsequent refresher sessions (FREQ n=10, INFREQ n=10). Time to achieve CPR skill success was significantly less in FREQ (median 21s, IQR: 15.75-30s) than in INFREQ (median 67s, IQR: 41.5-84s; p<0.001). Following actual resuscitations, CPR providers (n=9) rated "Rolling Refresher" training as effective (mean=4.2; Likert scale 1-5; standard deviation 0.67).
A novel "Rolling Refresher" CPR skill training approach using "just-in-time" and "just-in-place" simulation is effective and well received by PICU staff. More frequent refreshers resulted in significantly shorter times to achieve proficient CPR skills.
... Another limitation of our study is the lack of frequent simulation events at the same site over time for sustainability. While our results demonstrate improved confidence, multiple studies have demonstrated that resuscitation skills decline over time [23][24][25][26][27][28][29][30], often in as little as three months. In rural environments, frequent training sessions may be difficult to perform. ...
Introduction:
Neonatal resuscitation is a high acuity, low occurrence event (HALO), and in rural community hospitals, low birth rates prevent providers from regular opportunities to maintain essential resuscitation skills. Simulation is an effective training modality for medical education, although resources for simulation are often limited in rural hospitals. Our primary objective was to test the hypothesis that in situ neonatal resuscitation simulation training improves rural hospitals' delivery room team confidence in performing key Neonatal Resuscitation Program® (NRP®) skills. Our secondary objective was to compare confidence to performance as measured by adherence to NRP® guidelines.
Methods:
We conducted a quasi-experimental pre-training survey and post-training survey of delivery room team confidence in NRP® skills at five level one delivery hospitals before and after an in situ simulation training program. Participants included rural hospitals' usual delivery room team members. Participants rated their confidence on a five-point Likert scale. Simulations were analyzed using an adapted version of a validated scoring tool for NRP® adherence and presented as overall percentage scores.
Results:
Our data demonstrate a significant improvement in self-assessed confidence levels pre- and post-simulation training in key areas of neonatal resuscitation. Participants reported higher confidence in airway management (4 vs. 3, p=0.003), emergency intravenous access (3 vs. 2, p=0.007), and the ability to manage a code in the delivery room (4 vs. 3, p=0.013) and the operating room (4 vs. 3, p=0.028). Improvements were also noted in their team member's knowledge and skills to perform neonatal resuscitation. While improvements were appreciated in confidence, the performance of skills (NRP® adherence scores) was often in the sub-optimal performance range.
Conclusions:
An in situ-based neonatal resuscitation outreach simulation program improves self-confidence among rural delivery room teams. Additional research is needed to understand how to translate improved confidence into actual improved performance.
... Refresher training can help the participants to retain skills after the initial training [44][45][46] . A number of studies across the world are in agreement that there is need for regular, frequent refresher courses and up-to date certification for first responder care training [47][48][49] . It is also known that the kind of incidences that need first aid responses do not occur every other day [50] . ...
Introduction
Mountaineering activities have potential risks for injuries and illnesses. Extreme weather conditions, high altitude, limited resources and accessibility to transport and definitive medical services calls for mountaineering practitioners to be well prepared through training and certification in first responder care. This is useful in cases when they have an injured climber and need to offer support in the tier-one emergency system care before accessing further care in a medical facility. The study sought to establish the first responder care training status of mountaineering practitioners and the associations of mountaineering practitioners’ first responder care training levels and gender, age, years of work experience, and designation.
Methods
The study used cross-sectional analytical research design with a purposive sample of one hundred and thirty six (136) mountaineering practitioners in East Africa. Snowball sampling procedure was used to identify the respondents since there were no records indicating the population size or specific location of these mountaineering practitioners. A self-administrated questionnaire was used to collect data on whether they were trained or not; status of their up-to-date certification; institutions where they did their training and recertification; and their training levels in first responder care, which would cover the aim of the study.
Results
Majority of mountaineering practitioners (91.2%) had received some form of training. However, 47.1% had received training in basic first aid, which did not involve mountain related components. Outdoor practitioners’ up-to-date training was dependent on their age (p = 0.005), and years of work experience (p= 0.014).
Discussion
There is need for mountaineering practitioners to have standardized minimum training in wilderness specific first responder care. The study recommends that the training and recertification should be undertaken on a regular basis by the mountaineering practitioners in East Africa.
... Just-in-time training is another technique that has been shown to improve the acquisition and retention of CPR skills. 31,32 No prior research has explored the effect of JIT training on provider fatigue during management of cardiopulmonary arrest. We speculate that the lack of deterioration in CPR quality over time in all 3 groups may be related to the fact that participants in all groups had an opportunity to practice CPR for 2 minutes just before the simulated event. ...
Objectives:
Effective cardiopulmonary resuscitation (CPR) is critical to ensure optimal outcomes from cardiac arrest, yet trained health care providers consistently struggle to provide guideline-compliant CPR. Rescuer fatigue can impact chest compression (CC) quality during a cardiac arrest event, although it is unknown if visual feedback or just-in-time training influences change of CC quality over time. In this study, we attempt to describe the changes in CC quality over a 12-minute simulated resuscitation and examine the influence of just-in-time training and visual feedback on CC quality over time.
Methods:
We conducted secondary analysis of data collected from the CPRCARES study, a multicenter randomized trial in which CPR-certified health care providers from 10 different pediatric tertiary care centers were randomized to receive visual feedback, just-in-time CPR training, or no intervention. They participated in a simulated cardiac arrest scenario with 2 team members providing CCs. We compared the quality of CCs delivered (depth and rate) at the beginning (0-4 minutes), middle (4-8 minutes), and end (8-12 minutes) of the resuscitation.
Results:
There was no significant change in depth over the 3 time intervals in any of the arms. There was a significant increase in rate (128 to 133 CC/min) in the no intervention arm over the scenario duration (P < 0.05).
Conclusions:
There was no significant drop in CC depth over a 12-minute cardiac arrest scenario with 2 team members providing compressions.
... In January 2010, a study conducted to assess knowledge, attitude and practices of first aid measures in undergraduate students of Karachi, Pakistan, and it suggested that First aid training programs should be introduced at school and college level in developing countries to decrease the early mortality and morbidity of accidents and emergencies. [15] First aid neglecting can be also demonstrated by the lack of first aid training in the curricula of The Teachers' Institute. Only those prepared to be sport teachers have first aid as a part of their curriculum, nevertheless sport teachers didn't score any better, in fact the majority of them were in the poor category of this study which delivers a message that even when first aid is supposed to be taught, the process of teaching and training isn't in the right terms. ...
Background: A basic knowledge and understanding of first aid can be invaluable for individuals to be able to provide emergency care in the event of an accident, possibly saving lives and minimizing injury. Since injury is the fifth leading cause of death and children at the age of primary school are liable for accidents and lack of knowledge and good judgment of their teachers may lead to dangerous consequences when emergencies occur. Training teachers how to deal with accidents is of obvious importance. Objectives: To estimate the adequacy of primary school teachers' knowledge of first aid concerning external bleeding and fractures and Whether there's a difference in knowledge in regard to years spent in teaching or the teaching subject and to decide whether primary school teachers need training or not. Methods: This study is a cross-sectional Study was done over 5 months (from 01/Dec/2010 to 01/May/ 2011) in five randomly chosen primary schools in different regions in Baghdad/ Al-Rusafa,carried out on 100 primary school teachers without inclusion or exclusion criteria.
... Auch im Umgang mit einem automatischen externen Defibrillator (AED) bei Reanimationen vermindern sich sowohl bei Laien und auch bei medizinischem Personal [41,42] die Fähigkeiten und Fertigkeiten mit zunehmender Zeit deutlich [40,43,44]. Allerdings kann ein kurzes und regelmäßiges Wiederholungstraining (z. ...
Zusammenfassung
Hintergrund Im Jahr 2017 wurden weltweit etwa 4 Milliarden Menschen mit einem Flugzeug transportiert. Die International Air Transport Association (IATA) prognostiziert für Europa bis zum Jahr 2034 eine durchschnittliche jährliche Steigerung der Passagierzahlen von 2,7%. In der zivilen Luftfahrt treten Notfälle an Bord (sogenannte In-Flight Medical Emergencies, IFME) mit einer Häufigkeit von 1 pro 14 000 bis 1 pro 50 000 transportierte Passagiere auf. Belastbare Daten über die exakte Häufigkeit und Art von medizinischen Notfällen an Bord von Flugzeugen existieren nicht. Ein Herz-Kreislauf-Stillstand tritt statistisch gesehen nur in 0,3% der Notfälle an Bord auf. Dieses Ereignis ist jedoch mit einer Mortalität von 86% assoziiert und stellt daher Passagiere und Crew zugleich vor eine große Herausforderung. Mit der Leitlinie zum In-Flight Cardiac Arrest (IFCA) wurden 28 spezifische Empfehlungen erarbeitet. Ziel der Leitlinie war es, spezifische Handlungsempfehlungen für mitfliegende Ärzte, Kabinenpersonal (Cabin Crew) und auch Fluglinien zur Behandlung des Herz-Kreislauf-Stillstands an Bord von Luftfahrzeugen zu generieren.
... A gradual decline in CPR and AED skills following training has been demonstrated in laypersons and medically trained persons [2,9], and has been associated with the types of instructional techniques of employees [43], variations in programme delivery [58], and the time interval between training and re-assessment [21,44,48]. ...
By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.
... However, the current BLS training modalities are known to result in a rapid loss of BLS skills after training. 6 Which BLS teaching method results in the best short-term and long-term skills in laypersons and healthcare providers remains unknown. The 2010 and 2015 European Resuscitation Guidelines include using self-directed learning, a four-step training approach, feedback devices, frequent assessments and refresher courses. ...
Objective
The study objective was to implement two strategies (short emotional stimulus vs announced practical assessment) in the teaching of resuscitation skills in order to evaluate whether one led to superior outcomes.
Setting
This study is an educational intervention provided in one German academic university hospital.
Participants
First-yearmedical students (n=271) during the first3 weeks of their studies.
Interventions
Participants were randomly assigned to one of two groups following a sequence of random numbers: the emotional stimulus group (EG) and the assessment group (AG). In the EG, the intervention included watching an emotionally stimulating video prior to the Basic Life Support (BLS) course. In the AG, a practical assessment of the BLS algorithm was announced and tested within a 2 min simulated cardiac arrest scenario. After the baseline testing, a standardised BLS course was provided. Evaluation points were defined 1 week and 6 months after.
Primary outcome measures
Compression depth (CD) and compression rate (CR) were recorded as the primary endpoints for BLS quality.
Results
Within the study, 137 participants were allocated to the EG and 134 to the AG. 104 participants from EG and 120 from AG were analysed1 week after the intervention, where they reached comparable chest-compression performance without significant differences (CR P=0.49; CD P=0.28). The chest-compression performance improved significantly for the EG (P<0.01) and the AG (P<0.01) while adhering to the current resuscitation guidelines criteria for CD and CR.
Conclusions
There was no statistical difference between both groups’ practical chest-compression-performance. Nevertheless, the 2 min video sequence used in the EG with its low production effort and costs, compared with the expensive assessment approach, provides broad opportunities for applicability in BLS training.
... Auch im Umgang mit einem automatischen externen Defibrillator (AED) bei Reanimationen vermindern sich sowohl bei Laien und auch bei medizinischem Personal [21,22] die Fähigkeiten und Fertigkeiten mit zunehmender Zeit deutlich [20,23,24]. Allerdings kann ein kurzes und regelmäßiges Wiederholungstraining (z. ...
Background: In 2017, more than 3 billion people worldwide will travel by aircraft and commercial air transport. Although air travel is safe, between 1 out of 14,000 to 1 out of 50,000 passengers will experience acute medical problems (in-flight medical emergencies, IFME) during their flight. Cardiac arrest during air travel accounts for 0.3% of all IFME, but it is the cause of 86% in-flight deaths. Methods and results: By using a systematic literature search including the GRADE, RAND, and DELPHI methods, 28 specific recommendations on this topic have been created. Where evidence was lacking, an expert consensus was built. The main recommendations in the guideline are: emergency equipment location as well as content should be mentioned in the preflight safety announcement; it is very important to request help by an on-board announcement after identification of a patient with cardiac arrest; two-person CPR is considered optimum and should be performed if possible; the crew should be trained regularly in basic life support—ideally with a focus on CPR in aircraft; a diversion should immediately be performed if the patient has a return of spontaneous circulation. © 2017 Springer Medizin Verlag GmbH, ein Teil von Springer Nature
... Sin embargo, nuestros datos apoyarían que no se debe tanto a la escasa calidad como a la necesidad de repetir periódicamente la formación, dado que encontramos que cuanto más cercana en el tiempo es la formación, más conocimientos se retienen. Coincidiendo con nuestros hallazgos, las recomendaciones de otros expertos en RCP orientan en la dirección no solo de la formación sino también de su reciclaje periódico [20][21][22] , fundamentalmente porque se estima que la falta de experiencia en RCP real se puede compensar con formación continuada 16 . Además, en nuestra serie de datos, los conocimientos que se ven más positivamente afectados por la periodicidad de la formación son precisamente los que orientan hacia una RCP de mayor calidad en la práctica (p. ...
Background:
To determine the knowledge and willingness of local police officers (PO) to perform cardiopulmonary resuscitation (CPR), as well as to explore the association between CPR training and these variables.
Methods:
Cross-sectional study with a sample of 390 PO from Asturias (Spain). An anonymous questionnaire was used to measure nine basic aspects of CPR from the European Resuscitation Council and four indicators of attitude towards performing CPR in a real context. Information on CPR training and its periodicity was also collected, as well as basic socio-demographic and occupational variables.
Results:
Lack of CPR training was seen in 19.7% of PO, and 36.4% had received such training more than two years ago. Almost one out of four PO had performed at least one CPR in a real situation (24.1%), of which 9.6% had not been trained. The least remembered aspects of CPR were depth (11%) and frequency of chest compressions (24.4%). Only 49.7% of the agents felt sufficiently prepared to perform a CPR. Knowledge and disposition were significantly associated with having received training with a periodicity of less than two years.
Conclusions:
Given that PO are frequently first responders in situations of out-of-hospital cardiorespiratory arrest, specific training in CPR should be mandatory and periodic, with at least one course every two years. It would be interesting to determine which didactic instrumentation is most efficient for disseminating these training courses among police officers. Key words. Police. Cardiopulmonary resuscitation. Out-of-hospital cardiac arrest; attitude. Emergencies.
... While not a focus of this review, only Schumann et al. (2012) examined skill and knowledge retention from a WFA course. There is a growing body of literature on how well the lay public learns and retains first aid skills and on the ability of laypeople to perform first aid techniques (Berden et al., 1994). Both Schumann et al. and Berden et al. (1994) found poor skill retention and suggest the need for reduced complexity in training programs while increasing the frequency of recertification. ...
Wilderness First Aid is a common certification for outdoor recreationists, educators, and trip leaders. A panel of educators, researchers, and clinicians evaluated 15 core and eight elective WFA practices for strength of recommendations based on the quality of supporting evidence and balance between the benefits and risks/burdens according to the methodology stipulated by the American College of Chest Physicians. The strength of the evidence for these 23 WFA practices varies widely because of scant published research to date. When no evidence existed, the panel based recommendations on a consensus of the panelists for risk/benefit and best practices. This review clearly points out the need for conducting greater research to strengthen the level of evidence in numerous WFA topics and for educational strategies that improve retention of core knowledge, as well as skill application for the lay first aid provider.
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... While not a focus of this review, only Schumann et al. (2012) examined skill and knowledge retention from a WFA course. There is a growing body of literature on how well the lay public learns and retains first aid skills and on the ability of laypeople to perform first aid techniques (Berden et al., 1994). Both Schumann et al. and Berden et al. (1994) found poor skill retention and suggest the need for reduced complexity in training programs while increasing the frequency of recertification. ...
Despite the mental and physical benefits of visiting natural areas, and increases in outdoor activity participation among U.S. youth overall in the past decade, outdoor access is skewed toward nonurban, nonminority populations. This environmental justice issue is particularly pronounced for minority youth in urban areas, such as the Los Angeles Basin. While decreased contact with nature has been associated with increased technology use, the popularity of new technologies and social media outlets presents novel opportunities to connect underserved urban youth with natural areas. Seven focus groups with 42 urban youth in the L.A. Basin explored underserved youth perspectives on connecting with nature, social media, and how social media can deliver nature-related messages of interest to this population. Content analysis revealed commonly preferred social media platforms and Web-based activities, and six themes related to participants’ perceptions of nature: unique experiences, escape, social connections, challenge, adventure, and accessibility.
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... Bisher ist allerdings der optimale Abstand zwischen solchen Trainingeinheiten nicht definiert. Gerade im Umgang mit "Automatischen Externen Defibrillatoren" (AED) bei Reanimationen konnte bei Laien und medizinischem Personal [21,22] gezeigt werden, dass sich die Fähigkeiten mit der Zeit deutlich verschlechtern [20,23,24]. Auch Kabinenbesatzungen haben regelhaft Probleme, eine Reanimation korrekt durchzuführen, was aber andererseits für ein optimales Behandlungsergebnis unerlässlich ist [20]. ...
Pro Jahr reisen weltweit uber 3 Mrd. Menschen mit einem Luftfahrzeug. Bezogen auf die Anzahl transportierter Passagiere tritt ein medizinischer Notfall mit einer Haufigkeit von 1/14 000 bis 1/50 000 transportierten Passagieren auf. Der Herz-Kreislauf-Stillstand wahrend eines Fluges (in-flight cardiac arrest, IFCA) hat einen Anteil von 0,3 % an den Notfallen an Bord, besitzt aber andererseits eine Mortalitat von 86 %. Bisher existierte zum IFCA keine evidenzbasierte Leitlinie. Fur die Erstellung einer diesbezuglichen Leitlinie wurde eine Taskforce gegrundet, die publizierte Studien und die daraus abzuleitende Evidenz analysierte. Mittels systematischer Literaturanalyse und der Verwendung der Grade-, Rand- und Delphi-Methodik wurden spezifische Empfehlungen fur die Therapie des IFCA erstellt. Fur verschiedene Bereiche wurden spezifische Empfehlungen durch die Taskforce erarbeitet: Notfallausstattung an Bord, EKG, Reanimationstechniken, (Wiederholungs-)Training fur Besatzungen, Vorgehen nach „Return of Spontaneous Circulation“ (ROSC) und auserplanmasige Zwischenlandungen. Die Empfehlungen geben Arzten an Bord Hinweise, wie auf evidenzbasiertem Niveau mit IFCA-Patienten im Idealfall zu verfahren ist.
... [1] CPR is a simple and effective procedure if the skill required is maintained by frequent training. [2] Healthcare professionals are expected to have current knowledge of BLS/ACLS guidelines to revive unresponsive and cardiac arrest patients. Unlike in Western countries, there are no strict licensing protocols in India and other developing World J Emerg Med, Vol 7, No 4, 2016 Nambiar et al countries that mandate physicians, nurses and paramedics to be trained in current BLS/ACLS guidelines. ...
Background:
Healthcare professionals are expected to have knowledge of current basic and advanced cardiac life support (BLS/ACLS) guidelines to revive unresponsive patients.
Methods:
A cross-sectional study was conducted to evaluate the current practices and knowledge of BLS/ACLS principles among healthcare professionals of North-Kerala using pretested self-administered structured questionnaire. Answers were validated in accordance with American Heart Association's BLS/ACLS teaching manual and the results were analysed.
Results:
Among 461 healthcare professionals, 141 (30.6%) were practicing physicians, 268 (58.1%) were nurses and 52 (11.3%) supporting staff. The maximum achievable score was 20 (BLS 15/ACLS 5). The mean score amongst all healthcare professionals was 8.9±4.7. The mean score among physicians, nurses and support staff were 8.6±3.4, 9±3.6 and 9±3.3 respectively. The majority of healthcare professionals scored ≤50% (237, 51.4%); 204 (44.3%) scored 51%-80% and 20 (4.34%) scored >80%. Mean scores decreased with age, male sex and across occupation. Nurses who underwent BLS/ACLS training previously had significantly higher mean scores (10.2±3.4) than untrained (8.2±3.6, P=0.001). Physicians with <5 years experience (P=0.002) and nurses in the private sector (P=0.003) had significantly higher scores. One hundred and sixty three (35.3%) healthcare professionals knew the correct airway opening manoeuvres like head tilt, chin lift and jaw thrust. Only 54 (11.7%) respondents were aware that atropine is not used in ACLS for cardiac arrest resuscitation and 79 (17.1%) correctly opted ventricular fibrillation and pulseless ventricular tachycardia as shockable rhythms. The majority of healthcare professionals (356, 77.2%) suggested that BLS/ACLS be included in academic curriculum.
Conclusion:
Inadequate knowledge of BLS/ACLS principles amongst healthcare professionals, especially physicians, illuminate lacunae in existing training systems and merit urgent redressal.
... [3][4][5][6][7][8][9] Even after appropriate training, healthcare providers fail to perform CPR within established American Heart Association (AHA) guidelines during cardiac arrest. 8,[10][11][12][13][14][15][16][17] A recent AHA Consensus Statement recommended that "monitoring of CPR quality . . . should be incorporated into every resuscitation program". ...
Many healthcare providers rely on visual perception to guide cardiopulmonary resuscitation (CPR), but little is known about the accuracy of provider perceptions of CPR quality. We aimed to describe the difference between perceived versus measured CPR quality, and to determine the impact of provider role, real-time visual CPR feedback and Just-in-Time (JIT) CPR training on provider perceptions.
We conducted secondary analyses of data collected from a prospective, multicenter, randomized trial of 324 healthcare providers who participated in a simulated cardiac arrest scenario between July 2012 and April 2014. Participants were randomized to one of four permutations of: JIT CPR training and real-time visual CPR feedback. We calculated the difference between perceived and measured quality of CPR and reported the proportion of subjects accurately estimating the quality of CPR within each study arm.
Participants overestimated achieving adequate chest compression depth (mean difference range: 16.1%-60.6%) and rate (range: 0.2%-51%), and underestimated chest compression fraction (0.2-2.9%) across all arms. Compared to no intervention, the use of real-time feedback and JIT CPR training (alone or in combination) improved perception of depth (p<0.001). Accurate estimation of CPR quality was poor for chest compression depth (0-13%), rate (5-46%) and chest compression fraction (60-63%). Perception of depth is more accurate in CPR providers vs. team leaders (27.8% vs. 7.4%; p=0.043) when using real-time feedback.
Healthcare providers' visual perception of CPR quality is poor. Perceptions of CPR depth are improved by using real-time visual feedback and with prior JIT CPR training.
Copyright © 2014. Published by Elsevier Ireland Ltd.
... Notwithstanding the limited evidence about the quality of CPR provided in particular cases, there are sufficient instances in which CPR has been applied to conclude that maintaining and frequently testing the capacity to perform effective CPR is important for outdoor education supervisors, when the literature on retention of CPR skills is taken into account (Berden et al., 1994;Weaver, Ramirez, Dorfman, & Raizner, 1979). ...
... This is in accordance with previous studies that showed that even immediately after training correct CPR could only be performed by less than 65% of participants. [18][19][20] Figure 3 shows the comparison of the achieved total scores of both groups. Participants in the test group achieved a slightly higher total score than the individuals in the control group (21.11 Figure 3 Comparison of the achieved total scores for both groups. ...
... The practical CPR skill test was conducted using two Laerdal ResusciAnne® SkillReporter manikins, electronically calibrated to measure a range of resuscitation parameters (for example, compression depth and rate per minute, respiratory tidal volume, and rate per minute). While not able to represent all possible conditions for CPR application, it was assumed that the manikins provided an accurate opportunity to assess simulated CPR on an adult (Adelborg et al., 2011;Berden et al., 1994). The practical test was based on the New Zealand Resuscitation Council (NZRC) guidelines (NZRC, 2006) and adult collapse algorithm (NZRC, 2007) current at the time of the study and adopted by SLSNZ in their training of lifeguards. ...
The purpose of this paper is to report on the technical competency of volunteer surf lifeguards to perform CPR on a manikin in light of their lifeguard experience, age, and gender. The CPR skills of surf lifeguards on patrol at the beginning of the 2010–11 summer season were tested on manikins by observation of CPR procedures and electronic recording of compression and ventilation skills. Almost all lifeguards (n = 252) made the appropriate initial checks for responsiveness (98%). Compression skills were generally performed accurately with few technical errors (such as incomplete release). Most lifeguards (87%) over-ventilated the lungs (>600 ml) on each breath and, of these, one third (31%) over-ventilated to a point that may worsen gastric distension (> 1000ml). Males were significantly more likely (χ2 = 28.965, df = 14, p = .011) to over-inflate the lungs during testing. Reasons
for poor performance are discussed and ways of addressing errors are suggested.
... It is believed that with a better-trained population, many lives could be saved by means of bystander CPR [9,10]. Concern also exists about the quality of current CPR training because of issues such as poor retention, lack of training in so-called nontechnical skills, and negative reaction to the training11121314151617. In this study, we explored initial effects on students using a virtual world for CPR training [18]. ...
Background:
Multiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students' retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training.
Methods:
Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance.
Results:
The 6 months group displayed greater CPR-related knowledge than the control group, 93 (±11)% compared to 65 (±28)% (p < 0.05), the 18 months group scored in between (73 (±23)%).At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (±0.5), 1.5 (±1.0) and 4.5 (±1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (±44)% in the control group (p < 0.05) and 44 (±49)% in 18 months group where incorrectly paced; differences that disappeared during training.
Conclusions:
This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.
... 5 The skill retention rates for laypeople (similar to those who might take a WFA course) are similar to, or in many cases worse than, those of medical professionals. 6 Therefore, the intent of this study is to examine the retention of WFA knowledge, self-efficacy beliefs, and skills over time in a sample of WFA course participants through a quasiexperimental design examining groups 4 months, 8 months, or 12 months after course completion. Specifically, we tested the hypotheses that WFA knowledge, self-efficacy, and skill would decrease as the time interval from initial training increased. ...
The purpose of this study was to examine the retention of wilderness first aid (WFA) knowledge, self-efficacy beliefs, and skills over time in a sample of WFA course participants.
Seventy-two open enrollment (volunteer) WFA course participants were assessed at 4 months, 8 months, or 12 months after training. Changes in WFA knowledge and self-efficacy were assessed by written instruments after the course and at the follow-up interval (4, 8, or 12 months). The WFA skills were assessed by a scored medical scenario at the follow-up interval.
As the time interval increased, WFA knowledge, self-efficacy, and skill proficiency decreased. The WFA knowledge and self-efficacy beliefs were not highly correlated with skill performance.
Without additional training, regular use of the course content, or efforts to refresh thinking on key topics, the ability of WFA students to effectively apply their learning will likely decrease as time from training increases. With respect to these WFA courses, student scores on written tests did not accurately reflect competence in performing practical skills related to a medical scenario. In addition, student self-confidence in the ability to perform such skills did not strongly correlate with actual skills and ability.
... To ensure that any improvement between the pre-test and the post-test could be attributed to simulation and the structured debriefing, no interim educational intervention was provided. Further, skill derived from the practice effect tends to diminish with time, 20,21 and performance after courses, such as Pediatric Advanced Life Support, tends to decay after several months. 22 Thus, the sustained improvement in learner triage performance five months after the training seems unlikely to be due to practice effect. ...
Pediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners' acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance.
A 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high- and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre- and post-test scores and performance on pre- and post-debriefing simulations.
A total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P < .0001); five months later, there was maintenance of triage improvement, with a mean triage score of 7.8/10 patients (SD = 1.33, P < .0001). Over-triage of an uninjured child with special health care needs (CSHCN) (67.8% of learners prior to debriefing, 49.0% one week post-debriefing, 26.2% five months post-debriefing) and under-triage of head-injured, unresponsive patients (41.2% of learners pre-debriefing, 37.5% post-debriefing, 11.0% five months post-debriefing) were the most common errors.
Structured debriefings are a key component of PDM simulation education, and resulted in improved triage accuracy; the improvement was maintained five months after the educational intervention. Future curricula should emphasize assessment of CSHCN and head-injured patients.
... It is well established that skill retention is an issue as the time from training increases. [37][38][39][40][41] Multiple studies have documented rapid skill degradation after CPR training in all formats, 38,39,[42][43][44][45][46][47] suggesting that frequent exposures may be needed to refresh rescuers. Because of time constraints, this goal cannot be realized through traditional training but could be accomplished with frequent brief exposures. ...
Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA) but often is not performed. We hypothesized that subjects viewing very short Hands-Only CPR videos will (1) be more likely to attempt CPR in a simulated OHCA scenario and (2) demonstrate better CPR skills than untrained individuals.
This study is a prospective trial of 336 adults without recent CPR training randomized into 4 groups: (1) control (no training) (n=51); (2) 60-second video training (n=95); (3) 5-minute video training (n=99); and (4) 8-minute video training, including manikin practice (n=91). All subjects were tested for their ability to perform CPR during an adult OHCA scenario using a CPR-sensing manikin and Laerdal PC SkillReporting software. One half of the trained subjects were randomly assigned to testing immediately and the other half after a 2-month delay. Twelve (23.5%) controls did not even attempt CPR, which was true of only 2 subjects (0.7%; P=0.01) from any of the experimental groups. All experimental groups had significantly higher average compression rates (closer to the recommended 100/min) than the control group (P<0.001), and all experimental groups had significantly greater average compression depth (>38 mm) than the control group (P<0.0001).
Laypersons exposed to very short Hands-Only CPR videos are more likely to attempt CPR and show superior CPR skills than untrained laypersons. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01191736.
... It is believed that with a better-trained population, many lives could be saved by means of bystander CPR [9,10]. Concern also exists about the quality of current CPR training because of issues such as poor retention, lack of training in so-called nontechnical skills, and negative reaction to the training [11][12][13][14][15][16][17]. ...
Contemporary learning technologies, such as massively multiplayer virtual worlds (MMVW), create new means for teaching and training. However, knowledge about the effectiveness of such training is incomplete, and there are no data regarding how students experience it. Cardiopulmonary resuscitation (CPR) is a field within medicine in high demand for new and effective training modalities.
In addition to finding a feasible way to implement CPR training, our aim was to investigate how a serious game setting in a virtual world using avatars would influence medical students' subjective experiences as well as their retention of knowledge.
An MMVW was refined and used in a study to train 12 medical students in CPR in 3-person teams in a repeated fashion 6 months apart. An exit questionnaire solicited reflections over their experiences. As the subjects trained in 4 CPR scenarios, measurements of self-efficacy, concentration, and mental strain were made in addition to measuring knowledge. Engagement modes and coping strategies were also studied. Parametric and nonparametric statistical analyses were carried out according to distribution of the data.
The majority of the subjects reported that they had enjoyed the training, had found it to be suitable, and had learned something new, although several asked for more difficult and complex scenarios as well as a richer virtual environment. The mean values for knowledge dropped during the 6 months from 8.0/10 to 6.25/10 (P = .002). Self-efficacy increased from before to after each of the two training sessions, from 5.9/7 to 6.5/7 (P = .01) after the first and from 6.0/7 to 6.7/7 (P = .03) after the second. The mean perceived concentration value increased from 54.2/100 to 66.6/100 (P = .006), and in general the mental strain was found to be low to moderate (mean = 2.6/10).
Using scenario-based virtual world team training with avatars to train medical students in multi-person CPR was feasible and showed promising results. Although we found no evidence of stimulated recall of CPR procedures in our test-retest study, the subjects were enthusiastic and reported increased concentration during the training. We also found that subjects' self-efficacy had increased after the training. Despite the need for further studies, these findings imply several possible uses of MMVW technology for future emergency medical training.
... It is believed that with a better-trained population, many lives could be saved by means of bystander CPR [9,10]. Concern also exists about the quality of current CPR training because of issues such as poor retention, lack of training in so-called nontechnical skills, and negative reaction to the training [11][12][13][14][15][16][17]. ...
We investigated the retention of knowledge and skills after repeated Virtual World MOS (VWMOS) team training of CPR in high school students. An experimental group of 9 students were compared to a control group of 7 students. Both groups initially received traditional CPR training and the experimental group also received 2 VWMOS sessions six months apart. Although we found no significant differences in general basic life support knowledge, the changes that occurred in the CPR guidelines were retained 18 months after the last Virtual World training session in the experimental group. Moreover fewer deviations from the CPR guidelines occurred.
This paper, the second in a series, presents a partial analysis of outdoor education fatalities in Australia. It examines outdoor education related fatalities in Australia in the period 1960–2002 with a view to understanding how fatality prevention measures can be improved. The fatal incidents are reviewed from the perspectives of supervision, first aid, and rescue. The paper draws attention to particular supervision considerations around water, to the special case of unsupervised teenage boys around moving water or cliffs, and to the importance of planning for the possibility of the death of one or more supervisors. The analysis found evidence that underlines the importance of frequent CPR practice, but little to suggest that inadequate first aid had been a factor in any death. The study emphasises the importance of planning to ensure that medical aid can be obtained promptly, and presents a number of imperatives relating to rescue using a group’s own resources, or with outside assistance.
Das European Resuscitation Council (ERC) veröffentlichte 1998 zum letzten Mal Leitlinien für einfache lebensrettende Sofortmaßnahmen (BLS); [1]. Diese basierten auf den Empfehlungen des International Liaison Committee on Resuscitation (ILCOR) von 1997 [2]. Die American Heart Association unternahm in der Folge zusammen mit Vertretern des ILCOR eine Reihe evidenzbasierter Auswertungen der wissenschaftlichen Untersuchungen zur Reanimation [3], Diese wurden im August 2000 als „Leitlinien zur kardiopulmonalen Reanimation und kardiovaskulären Notfallversorgung“ veröffentlicht [4, 5]. Die Basic Life Support and Automated External Defibrillation Working Group (BLS & AED Group) empfiehlt unter Berücksichtigung dieser Veröffentlichung und ergänzender wissenschaftlicher Literatur, die in diesem Beitrag dargestellten geänderten BLS-Leitlinien.
Premature and unexpected death, especially in children, is tragic and very unacceptable. Effective treatments for sudden death of pediatric patients continue to emerge. Modern cardiopulmonary resuscitation function began with the widespread introduction of closed-chest cardiac massage in 1960; however, despite 35 years of research and refinement, more than 90% of children who receive cardiopulmonary resuscitation do not survive. This article summarizes and expands on current treatment concepts for pediatric sudden death. Emphasis is placed on procedures and techniques that likely are accessible in most medical centers caring for critically ill and injured children.
The survival chain: The delay to restoration of spontaneous circulation is the key to prognosis of cardiac arrest occurring outside the hospital. Among the many etiologies of cardiac arrest sudden onset ventricular fibrillation is the number one cause of sudden death in adults. Better prognosis depends on effective organisation founded on the concept of a "survival drain". Alert and resuscitation: By alerting the emergency units and performing the basic gestures of cardiopulmonary resuscitation (freeing the airways, mouth-to-mouth ventilation and closed chest cardiac massage) those witnessing the event take the first steps in the survival chain while waiting for the paramedical and medical teams to arrive. Defibrillation: In case of ventricular fibrillation, prognosis is directly related to the delay to defibrillation. Defibrillators used by specially trained paramedics before a physician arrives on the scene have considerably improved prognosis. Specialized resuscitation: Precise algorithms help guide treatment in accordance with the observed cardiac rhythm. Tracheal intubation and artificial ventilation are fundamental. Among the useful drugs, epinephrine is by far the most important for improving myocardial and cerebral perfusion, improving the chances of recovering spontaneous circulation. The only anti-arrhythmic drug currently used is lidocaine infusion of alkaline fluid is only useful in specific cases of prolonged resuscitation. Expired CO2 monitoring may be a useful guide, but discontinuing resuscitation is strictly a medical decision. After resuscitation: When spontaneous circulation has been achieved, the patient must be transported to a cardiac hospital for specialized care and etiological treatment.
In this study we have set up an experimental design to assess the effectiveness of a board game for learning new content (first aid). A traditional lecture method was used as control condition. The game was designed according to the curricular objectives of the Flemish secondary school curriculum. The sample consisted of 120 students (13-14 years old), who were assigned to two conditions, a gaming application and a traditional lecture method. Similarities between both conditions included the time frame (1 hour), the content (basic first aid) and interaction/feedback availability. The traditional lecture was given by two teachers (in two classrooms) using an identical powerpoint presentation and demonstrations. In the game condition, students were randomly divided into groups of four players. Three teachers were present to assist students with playing the game and performing demonstrations. The effects of the learning environments (game versus traditional lecture) on students' achievement were examined through a test of first aid knowledge. All 120 participants were subjected to a pre-test and a post-test using a paper-and-pencil test. Two months after the intervention, the participants took a retention test and filled out a questionnaire assessing the participant's enjoyment, interest and motivation. An analysis of pre and post knowledge tests showed that both conditions produced significant increases in knowledge. The lecture was significantly more effective in increasing knowledge, as compared to the game condition. A significant decrease in scores was found for both conditions two months after the learning experience. Participants indicated that they liked the game condition more than their fellow participants in the traditional lecture condition. These results suggest that traditional lectures are more effective in increasing student knowledge, while educational games are more effective for student enjoyment. From this case study we recommend alteration or combination of these teaching methods to make learning both effective and enjoyable.
The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines.
To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA.
Prospective, randomized, 2 × 2 factorial-design trial with explicit methods (July 1, 2012, to April 15, 2014) at 10 International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) institutions running a standardized simulated CPA scenario, including 324 CPR-certified health care professionals assigned to 3-person resuscitation teams (108 teams).
Each team was randomized to 1 of 4 permutations, including JIT training vs no JIT training before CPA and real-time VisF vs no real-time VisF during simulated CPA.
The proportion of CCs with depth exceeding 50 mm, the proportion of CPR time with a CC rate of 100 to 120 per minute, and CC fraction (percentage CPR time) during simulated CPA.
The quality of CPR was poor in the control group, with 12.7% (95% CI, 5.2%-20.1%) mean depth compliance and 27.1% (95% CI, 14.2%-40.1%) mean rate compliance. JIT training compared with no JIT training improved depth compliance by 19.9% (95% CI, 11.1%-28.7%; P < .001) and rate compliance by 12.0% (95% CI, 0.8%-23.2%; P = .037). Visual feedback compared with no VisF improved depth compliance by 15.4% (95% CI, 6.6%-24.2%; P = .001) and rate compliance by 40.1% (95% CI, 28.8%-51.3%; P < .001). Neither intervention had a statistically significant effect on CC fraction, which was excellent (>89.0%) in all groups. Combining both interventions showed the highest compliance with American Heart Association guidelines but was not significantly better than either intervention in isolation.
The quality of CPR provided by health care professionals is poor. Using novel and practical technology, JIT training before CPA or real-time VisF during CPA, alone or in combination, improves compliance with American Heart Association guidelines for CPR that are associated with better outcomes.
clinicaltrials.gov Identifier: NCT02075450.
Se abordan los principales puntos de las últimas Guías de Actuación en Reanimación Cardiopulmonar Básica de la American Heart Association, el Resuscitation European Council y el International Liaison Committee, haciendo especial hincapié en las modificaciones introducidas y el porqué de las mismas con respecto a las guías previas.
This study was to extrapolate potential roles of augmented reality goggles as a clinical support tool assisting in the reduction of preventable causes of death on the battlefield. Our pilot study was designed to improve medic performance in accurately placing a large bore catheter to release tension pneumothorax (prehospital setting) while using augmented reality goggles. Thirty-four preclinical medical students recruited from Morehouse School of Medicine performed needle decompressions on human cadaver models after hearing a brief training lecture on tension pneumothorax management. Clinical vignettes identifying cadavers as having life-threatening tension pneumothoraces as a consequence of improvised explosive device attacks were used. Study group (n = 13) performed needle decompression using augmented reality goggles whereas the control group (n = 21) relied solely on memory from the lecture. The two groups were compared according to their ability to accurately complete the steps required to decompress a tension pneumothorax. The medical students using augmented reality goggle support were able to treat the tension pneumothorax on the human cadaver models more accurately than the students relying on their memory (p < 0.008). Although the augmented reality group required more time to complete the needle decompression intervention (p = 0.0684), this did not reach statistical significance.
Several recent reports, including the major study by the Institute of Medicine of the American Academy of Sciences, indicate alarmingly high number of medical errors committed during medical operations. Among the primary sources of such errors are lack of training, lapsed knowledge and skills, and inadequate access to remedial resources. Unsurprisingly, a large number of treatment errors (both diagnostic and procedural) take place at healthcare facilities that are distant from large medical education centers, where the distance of 50 miles may indicate a very substantial deterioration of the available care. Moreover, many of these errors originate at the prehospital level where the inadequate training of the field personnel at virtually all levels of proficiency results in otherwise avoidable morbidity and mortality. Their training, while following the current regulations, is infrequent, rarely under the direction of experts available at major emergency/trauma centers, and, accordingly to our own studies (US Navy and US Coast Guard) and the work of others - largely inadequate and hampered by a severe retention loss leading to a substantially decreased level of medical readiness. One of the major issues in addressing the problem of inadequate training is that of providing efficient medical training courses to a large number of personnel dispersed at several facilities. Traditionally, education of such type is affected by a very high cost, uneven quality of instruction, and inability to provide adequate exposure in the absence of sophisticated training tools. Probably the most efficient solution to this global dilemma has been recently provided by MedSMART, Inc., whose unique approach proposes implementation of Advanced Medical Distributed Learning concepts basing them on the integration of the Internet and the remote, interactive access to the Human Patient Simulators. The concept allows, probably for the first time in the history of medicine, for the worldwide training of medical personnel that can be provided by otherwise almost entirely inaccessible leading international experts in emergency and trauma medicine. The most immediate consequence of the implementation of these concepts results in a highly unique, real time/real life exposure to the management of medical emergencies.
Introduction: CPR training is not targeted effectively to family members of individuals at highest risk of cardiac arrest. Participants in traditional CPR classes (TRAD) average 31 years of age, while family members of cardiac patients average 55 years. Three-quarters of all out-of-hospital cardiac arrests occur in the home. Video self-instruction (VSI) is a combination of practicing on an inexpensive manikin while watching a 34-minute videotape without instructor or book. Because we have previously shown that VSI is effective for training younger adults,* the purpose of the study was to measure skill achievement of older subjects after VSI compared to TRAD training. Methods: We exposed 201 subjects age 40 years and older (mean 59 ± 10.9) to either VSI or TRAD and tested them individually immediately following training using American Heart Association criteria, validated methods and a Laerdal Skillmeter™ manikin. Results: VSI subjects performed an average of 20.8% of all compressions and 25.8% of all ventilations correctly vs.3.4% of compressions and 1.7% of ventilations for TRAD (p < .001). VSI subjects performed an average of 10.1 of 14 skills correctly vs. an average of 4.7 for TRAD (p < .001). On a measure of overall performance, only 17.8% of VSI subjects were rated as "not competent" (i.e., unable to obtain a combination of any chest rise and any compression of the sternum) compared to 70.0% of TRAD subjects. Two-thirds of VSI subjects were rated "competent" or better (i.e., capable of performing CPR that "would probably be effective") compared to 5% of TRAD subjects (p < .001). Conclusions: VSI provides an effective means of training persons over 40 years of age that achieves skill performance superior to TRAD. VSI can be used in the home, is convenient and inexpensive, and can be targeted to older individuals who do not participate in TRAD classes.
Each minute's delay to treatment for out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) reduces the likelihood of survival by ten per cent. Automated external defibrillators (AEDs) were developed to make rapid definitive treatment more widely available.AEDs use a computer algorithm to diagnose the collapsed patient's heart rhythm and determine the need for a defibrillatory electric shock. This requires no intellectual input from the operator, whose actions are directed by simple written and recorded vocal prompts.
Increasing the number of members of the public with the ability to access and use AEDs and provide cardiopulmonary resuscitation (CPR) is a cost-effective strategy for reducing deaths from OHCA. However, conventional training often results in inadequate skill acquisition and fails to ensure skill retention beyond three to six months. Classes without instructors and which use computer-assisted learning or automated voice-advisory manikins have resulted in competence similar to that achieved with traditional training, and may be more cost-effective and
convenient. Simplified staged CPR classes offer improved skill acquisition and have a moderate benefit for skill retention. Short self-instructional video training classes or frequently repeated brief practice sessions with feedback from a voice-advisory manikin (both in the absence of an instructor) offer the greatest benefit for CPR skill acquisition and retention, but have not been used for AED instruction. Further research is required to determine the optimal method for training lay members of the public to use AEDs. It seems, however, that the ideal teaching strategy is unlikely to utilise a conventional instructor-led model.
High quality chest compression is one of the key factors in successful resuscitation. A high standard of training is therefore decisive. We aimed to investigate the strengths and weaknesses of teaching chest compression in a study designed to highlight where targeted improvements in the quality of our chest compression training can and must be made.
Retrospective analysis of prospectively documented data with 234 participants, and recording and analysis of chest compression variables before and after a BLS training course.
The results after the course were good for compression depth (94% correct), moderate for compression frequency (83% correct) and decompression (82% correct), unsatisfactory for hand positioning (74% correct) and poor for the compression/decompression ratio (32% correct). Practical instruction brought about improvements of between 9% and 48%. The greatest improvement was seen for hand positioning (48%), followed by compression depth (32%), compression rate (32%), and the compression/decompression ratio (20%). Training had only a slight effect on the degree of decompression (9%). Significant deteriorations were also noted after the course, for compression rate (11%) and the compression/decompression ratio (12%).
Chest compression training showed weakness for four out of five variables. Only the end results for compression depth were satisfactory. The deficits observed in the training on chest compression were relevant and must be remedied. One possibility would be initial step-by-step training and assessment of each component of chest compression, concentrating in particular on hand positioning and compression/decompression ratio.
Despite the passage of 50 years since the introduction of closed chest compression and mouth-to-mouth rescue breathing as the techniques of modern cardiopulmonary resuscitation (CPR), the simple techniques remain the backbone of successful resuscitation of victims of cardiac arrest. In particular, the importance of high quality chest compressions is increasingly clear. Current evidence demonstrates chest compressions should be provided at a rate of 100 compressions a minute to a depth of 4 to 5 cm (1.5 to 2 inches) with full chest recoil between compressions. Additionally, all efforts should be made to minimize interruptions in chest compressions, including single shock defibrillation and elimination of pulse check postdefibrillation in favor of continued chest compressions immediately postshock. The emphasis on high quality chest compressions is echoed in the most recent CPR guidelines of the American Heart Association and the International Liaison Committee on Resuscitation. The role of rescue breathing is currently debated; however, it is likely important in prolonged arrests or those of non-cardiac etiology. Current recommendations encourage inclusion of rescue breaths by trained responders, but allow for elimination of rescue breathing and emphasis on chest compressions for responders untrained or unconfident in rescue breathing. Early defibrillation is a key component to successful resuscitation of ventricular tachycardia and ventricular fibrillation arrest; however, implementation of defibrillation should be coordinated with CPR to minimize interruptions in chest compressions. Aside from early defibrillation, there are no clear adjuncts to CPR that improve survival. However, postresuscitation therapies such as therapeutic hypothermia may become an important part of early resuscitation management as tools to provide hypothermia become increasingly portable and capable of rapid cooling.
To determine whether listening to music during cardiopulmonary resuscitation (CPR) training increases the proportion of lay people delivering chest compressions of 100 per minute.
Prospective randomised crossover trial.
Large UK university.
130 volunteers (81 men) recruited on an opportunistic basis. Exclusion criteria included age under 18, trained health professionals, and cardiopulmonary resuscitation (CPR) training within the past three months.
Volunteers performed three sequences of one minute of continuous chest compressions on a skill meter resuscitation manikin accompanied by no music, repeated choruses of Nellie the Elephant (Nellie), and That's the Way (I like it) (TTW) according to a pre-randomised order.
Rate of chest compressions delivered (primary outcome), depth of compressions, proportion of incorrect compressions, and type of error.
Median (interquartile range) compression rates were 110 (93-119) with no music, 105 (98-107) with Nellie, and 109 (103-110) with TTW. There were significant differences within groups between Nellie v no music and Nellie v TTW (P<0.001) but not no music v TTW (P=0.055). A compression rate of between 95 and 105 was achieved with no music, Nellie, and TTW for 15/130 (12%), 42/130 (32%), and 12/130 (9%) attempts, respectively. Differences in proportions were significant for Nellie v no music and Nellie v TTW (P<0.001) but not for no music v TTW (P=0.55). Relative risk for a compression rate between 95 and 105 was 2.8 (95% confidence interval 1.66 to 4.80) for Nellie v no music, 0.8 (0.40 to 1.62) for TTW v no music, and 3.5 (1.97 to 6.33) for Nellie v TTW. The number needed to treat for listening to Nellie v no music was 5 (4 to 10)-that is, the number of cardiac arrests required during which lay responders listen to Nellie to facilitate one patient receiving compressions at the correct rate (v no music) would be between four and 10. A greater proportion of compressions were too shallow when participants listened to Nellie v no music (56% v 47%, P=0.022).
Listening to Nellie the Elephant significantly increased the proportion of lay people delivering compression rates at close to 100 per minute. Unfortunately it also increased the proportion of compressions delivered at an inadequate depth. As current resuscitation guidelines give equal emphasis to correct rate and depth, listening to Nellie the Elephant as a learning aid during CPR training should be discontinued. Further research is required to identify music that, when played during CPR training, increases the proportion of lay responders providing chest compressions at both the correct rate and depth.
Ziel: Seit fast 50 Jahren ist bekannt, dass bei Patienten mit plötzlichem Herztod unter Normothermie binnen vier Minuten ein Kreislauf wiederhergestellt werden muss, um ein Überleben ohne neurologische Folgeschäden zu ermöglichen. Mit der Veröffentlichung der Methode der klassischen cardiopulmonalen Reanimation 1961 begannen die Bemühungen, für diese Fälle ein möglichst kompetentes Notfallsystem zu entwickeln. In diesem Zusammenhang wurde der Begriff der "Rettungskette" geprägt, in deren Durchführung die "Erste-Hilfe" durch den Laien eine führende Rolle spielt. Zur Zeit wird in Europa bei präklinischen Herzkreislaufstillständen eine Überlebensrate von weniger als 10% erreicht. Neben der reinen Inzidenz von Laien-CPR (10-50%) hat auch die Qualität der Maßnahmen einen wesentlichen Einfluß auf den Erfolg der Reanimationsbemühungen. Verschiedene Autoren haben bereits innerhalb des ersten Jahres nach der Ausbildung mangelhafte Fähigkeiten bei Laien nachgewiesen, die dem natürlichen Vergessensprozess zugeschrieben wurden. Unter der Hypothese, dass bereits die initiale Breitenausbildung nicht in der Lage ist, ausreichende Fähigkeiten an Laien zu vermitteln, war es Ziel dieser Studie, deren Effektivität zu evaluieren. Methodik: Untersucht wurden die Kurse "Erste-Hilfe" und "Lebensrettende Sofortmaßnahmen" bei den drei Hilfsorganisationen DRK, JUH und MHD. Im Zeitintervall von 24 Stunden nach abgeschlossener Ausbildung wurden die Teilnehmer auf ihre Fähigkeit hin untersucht, am Übungsmodell einen kardiozirkulatorischen Notfall einzuschätzen und ohne Hilfsmittel zu therapieren. Gefordert war entweder eine vollständige CPR oder eine alleinige Beatmung bei Apnoe aber vorhandenem Puls. Anhand von Videoaufzeichnungen und gedruckten Registrierungen des Übungsmodells wurden die einzelnen Schritte von Diagnostik, Beatmung und Thorax-kompression ausgewertet, und in vier Leistungsstufen klassifiziert. Ergebnisse: Die Auswertung zeigte, dass trotz zeitnaher Ausbildung, weniger als die Hälfte der Probanden "minimale Reanimationsleistungen" erbringen konnte. Dieses geringste, auch als "pump and blow" bezeichnete Leistungsniveau klammert diagnostische Schritte komplett aus und beinhaltet nur rudimentäre Fähigkeiten von Kompression und Beatmung. Die Leistungsstufe der "ausreichenden Reanimationsleistung" mit gesteigerten Anforderungen an Beatmung und Thoraxkompression (ebenfalls ohne Berücksichtigung der Diagnostik) wurde lediglich von jedem fünften Teilnehmer erreicht. Der Leistungsstufe "gut", die zusätzlich diagnostische Anforderungen implizierte, konnten zwei Probanden (0,6%) zugeordnet werden. Den noch anspruchsvolleren Anfor-derungen von AHA und ERC wurde keiner aus der untersuchten Gruppe gerecht. Schlussfolgerung: Die Ergebnisse belegen, dass mittels des aktuellen Ausbildungskonzepts keine ausreichenden Fähigkeiten an die Laienbevölkerung vermittelt werden. Des weiteren erscheinen die internationalen Empfehlungen als Ausbildungsziel für Laien deutlich zu komplex gestaltet, sodass die Definition eines konkreten, aber simplifizierten Lernziels sinnvoll erscheint. Anhand dessen könnten die Kurse lernzielorientiert statt wie bisher zeitkontingentiert abgehalten werden. und ein einheitlicher Ausbildungsstand wäre zumindest zu diesem Zeitpunkt gewährleistet. Positiv auswirken würde sich eine solche Unterrichtsform auch hinsichtlich einer besseren Evaluationsmöglichkeit und im Hinblick auf Motivationsförderung. Da das Lernziel primär praktische Fertigkeiten beinhaltet und die CPR eine komplexe Aufgabe mit bis zu 50 psychomotorischen Einzelfähigkeiten ist, würde ein solches Konzept automatisch längere Praxiszeiten am Übungsmodell beinhalten. Auch eine intensivere Schulung der Ausbilder erscheint notwendig. Hierbei sollten besonders Fähigkeiten wie objektive Einschätzung der Teilnehmer und konstruktive Kritik trainiert werden.
One of the most important lacks in preclinical care of emergency victims is insufficient quality of Basic Life Support provided by layhelpers. Outcome of emergency patients could be significantly enhanced by improving BLS skills of the public. This work evaluated an expert system for mobile multimedia devices consisting of a decision making aid component and a direct instruction progam part. The use of the expert system significantly improved quality of BLS provided by layhelpers.
Bei 155 Ärzten und Arzthelferinnen wurde ein Notfalltraining durchgeführt. Davor und danach wurde ein multiple-choice-Test mit acht Fragen zur Reanimation durchgeführt. Es zeigte sich ein signifikanter Anstieg der richtigen Antworten von 69,7 % auf 94,7%. Teilnehmer, deren letztes Training bis zu zwei Jahre zurücklag, erreichten signifikant bessere Ergebnisse. Ebenso wurde durch Fragebögen die Ausstattung von 118 Arztpraxen untersucht. Hier zeigten sich erhebliche Unterschiede je nach Fachrichtung des Arztes. Nur ca. 20 % der Ärzte sind mit modernen AED-Geräten zur Defibrillation ausgestattet. Gerätschaften zur Intubation halten ca. 90 % vor, Sauerstoff dagegen nur ca. 80%, Sauerstoff-Reservoire weniger als die Hälfte. Opiate sind nur bei 72% bevorratet, Cordarex nur bei einem Drittel. Folgende Forderung lassen sich ableiten: -verpflichtende Fortbildungsmaßnahmen zur Reanimation -dies mindestens alle zwei Jahre (im Rahmen des Qualitätsmanagements) -Verbesserung der notfallmedizinischen Geräte- und Medikamentenausstattung A training in emergency medical aid was realized with 155 doctors and physician assistants. They were tested before and afterwards with a multiple-choice-test with eight questions. A significant increase of correct answers from 69,7% to 94,4% was shown. Participants, who had a training in a period of the last two years, get significant better results. Also the equipment of 118 medical practices was tested by questionaries. Significant differences depending on specializations was shown. Only about 20% are equipped with modern AED´s for defibrillation. Equipment for intubation has about 90%, oxygen only about 80%, oxygen-reservoirs less than the half. Only 72% are equipped with opiods, only a third with cordarex. Because of this following postulations: -obligatory training in reanimation and resuscitation -at least all two years ( within quality management) -improvement of medical and technical equipment
Groups were trained to a moderate or high level of proficiency on 2 perceptual-motor tasks then retrained after no-practice intervals up to 2 years in duration. "… absolute loss in level of proficiency was apparently not affected by amount of training and was greater the longer the no-practice interval. A greater proportion of proficiency was lost by groups receiving less training and groups receiving longer no-practice intervals. Retraining to the earlier level of proficiency took more trials the longer the no-practice interval and the greater the amount of training." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Twenty-three chapters of the American Red Cross located in the Northeast participated in this study of achievement in adult cardiopulmonary resuscitation (CPR) classes. Sixty-eight classes offered to the public were studied by a pencil-and-paper survey and a specially developed written test. This study locates student, instructor, and course factors associated with achievement in CPR classes. Student factors found to be significant predictors of achievement were reading difficulty, age, and prior CPR training. The only instructor factor to predict student achievement was training within the 12 months prior to teaching the studied class. Showing a videotape to the class and distributing workbooks before the class also had a significant positive effect on student achievement. The addition of material by the instructor decreased achievement.
Physicians and nurses in a community hospital who successfully completed the standard 1-day training program in basic life support cardiopulmonary resuscitation (CPR) were retested 6 and 12 months after training. Their perceptions of their knowledge of and skill in CPR were recorded along with an account of the roles they had taken in CPR incidents. The physicians and nurses initially had the same level of knowledge of CPR, but the physicians learned significantly more and retained it longer. After training, the nurses participated much more in CPR incidents, limiting themselves to basic life support functions. The physicians' participation, however, remained at about the same level and was limited to advanced life support functions. By 12 months after training the scores in both groups were similar to the pretraining scores, which suggests that practice with feedback is necessary during the 1-year period before retraining and recertification. It may be that the two groups require different training programs.
In cardiac arrest early initiation of bystander-CPR, before arrival of the Emergency Medical System (EMS) and initiation of Advanced Life Support (ALS), is widely accepted as a determinant of survival. Since the citizen is the most likely potential witness of a cardiac arrest event, this knowledge was a major incentive to train citizens in basic CPR all over the world in small and large scaled courses.
A recursive estimation model is used to investigate the roles of cardiopulmonary resuscitation (CPR) and advanced life support in improving survival from out-of-hospital cardiac arrest. The importance of life support measures is clearly evidenced in the analysis: Fewer elapsed minutes between the cardiac arrest and the start of CPR increase the probabilities of both a favorable cardiac rhythm and defibrillation and the probability of survival. Similarly, a shorter elapsed time between the start of CPR and defibrillation is significantly related to a higher probability of survival of the cardiac arrest. Personal characteristics also contribute to survival, but primarily via their association with a favorable initial postarrest cardiac rhythm and the probability of defibrillation. The initial postarrest cardiac rhythm is shown to be an indicator of the heart's condition, but when other factors associated with survival are included in the analysis, it does not independently influence an individual's probability of survival.
• The immediate delivery of bystander-administered cardiopulmonary resuscitation (CPR), coupled with the rapid delivery of advanced cardiac life support, can significantly reduce mortality from out-of-hospital cardiac arrest. Because the majority of sudden cardiac deaths occur in the victim's home with family members present, family members of cardiac patients at high risk for sudden death are the logical focus of CPR training. However, previous research has shown that only a small minority of family members of cardiac patients actually learn CPR and that health care professionals have failed to recommend CPR training in this population, in part due to concerns about their ability to learn CPR. The purpose of this study was to describe learning capabilities in this population and to identify characteristics of unsuccessful learners. To this end, we taught CPR to 83 family members of cardiac patients who were at risk for sudden cardiac death. Subjects had no CPR training within the past two years. Eighty-one percent of the subjects successfully learned CPR. Of the demographic and psychological characteristics examined, only gender, age, and depression were significant in explaining differences in CPR skills attainment ability. The elderly, the depressed, and males were more likely to be unsuccessful in demonstrating adequate CPR skills. Our results suggest that the majority of family members of cardiac patients can learn CPR successfully. Specific training strategies may need to be developed and tested to enhance CPR training in those family members of cardiac patients predicted to have difficulty learning CPR.
(Arch Intern Med 1989;149:61-64)
Cardiac resuscitation after cardiac arrest or ventricular fibrillation has been limited by the need for open thoracotomy and direct cardiac massage. As a result of exhaustive animal experimentation a method of external transthoracic cardiac massage has been developed. Immediate resuscitative measures can now be initiated to give not only mouth-to-nose artificial respiration but also adequate cardiac massage without thoracotomy. The use of this technique on 20 patients has given an over-all permanent survival rate of 70%. Anyone, anywhere, can now initiate cardiac resuscitative procedures. All that is needed are two hands.
Time is an essential element for successful CPR. Two time factors are particularly important: the duration of complete CA and the time to advanced life support. According to a registration protocol, these time factors, together with other variables and outcome were recorded in 3083 CA cases, treated by the NICU teams of 7 major Belgian hospitals. The mean duration of complete CA is 10.3 min for CPR failure (79%); 5.3 min for initial CPR success (21%); 3.4 min for long-term CPCR success (7%). The mean time to ALS is 19.7 min for CPR failure; 14.6 min for initial CPR success: 12.7 min for long-term CPCR success. Both duration of CA and time to ALS are independently related to outcome; the mean duration of BLS is less than 10 min and not significantly related to outcome. Response time of BLS and ALS are increasingly important in their ‘rapid response’ failure zone (time to ALS more than 8 min, time to BLS more than 4 min). The tiered MICU system, with nurse paramedics before physicians, has equal time to ALS and comparable outcome results to the non-tiered MICU system. According to our present experience, the following time goals are proposed for Belgian EMS-MICU systems: duration of CA less or equal to 4 min (introduction time ⩽1 min and response time of BLS ⩽3 min) and time to ALS ⩽9 min. These time goals stand, in Belgium for perfection of public training in CPR and for spreading of a higher number of MICU teams countrywide.
TWO PARADOXES lie behind the question posed in the title of this article. First, rapid and widespread dissemination of the technique of cardiopulmonary resuscitation (CPR) occured before the underlying physiology was fully understood. Second, data that indicate discouragingly low coronary and carotid artery flow rates contrast sharply with the obvious lifesaving capacity of basic CPR.CPR
In the early 1960s, Kouwenhoven et al1 demonstrated the effectiveness of closed-chest compressions for cardiac arrest; rapid worldwide dissemination of the technique soon followed. By 1974, the endorsement of influential groups such as the American Heart Association secured broad acceptance for standard CPR.2 Kouwenhoven and co-workers thought that during CPR blood was expelled by compression of the heart between the sternum and vertebral bodies. Later, however, various research laboratories conducted what were, in effect, post hoc investigations into the physiology of CPR; by the 1980s, few researchers subscribed to Kouwenhoven and co-workers'
Lay persons trained in cardiopulmonary resuscitation (CPR) were evaluated six months after completion of a four-hour basic life support course to determine the degree to which CPR cognitive and psychomotor performance skills were retained. Evaluation criteria were based on the American Heart Association's recommended standards. The data disclosed a significant decrease in the resuscitators' retention of CPR knowledge and skills.
(JAMA 241:901-903, 1979)
A new method of producing artificial circulation by external sternal compression without thoracotomy was evaluated in 138 episodes of cardiac arrest in 118 patients. Seventy-six arrests occurred outside the operating and recovery room areas. Seven out of every 10 were in asystole; the remainder were in ventricular fibrillation. Cardiac action was restored in 107 (78%) of the 138 cardiac arrests. In 84 (60%) of the 138, the prearrest status of the central nervous system and heart was regained. Twenty-eight (24%) of the 118 patients survived the arrest and inciting disease to leave the hospital. In patients with sudden cardiac arrest, rapid diagnosis followed by immediate artificial ventilation and circulation adequately protected the central nervous system. Cardiotonic drugs, electrocardiograms, ventricular defibrillation, and continued cardiovascular and pulmonary support were employed as needed.
One hundred and twenty four occupational first aiders were tested on their ability to carry out cardiopulmonary resuscitation (CPR) at varying times following training (up to three years). Expert assessment of printouts from a Recording Resusci-Anne manikin indicated that only 12 per cent of those tested would be capable of carrying out effective CPR. Measures derived from the same printouts showed that there was a rapid and linear decay in CPR skills over time with fewer than 20 per cent of subjects achieving a score of 75 per cent on performance after only six months had elapsed since training.
Variables such as age, sex, height, weight and practice on a manikin were not found to influence performance.
Despite certain drawbacks in the design of the study it is clear that retraining in CPR skills should be more frequent than the three years recommended by present industrial first aid legislation.
The survival-rate in 75 of 631 patients with cardiac arrest in whom resuscitation was started outside hospital by lay people was 36%. Only 8% survived when attempts at resuscitation were delayed until the arrival of an ambulance team which included an anaesthetist and a specially trained nurse. These data show the importance of anoxia-time (time from cessation of circulation to initiation of resuscitation) to the chances of survival after resuscitation) to the chances of survival after resuscitation, and support the idea that lay people should be taught and encourage to perform cardiopulmonary resuscitation.
As part of an evaluation of whether the addition of paramedic services can reduce mortality from out-of-hospital cardiac arrest compared to previously existing emergency medical technician (EMT) services, factors associated with successful resuscitation were studied. A surveillance system was established to identify cardiac arrest patients receiving emergency care and to collect pertinent information associated with the resuscitation. Outcomes (death, admission, and discharge) were compared in two areas with different types of prehospital emergency care (basic emergency medical technician services vs. paramedic services). During the period April 1976 through August 1977, 604 patients with out-of-hospital cardiac arrest received emergency resuscitation. Eighty-one per cent of these episodes were attributed to primary heart disease. Considered separately, four factors were found to have a significant association with higher admission and discharge rates :1) paramedic service, 2) rapid time to initiation of cardiopulmonary resuscitation (CPR), 3) rapid time to definitive care, and 4) bystander-initiated CPR. Using multivariate analysis, rapid time to initiation of CPA and rapid time to definitive care were most predictive of admission and discharge. Age was also weakly predictive of discharge. These findings suggest that if reduction in mortality is to be maximized, cardiac arrest patients must have CPR initiated within four minutes and definitive care provided within ten minutes.
Several time-related variables involving resuscitation from out-of-hospital cardiac arrest were studied. Short time intervals from collapse to initiation of cardiopulmonary resuscitation (CPR) and to provision of definitive care were significantly associated with survival from cardiac arrest. The two times were jointly related, and one short time without the other was unlikely to result in survival. If CPR was initiated within four minutes and if definitive care was provided within eight minutes, 43% of patients survived. If either time was exceeded, the chances of survival fell dramatically. The time to initiation of CPR and definitive care are factors directly influenced by emergency medical service program decisions. A realistic option to improve time to initiation of CPR is widespread citizen CPR training. A possible option to improve the time to definitive care is the training of emergency medical technicians in defibrillation.
(JAMA 241:1905-1907, 1979)
Lay persons trained in cardiopulmonary resuscitation (CPR) were evaluated six months after completion of a four-hour basic life support course to determine the degree to which CPR cognitive and psychomotor performance skills were retained. Evaluation criteria were based on the American Heart Association's recommended standards. The data disclosed a significant decrease in the resuscitators' retention of CPR knowledge and skills.
Standards for external cardiac compression include compression of the chest for 50 per cent of cycle time and a compression rate of 60 per minute. Warnings are given against 'quick jabs'. Animal studies do, in fact, suggest that the duration of prolonged compression is important in effective resuscitation. To achieve a duration of 50 per cent during manual external cardiac compression, there must be a distinct pause at maximal compression. Application of this principle to man appears to have been slow, perhaps because of doubts about the applicability of animal data to man. In view of the obvious importance of vital-organ perfusion during cardiopulmonary resuscitation, the authors have examined the effects of varying compression rate and duration on velocity of carotid-artery flow and arterial pressure during cardiopulmonary resuscitation in man.
A valid and reproducible system for determining basic cardiac life support (BCLS) skills can help to evaluate the effect of instruction courses and to estimate the results of educational activities. The aim of this study was to develop and test such a system in accordance with the Standards and Guidelines of the American Heart Association (AHA). Five criteria were defined in advance towards such a system (1) Inadequate techniques must be reflected by a fail score. (2) Skilled persons should achieve a pass score. (3) The effect of training must be reflected by an improvement of the score. (4) Inter- and intra-observer variability must be negligible. (5) The system should be simple to apply. The system was developed, and in order to test the system, the BCLS skills of 40 ambulance nurses were tested once and those of 148 lay people twice. All cardiopulmonary resuscitation (CPR) attempts were performed on a mannequin. The relevant parameters of the attempt were continuously recorded and printed. Penalty points were assigned in a predefined way for aberrations of the techniques advised in the Standards and Guidelines. The system satisfied the five criteria mentioned above. It therefore offers a reliable and reproducible evaluation of BCLS skills.
During instruction in basic cardiopulmonary resuscitation (CPR) skills, cardiac massage and mouth-to-mouth ventilation are applied without interruption for no longer than a few minutes. The aim of this study was to see if the quality of technique during the first 2 min of CPR reflects the resuscitators ability to perform CPR over a 15 min period. Assessments were done with a resuscitation mannequin from which recordings of several variables were made at 2, 5, 10, and 15 min after the start of CPR. 60 lay volunteers who had received CPR training were studied, and six variables that describe the quality of CPR technique were recorded and scored with a predefined scoring system. No deterioration in CPR skills was seen during 15 min. We conclude that the initial 2 min assessment reflects the resuscitators ability to perform CPR over a longer period.
Many studies (several even before American Heart Association recommended in 1973 that lay public be trained in cardiopulmonary resuscitation (CPR] have documented that retention of CPR skills is poor, unaffected by modifications in curriculum or whether the students are lay or professional. We chose to investigate what actually occurs during a CPR course, and gained the following insights: despite clearly defined curricula, we found that instructors did not teach in a standardized way. Practice time was limited and errors in performance were not corrected. Instructors consistently rated the students' overall performance as acceptable; at the same time, using the same checklist, we consistently rated performance as unacceptable. The checklist is an inaccurate tool for evaluating CPR performance. Despite the poor performance that we documented, students and instructors were satisfied with the courses and believed that the level of performance was high. As a result of these studies, we discovered that the problem of poor retention of CPR skills may lie not with the learner or the curriculum, but with the instructor. But, since lives are being saved with bystander CPR, does this documented poor retention matter? Perhaps the solution is not only to improve instructor training to make certain that students receive adequate practice time and accurate skill evaluation, but also to modify the criteria for correct performance when testing for retention. These criteria should be based on the minimum CPR skills that are required to sustain life for the critical 4-8 min before defibrillation and other advanced cardiac life support are delivered.
A recursive estimation model is used to investigate the roles of cardiopulmonary resuscitation (CPR) and advanced life support in improving survival from out-of-hospital cardiac arrest. The importance of life support measures is clearly evidenced in the analysis: Fewer elapsed minutes between the cardiac arrest and the start of CPR increase the probabilities of both a favorable cardiac rhythm and defibrillation and the probability of survival. Similarly, a shorter elapsed time between the start of CPR and defibrillation is significantly related to a higher probability of survival of the cardiac arrest. Personal characteristics also contribute to survival, but primarily via their association with a favorable initial postarrest cardiac rhythm and the probability of defibrillation. The initial postarrest cardiac rhythm is shown to be an indicator of the heart's condition, but when other factors associated with survival are included in the analysis, it does not independently influence an individual's probability of survival.
An emergency medicine and trauma programme was implemented at Ben Gurion University Medical School in Israel. Clinical performance assessment of the first-year course in emergency medicine and trauma was done using a practical examination (PE). In the continuous process of critically reviewing the course objectives and assessment methods the objective structured clinical examination (OSCE) was chosen, for the first time in our medical school, as a tool for course development as well as evaluation of the existing PE. Seven experimental OSCE stations were designed which covered some of the course and practical examination topics. Twenty-six first-year medical students have taken both examinations concurrently. Twenty-three students answered an attitude questionnaire regarding both examinations. Results have indicated that the OSCE provided additional and crucial information on students' deficiencies in clinical performance which were not available from the PE. Those differences were probably due to realistic OSCE station content, highly simulated set-ups, and the objectivity of the examiner, all of which have contributed to a more challenging examination, as compared to the PE. The OSCE in emergency medicine and trauma seemed to have a relatively high level of acceptance by both staff and students. In our opinion it seems that the OSCE is a better tool for first-year level final assessment in emergency medicine and trauma. is a better tool for first-year level final assessment
Survival from out-of-hospital cardiac arrest in cities with populations of more than 1 million has not been studied adequately. This study was undertaken to determine the overall survival rate for Chicago and the effect of previously reported variables on survival, and to compare the observed survival rates with those previously reported.
Consecutive prehospital arrest patients were studied prospectively during 1987.
The study area was the city of Chicago, which has more than 3 million inhabitants in 228 square miles. The emergency medical services system, with 55 around-the-clock ambulances and 550 paramedics, is single-tiered and responds to more than 200,000 emergencies per year.
We studied 3,221 victims of out-of-hospital cardiac arrest on whom paramedics attempted resuscitation.
Ninety-one percent of patients were pronounced dead in emergency departments, 7% died in hospitals, and 2% survived to hospital discharge. Survival was significantly greater with bystander-witnessed arrest, bystander-initiated CPR, paramedic-witnessed arrest, initial rhythm of ventricular fibrillation, and shorter treatment intervals.
The overall survival rates were significantly lower than those reported in most previous studies, all based on smaller communities; they were consistent with the rates reported in the one comparable study of a large city. The single factor that most likely contributed to the poor overall survival was the relatively long interval between collapse and defibrillation. Logistical, demographic, and other special characteristics of large cities may have affected the rates. To improve treatment of cardiac arrest in large cities and maximize the use of community resources, we recommend further study of comparable metropolitan areas using standardized terms and methodology. Detailed analysis of each component of the emergency medical services systems will aid in making improvements to maximize survival of out-of-hospital cardiac arrest.
Investigated the influence of training on the acquisition and retention of cardiopulmonary resuscitation (CPR) skills by 38 sixth-grade children. Three training methods were compared: precise elaboration, imprecise elaboration, and maintenance rehearsal. Each of these methods was coupled with behavioral training and compared to a no-treatment control condition. Three CPR situations were selected for training: breath and pulse present, breath absent/pulse present, and breath and pulse absent. Data were collected at pretest, posttest, and 1-, 3-, and 5-month follow-ups, the dependent variable responses occurring in sequence. Results indicated that children in the three treatment conditions acquired and maintained the CPR responses at a significantly higher level than the control group. Evidence for the potential superiority of the precise elaboration group over the other conditions was provided.
We now know that the elements required to achieve the highest survival rates from out-of-hospital cardiac arrest include: witnessed arrest, rapid telephone notification of the emergency medical service, early initiation of cardiopulmonary resuscitation, rapid arrival within minutes of emergency personnel equipped with a defibrillator, and early advanced airway management and intravenous pharmacology. In the United States, and in several other countries innovative approaches have been tried to bring all these elements together in one system. These approaches include community-wide CPR training programs, telephone-assisted CPR instruction delivered at the time of a cardiac arrest, early defibrillation performed by family members of high risk patients, early defibrillation performed by minimally trained community responders, and early defibrillation performed by minimally trained ambulance personnel. Controlled, prospective studies have demonstrated the effectiveness and practicality of all of these approaches. New studies are in progress with the prehospital use of early transcutaneous cardiac pacing and these show promise. This article reviews the evidence that supports these multi-layered and innovative approaches to the treatment of out-of-hospital cardiac arrest.
At the end of a study program, evaluating the feasibility and the effectiveness of a unique training session on a school population, the majority of the students were asking for additional training opportunities. We therefore set up the present study with the purpose of evaluating skills, knowledge and attitude concerning CPR, after respectively one and two training sessions. 265 students from 4 different school levels were trained. 6 months later 134 answered a questionnaire and were again trained in CPR, 129 students answered the same questionnaire and were tested for their skills in CPR. Ten months later 75 students who had two training sessions answered again the questionnaire and 65 among them were tested for their skills. The two training sessions were identical, given by lay teachers priorly instructed in CPR, and consisted of a video-program and practical demonstration, followed by individual practice on training manikins. Both training sessions lasted 100 min. Evaluation of skills was performed by emergency physicians not involved in the training. Seventeen different items, representing each step in CPR were scored. Repeated training induces significant improvement of total skill scoring, without significant difference between boys and girls, but with improvement of scoring with class level. When looking at the different steps, the improvement in scoring is most impressive in certain steps which scored poorly after one training session, such as backward tilt of the head, a keystone in CPR. The steps concerning mouth-to-mouth breathing and external thoracic compressions reach, 10 months after the second training, an average of 1.6 out of 2 (80% correct) as compared to 1.44 out of 2 (71.9% correct) after one training. Knowledge concerning CPR does not increase significantly after the second training session. The time lapse of 10 months since the second training session may have played a role, although the methodology excluding interactive instruction may also explain this discrepancy. The influence on attitude shows that fear to apply CPR increased significantly after one training session and does not significantly lower after the second training. This attitude seems to be rather person-linked, for no correlation was found with age, theoretical knowledge or practical skill scoring. We have no way of knowing whether the statement concerning fear to apply CPR will correspond with such an attitude when confronted with a concrete emergency situation.
Prevalence of bystander CPR and effect on outcome has been evaluated on 3053 out-of-hospital cardiac arrest (CA) events. Bystander CPR was performed in 33% of recorded cases (n = 998) by lay people in 406 cases (family members 178, other lay people 228) and by bystanding health care workers in 592 cases (nurses 86, doctors 506). Family members and lay people mainly applied CPR in younger CA victims at public places, roadside or at the working place. Sudden infant death syndrome (SIDS) and drowning are highly represented. Health care workers performed CPR mainly in older patients, at public places or at the roadside and especially in case of cardiac or respiratory origin. CA caused by trauma/exsanguination and intoxication/metabolic origin received less bystander CPR (23% resp. 22%). Cardiac arrests receiving bystander CPR are more frequently witnessed and have a shorter access time to the emergency medical service (EMS) system and shorter response time of basic life support (BLS). Advanced life support (ALS) response time is significantly longer. In witnessed arrests of cardiac origin receiving bystander CPR a significantly better late survival was observed. In non-witnessed arrests of cardiac origin early and late survival are significantly higher in patients receiving bystander CPR. In CA events where response time of ALS exceeds 8 min, the beneficial effect of bystander CPR is most significant. Furthermore no deleterious effect of bad technique or inefficient bystander CPR can be demonstrated.
The immediate delivery of bystander-administered cardiopulmonary resuscitation (CPR), coupled with the rapid delivery of advanced cardiac life support, can significantly reduce mortality from out-of-hospital cardiac arrest. Because the majority of sudden cardiac deaths occur in the victim's home with family members present, family members of cardiac patients at high risk for sudden death are the logical focus of CPR training. However, previous research has shown that only a small minority of family members of cardiac patients actually learn CPR and that health care professionals have failed to recommend CPR training in this population, in part due to concerns about their ability to learn CPR. The purpose of this study was to describe learning capabilities in this population and to identify characteristics of unsuccessful learners. To this end, we taught CPR to 83 family members of cardiac patients who were at risk for sudden cardiac death. Subjects had no CPR training within the past two years. Eighty-one percent of the subjects successfully learned CPR. Of the demographic and psychological characteristics examined, only gender, age, and depression were significant in explaining differences in CPR skills attainment ability. The elderly, the depressed, and males were more likely to be unsuccessful in demonstrating adequate CPR skills. Our results suggest that the majority of family members of cardiac patients can learn CPR successfully. Specific training strategies may need to be developed and tested to enhance CPR training in those family members of cardiac patients predicted to have difficulty learning CPR.
We studied the effectiveness of two refresher methods on skills that did not involve mannequin practice. Sixty-seven Seattle subjects trained one year earlier were pretested and randomly assigned to one of two treatments that covered the technique of one-rescuer CPR: reading a three-page review (n = 33); or viewing a 15-minute videotape (n = 34). Subjects were tested on a recording mannequin immediately after the refresher. Pretest scores were low on almost all skills. After treatment, both groups demonstrated significant improvement (P less than .01), especially on checking the carotid pulse, correct hand position, and ventilation volume. Although students who had watched the tape performed better on compression rate (P less than .05), there was virtually equivalent improvement on the other skills regardless of treatment. Both methods showed promise for reversing skills degradation without mannequin practice.
The effectiveness of bystander CPR recently has been challenged. We undertook a ten-year retrospective review of our prehospital experience with witnessed cardiorespiratory arrest to ascertain save rates in patients receiving and not receiving CPR before paramedic advanced life support (ALS). Traumatic and poisoning arrests and children less than 18 years old were excluded. A total of 1,905 patients presenting to a paramedic system from November 1, 1973, to October 31, 1983, were bystander-witnessed arrests and attempted paramedic resuscitations. Four hundred five paramedic-witnessed arrests were excluded. One hundred eighty-two of 1,248 (14.6%) who had CPR initiated before paramedic ALS arrival were saves, compared to 38 of 252 (15%) who had no CPR initiated until paramedic arrival (P = NS). A save was defined as a patient discharged from the hospital. The respective save rates for coarse ventricular fibrillation were 148 of 628 (23.6%) (CPR before paramedic arrival) vs 35 of 151 (CPR delayed until paramedic arrival) (23.2%); electromechanical dissociation (EMD), 11 of 209 (5.3%) vs 0 of 38; asystole, 19 of 401 (4.7%) vs 3 of 61 (4.9%); and ventricular tachycardia, four of ten (40%) vs 0 of two. In this prehospital system, bystander/first responder CPR was found not to improve hospital discharge rates except in patients with initially documented rhythm of EMD.
The theoretical knowledge and practical performance of 166 lay people attending a short cardiopulmonary resuscitation course were evaluated according to the American Heart Association standards. Before tt course no participant was able to perform even a bad attempt at cardiopulmonary resuscitation. Theoretical knowledge was good at the end of the course and at the refresher course six months later. At the end of the initial course 65% (57/88) of the participants examined could adequately compress and ventilate the manikin. After six months 44% (30/68) could perform resuscitation adequately. Women were as proficient as men, and elderly people in general were as proficient as the younger ones. The skill of carotid artery palpation was surprisingly well retained after six months. Data on pulmonary ventilation and cardiac massage were recorded simultaneously on a recording resuscitation manikin. When these objective data were compared with the American Heart Association standards only a few participants were able to perform correct cardiopulmonary resuscitation. The number of compressions and ventilations per minute were often insufficient. A large discrepancy between self, subjective, and objective assessment of cardiopulmonary resuscitation knowledge and performance was found. The importance of a rapid diagnosis, an immediate call for help, an adequate rate of cardiac massage, and a reduction in the time needed for ventilation should be emphasised at these courses. Refresher courses should be provided at least twice a year.
The effect of bystander cardiopulmonary resuscitation (CPR) was studied in 2142 emergency medical service (EMS) cardiac arrest runs. When bystander CPR was administered to cardiac arrest victims, 22.9% of the victims survived until they were admitted to the hospital and 11.9% were discharged alive. In comparison, the statistics for cardiac arrest victims who did not receive bystander CPR were 14.6% and 4.7%, respectively (p less than 0.001). A critical factor in patient survival was the amount of time that elapsed before the EMS personnel arrived and administered CPR. Patients who received bystander CPR were more likely to have ventricular fibrillation when the EMS arrived. Other factors relating to patient survival were the location of the victim at the time of the cardiac arrest and the age of the victim. Understanding these factors is important in developing community strategies to treat patients with cardiac arrest out of hospital.
Prehospital bystander cardiopulmonary resuscitation (CPR) was studied to determine if it affected the outcome of defibrillation. Four hundred twenty-one consecutive witnessed cardiopulmonary arrests presenting with the initial rhythm of coarse ventricular fibrillation treated by the Milwaukee County Paramedic System from January 1980 to June 1982 were analyzed. Pediatric, trauma, and poisoning patients and those receiving intravenous or endotracheal medications before defibrillation (58) were excluded. Immediate professional bystander CPR (physician, nurse, EMT) and citizen bystander CPR were compared to a control group receiving no bystander CPR until arrival of EMS personnel. A successful defibrillation occurred if defibrillation prior to administration of medication produced an effective cardiac rhythm with pulses. Eighty-eight of the 363 remaining patients (24%) converted with initial defibrillations. While the group receiving professional bystander CPR had a higher successful defibrillation rate than did the no-CPR group (35% vs 22%, P less than .04), citizen bystander CPR and no-CPR groups had similar successful defibrillation rates (24% vs 22%, no significant difference). One hundred eighty-six of the 363 patients (51%) were transported to a hospital with a rhythm and a pulse (a successful resuscitation). Ninety-seven of the 363 patients (27%) were discharged alive from the hospital (a save). Patients who were converted successfully using initial "quick-look" defibrillations were far more likely to be successfully resuscitated (79/88 [90%] vs 107/275 [39%], P greater than .0001) and to be discharged alive from the hospital (54/88 [61%] vs 43/275 [16%], P greater than .0001) than were those who required further advanced cardiac life support techniques.(ABSTRACT TRUNCATED AT 250 WORDS)
A randomized prospective study was done to examine long-term cardiopulmonary resuscitation (CPR) cognitive and motor skills retention and to compare the "self-taught" modular course with the standard lecture course. Both cognitive and motor skills were tested at one-, two- and four-year intervals after the initial course. Approximately half the students in both the modular and standard lecture courses also took a refresher course after one year. While there was no significant difference (P greater than .05) in retention based on the method of teaching (modular vs lecture course), students who took the refresher course after one year performed significantly better (P less than .01) at the two-year interval. Results four years after the initial CPR course (three years after the refresher course) were uniformly poor in both groups. Only three of 104 students were able to meet American Heart Association standards for the performance of CPR. Refresher courses are vital if CPR is to be performed effectively and competently. They should be available on a continuing basis with self-taught courses providing a good alternative to the formal didactic course as a means of providing instruction.
Performance in and knowledge of cardiopulmonary resuscitation (CPR) were assessed in a group of preclinical medical students who had received CPR certification either two or three weeks (group 0), one year (group 1), or two years (group 2) prior to the study. Assessment, ventilation, compression, and complications caused by incorrect technique were evaluated. A written examination was also given. There was significantly higher rate of failure to perform adequate CPR by students in groups 1 and 2 when compared with group 0 (p less than .05). There was no significant difference between the failure rates of groups 1 and 2. The most frequent errors related to chest compression rate and an inability to adhere to the recommended single-rescuer compression-to-ventilation ratio. Written test scores were also higher in group 0 than either group 1 or 2 (p less than .001). Written examination scores were not reliable predictors of CPR skill in individual cases.
In 1979-1980, 950 telephone company personnel were trained and tested at the basic rescuer level on recording manikins. In October 1981, a random group of 40 were retested without warning on the recording manikin. Skills retention was measured by comparing the tapes from training and retesting. Sixteen (40%) of those retested were able to perform effective ventilations and compressions of the manikin with 60% to 70% average retention compared to their training scores. The remaining 24 (60%) had ineffective ventilations or compressions or both. The two groups did not differ in the performance level achieved during training, or in the time interval between training and retesting. Eleven individuals retested at 13 to 14 months did not perform better than those retested later, suggesting the maximum skills deterioration had occurred within the first year. However, the effective performance group on the average were younger, and the majority had first aid training in addition to their CPR training. Only one had CPR retraining. This study supports the following recommendations: 1) lay basic rescuers should be retrained within the first year; 2) further studies of the factors influencing retention are advisable; 3) the younger age groups should be the first priority for citizen CPR training; and 4) because first aid training appears to improve CPR retention, training in both should be encouraged.
To investigate the ability of qualified general nurses to perform cardiopulmonary resuscitation and to compare these skills with those of a group of ambulance nurses.
Cross-sectional assessment of practical cardiopulmonary resuscitation skills.
141 Dutch general nurses.
The practical skills were tested with six primary variables that describe the quality of cardiopulmonary resuscitation techniques in a training situation. A total score on the skills was computed based on a predefined scoring system.
The percentage of general nurses who were able to achieve a pass score (i.e., the total score did not exceed 15 penalty points) was 6.4 percent. The average score was 37.8 penalty points. Eighty-eight percent of the ambulance nurses achieved a pass score. The average number of penalty points was 10.5.
The practical skills in cardiopulmonary resuscitation are insufficient in the majority of this sample of general nurses in The Netherlands. The findings of this study should be used as a base to design an optimal form and content of an educational re-instruction program. We expect that a considerable improvement could be achieved by more frequent cardiopulmonary resuscitation re-instruction.
Early access to the EMS system helps insure early CPR, defibrillation, and advanced care. Early access is easiest to achieve with 911 systems and widespread community education and publicity. It may also be taught during citizen-CPR classes. Early CPR helps patients by slowing the process of dying, but its effectiveness disappears within minutes, and defibrillation must soon follow. A citizenry well-informed about cardiac emergencies and well-trained in CPR appears to be the best method to achieve early recognition and early CPR. The earliest possible delivery of defibrillation is critical and, almost by itself, sufficient for many sudden death cases. It has, therefore, emerged as the single most effective intervention for patients in nontraumatic cardiac arrest. Automated external defibrillators help accomplish this goal and now permit widespread implementation of a variety of early defibrillation programs. Early advanced care helps those who do not immediately convert to an organized cardiac activity or who do not achieve a spontaneous circulation following early defibrillation. Advanced care allows a system to approach its highest possible survival rate by respiratory and anti-arrhythmic stabilization and monitoring of patients in the post-resuscitation period. At present, early CPR and rapid defibrillation, combined with early advanced care, can result in long-term survival rates as high as 30% for witnessed VF. Because neurological and psychological recovery from cardiac arrest are tied to the time within which these critical interdependent treatment modalities are delivered (1, 87), high resuscitation rates will also lead to a high percentage of patients who recover to their pre-arrest neurologic level. The public health challenge is to develop programs that will allow recognition, access, bystander-CPR, defibrillation, and advanced care to be delivered as quickly as possible, ideally within moments of the collapse of a sudden death victim. Achievement of such a goal requires the deployment of multiple properly directed programs within an EMS system; each program lends strength to the chain of survival, thereby enhancing successful recovery and long-term survival. What benefits would occur if a majority of EMS systems in the United States could establish cost-effective programs with respectable survival rates? The AHA estimates that full implementation of potential life-saving mechanisms in the community may save 10,000-100,000 lives each year in the US (2). If the maximum survival rate for all nontraumatic cardiac arrests in mature EMS systems is about 20% (33) among the annual 400,000 out-of-hospital cardiac arrests, 80,000 persons would be saved (33).(ABSTRACT TRUNCATED AT 400 WORDS)
Lay citizens trained in a three-hour course can perform CPR at an acceptable level when tested immediately after class. By one year after training, retention of most CPR skills is poor. The 20- 15 minutes necessary for retention testing appeared to improved performance on subsequent retention testing. Therefore, a one-how review class with mannequin practice was established to reinforce skills. For students initially trained one year earlier, review classes significantly improved competency in almost all procedures and raised it to the level found after initial training.