Influence of nationwide policy on citizens’ awareness and willingness to perform bystander cardiopulmonary resuscitation

Aims

Public awareness to cardiopulmonary resuscitation (CPR) and cardiac arrest is influenced by systemic factors including related policies and legislations in the community. Here, we describe and compare the results of the two nationwide CPR surveys in 2007 and 2011 examining public awareness and attitudes to bystander CPR in South Korea along with changes in nationwide CPR policies and systemic factors.

Methods

This population-based study used specially designed questionnaires via telephone surveys. We conducted bi-temporal surveys by stratified cluster sampling to assess the impact of age, gender, and geographic regions in 2007 (n = 1029) and in 2011 (n = 1000). Logistic regression analysis was performed to identify factors associated with willingness to perform bystander CPR.

Results

Public awareness of automated external defibrillators increased from 3.0% in 2007 to 32.6% in 2011. The proportion of the population that underwent CPR training within the previous 2 years increased significantly from 26.9% to 49.0%. The factors most related with intention of bystander CPR were male gender, younger age, CPR awareness, recent CPR training, and qualified CPR learning. In 2011, 75.8% of respondents were more willing to perform bystander CPR for stranger vs. 68.3% in 2007 (p = 0.002). Additional dispatcher hands-only CPR increased this proportion (85.8%, p < 0.001). However, bystander CPR experience rates remained unchanged (3.6–3.9%).

Conclusion

Changes in nationwide CPR policies and systemic factors affected citizens’ awareness and willingness to perform bystander CPR. Additionally, applied dispatcher hands-only CPR and publicity increased public willingness to perform bystander CPR.     

Quality of CPR performed by trained bystanders with optimized pre-arrival instructions

Objective

Telephone-CPR (T-CPR) can increase initiation of bystander CPR. We wanted to study if quality oriented continuous T-CPR would improve CPR performance vs. standard T-CPR.

Method

Ninety-five trained rescuers aged 22–69 were randomized to standard T-CPR or experimental continuous T-CPR (comprises continuous instructions, questions and encouragement). They were instructed to perform 10 min of chest compressions-only on a manikin, which recorded CPR performance in a small, confined kitchen. Three video-cameras captured algorithm time data, CPR technique and communication. Demography and training experience were captured during debriefing.

Results

Participants receiving continuous T-CPR delivered significantly more chest compressions (median 1000 vs. 870 compressions, p = 0.014) and compressed more frequently to a compression rate between 90 and 120 min⁻¹ (median 87% vs. 60% of compressions, p < 0.001), compared to those receiving standard T-CPR. This also resulted in less time without compressions after CPR had started (median 12 s vs. 64 s, p < 0.001), but longer time interval from initiating contact with dispatcher to first chest compression (median 144 s vs. 84 s, p < 0.001). There was no difference in chest compression depth (mean 47 mm vs. 48 mm, p = 0.90) or in demography, education and previous CPR training between the groups.

Conclusion

In our simulated scenario with CPR trained lay rescuers, experimental continuous T-CPR gave better chest compression rate and less hands-off time during CPR, but resulted in delayed time to first chest compression compared to standard T-CPR instructions.     

First quantitative analysis of cardiopulmonary resuscitation quality during in-hospital cardiac arrests of young children

Aim

The objective of this study is to report, for the first time, quantitative data on CPR quality during the resuscitation of children under 8 years of age. We hypothesized that the CPR performed would often not achieve 2010 Pediatric Basic Life Support (BLS) Guidelines, but would improve with the addition of audiovisual feedback.

Methods

Prospective observational cohort evaluating CPR quality during chest compression (CC) events in children between 1 and 8 years of age. CPR recording defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF), leaning (%> 2.5 kg.)). Audiovisual feedback was according to 2010 Guidelines in a subset of patients. The primary outcome, “excellent CPR” was defined as a CC rate ≥100 and ≤120 CC/min, depth ≥50 mm, CCF >0.80, and <20% of CC with leaning.

Results

8 CC events resulted in 285 thirty-second epochs of CPR (15,960 CCs). Percentage of epochs achieving targets was 54% (153/285) for rate, 19% (54/285) for depth, 88% (250/285) for CCF, 79% (226/285) for leaning, and 8% (24/285) for excellent CPR. The median percentage of epochs per event achieving targets increased with audiovisual feedback for rate [88 (IQR: 79, 94) vs. 39 (IQR 18, 62) %; p = 0.043] and excellent CPR [28 (IQR: 7.2, 52) vs. 0 (IQR: 0, 1) %; p = 0.018].

Conclusions

In-hospital pediatric CPR often does not meet 2010 Pediatric BLS Guidelines, but compliance is better when audiovisual feedback is provided to rescuers.     

Chest compression-only cardiopulmonary resuscitation performed by lay rescuers for adult out-of-hospital cardiac arrest due to non-cardiac aetiologies

Objective

Bystander CPR improves survival in patients with out-of-hospital cardiac arrest (OHCA). For adult sudden collapse, bystander chest compression-only CPR (COCPR) is recommended in some circumstances by the American Heart Association and European Resuscitation Council. However, adults who arrest from non-cardiac causes may also receive COCPR. Because rescue breathing may be more important for individuals suffering OHCA secondary to non-cardiac causes, COCPR is not recommended for these cases. We evaluated the relationship of lay rescuer COCPR and survival after OHCA from non-cardiac causes.

Methods

Analysis of a statewide Utstein-style registry of adult OHCA, during a large scale campaign endorsing COCPR for OHCA from presumed cardiac cause. The relationship between lay rescuer CPR (both conventional CPR and COCPR) and survival to hospital discharge was evaluated.

Results

Presumed non-cardiac aetiologies of OHCA accounted for 15% of all cases, and lay rescuer CPR was provided in 29% of these cases. Survival to hospital discharge occurred in 3.8% after conventional CPR, 2.7% after COCPR, and 4.0% after no CPR (p = 0.85). The proportion of patients receiving COCPR was much lower in the cohort of OHCA from respiratory causes (8.3%) than for those with presumed cardiac OHCA (18.0%; p < 0.001).

Conclusions

In the setting of a campaign endorsing lay rescuer COCPR for cardiac OHCA, bystanders were less likely to perform COCPR on OHCA victims who might benefit from rescue breathing.     

Pushing harder,pushing faster,minimizing interruptions… But falling short of 2010 cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation

Aim

The objective of this study was to evaluate the effect of instituting the 2010 Basic Life Support Guidelines on in-hospital pediatric and adolescent cardiopulmonary resuscitation (CPR) quality. We hypothesized that quality would improve, but that targets for chest compression (CC) depth would be difficult to achieve.

Methods

Prospective in-hospital observational study comparing CPR quality 24 months before and after release of the 2010 Guidelines. CPR recording/feedback-enabled defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF, %), leaning (% > 2.5 kg)). Audiovisual feedback for depth was: 2005, ≥38 mm; 2010, ≥50 mm; for rate: 2005, ≥90 and ≤120 CC/min; 2010, ≥100 and ≤120 CC/min. The primary outcome was average event depth compared with Student's t-test.

Results

45 CPR events (25 before; 20 after) occurred, resulting in 1336 thirty-second epochs (909 before; 427 after). Compared to 2005, average event depth (50 ± 13 mm vs. 43 ± 9 mm; p = 0.047), rate (113 ± 11 CC/min vs. 104 ± 8 CC/min; p < 0.01), and CCF (0.94 [0.93, 0.96] vs. 0.9 [0.85, 0.94]; p = 0.013) increased during 2010. CPR epochs during the 2010 period more likely to meet Guidelines for CCF (OR 1.7; CI95: 1.2–2.4; p < 0.01), but less likely for rate (OR 0.23; CI95: 0.12–0.44; p < 0.01), and depth (OR 0.31; CI95: 0.12–0.86; p = 0.024).

Conclusions

Institution of the 2010 Guidelines was associated with increased CC depth, rate, and CC fraction; yet, achieving 2010 targets for rate and depth was difficult.     

Effects of BLS training on factors associated with attitude toward CPR in college students

Aim

In order to elucidate the factors for willingness to perform CPR, we evaluated the responses of college students to questionnaires before and after basic life support (BLS) training.

Methods

Before and after participating in a small group BLS course, 259 students completed questionnaires. A logistic regression model was used to elucidate independent factors for their willingness to attempt resuscitation.

Results

Factors associated with willingness to perform BLS for strangers were “anxiety for a bad outcome” (odds ratio (OR) 0.08) and “having knowledge of automated external defibrillator (AED)” (OR 4.5) before training. The proportion of students showing willingness to perform BLS increased from 13% to 77% after the training even when the collapsed person is a stranger. After training, “anxiety for being sued because of a bad outcome” (OR 0.3), and “anxiety for infection” (OR 3.8) were significant factors. Those who preferred to perform BLS without ventilation increased from 40% to 79% (p < 0.0001).

Conclusion

The proportion of students showing willingness to perform BLS increased after the training. Significant association between “anxiety for infection” and willingness to perform BLS might indicate that those who wish to perform BLS developed their awareness of risk of infection more than the counterparts. For future guidelines for resuscitation and the instruction consensus, the reluctance of bystanders to perform CPR due to the hesitation about mouth-to-mouth ventilation should be reconsidered with other recent reports indicating the advantage of compression-only CPR.     

Bystander-initiated CPR in an Asian metropolitan: Does the socioeconomic status matter?

Objectives

To determine the association of neighborhood socioeconomic status (SES) with bystander-initiated cardiopulmonary resuscitation (CPR) and patient outcomes of out of hospital cardiac arrests (OHCAs) in an Asian metropolitan area.

Methods

We performed a retrospective study in a prospectively collected cohort from the Utstein registry of adult non-traumatic OHCAs in Taipei, Taiwan. Average real estate value was assessed as the first proxy of SES. Twelve administrative districts in Taipei City were categorized into low versus high SES areas to test the association. The primary outcome was bystander-initiated CPR, and the secondary outcome was patient survival status. Factors associated with bystander-initiated CPR were adjusted for in multivariate analysis. The mean household income was assessed as the second proxy of SES to validate the association.

Results

From January 1, 2008 to December 30, 2009, 3573 OHCAs received prehospital resuscitation in the community. Among these, 617 (17.3%) cases received bystander CPR. The proportion of bystander CPR in low-SES vs. high-SES areas was 14.5% vs. 19.6% (p < 0.01). Odds ratio of receiving bystander-initiated CPR in low-SES areas was 0.72 (95% confidence interval: [0.60–0.88]) after adjusting for age, gender, witnessed status, public collapse, and OHCA unrecognized by the online dispatcher. Survival to discharge rate was significantly lower in low-SES areas vs. high-SES areas (4.3% vs. 6.8%; p < 0.01). All results above remained consistent in the analyses by mean household income.

Conclusions

Patients who experienced an OHCA in low-SES areas were less likely to receive bystander-initiated CPR, and demonstrated worse survival outcomes.     

Rescuer Fatigue in the Elderly: Standard vs. Hands-only CPR

Background

Hands-only cardiopulmonary resuscitation (HO-CPR) is recommended as an alternative to standard CPR (STD-CPR). Studies have shown a degradation of adequate compressions with HO-CPR after 2 min when performed by young, healthy medical students. Elderly rescuers' ability to maintain an adequate compression rate and depth until emergency medical services (EMS) arrives is unknown.

Objectives

The specific aim of this study was to compare elderly rescuers' ability to maintain adequate compression rate and depth during HO-CPR and STD-CPR in a manikin model.

Methods

In this prospective, randomized crossover study, 17 elderly volunteers performed both HO-CPR and STD-CPR, separated by at least 2 days, on a manikin model for 9 min each. The primary endpoint was the number of adequate chest compressions (> 38 mm) delivered per minute. Secondary endpoints were total compressions, compression rate, and the number of breaks taken for rest.

Results

There was no difference in the number of adequate compressions between groups in the first minute; however, the STD-CPR group delivered significantly more adequate chest compressions in minutes 2–9 (p < 0.05). The total number of compressions delivered was significantly greater in the HO-CPR than STD-CPR group when considering the entire resuscitation period. A significantly greater number of rescuers took breaks for rest during HO-CPR than STD-CPR.

Conclusions

Although HO-CPR resulted in a greater number of overall compressions than STD-CPR, STD-CPR resulted in a greater number of adequate compressions in all but the first minute of resuscitation.     

The effect of two different counting methods on the quality of CPR on a manikin—A randomized controlled trial

Objectives

To compare the quality of cardiopulmonary resuscitation (CPR) and rescuers’ exhaustion using different methods of counting, and to establish an appropriate method of counting.

Materials and methods

Forty-eight subjects who had received formal training in basic life support (BLS) were recruited from doctors and nurses working in the Emergency Department of a university hospital. They performed 3 min of continuous chest compressions using two different methods of counting, one after the other, on an adult resuscitation manikin. The total number of compressions, the number of these considered satisfactory, the peak heart rate of subjects and the time to peak heart rate were all recorded. Perceived fatigue and discomfort was evaluated by self-reported survey results with use of a visual analogue scale (VAS).

Results

The effective power of external chest compression and the mean compression depth when counting from 1 to 10, repeated three times, were greater than those achieved when counting from 1 to 30 during 3 min of CPR (67.48% vs. 57.81% and 44.52 mm vs. 40.48 mm, P < 0.05). The exhaustion-score using the VAS (22.15 points) was lower and the time to peak heart rate (124.88 s) was longer when counting from 1 to 10, repeated three times, than when rescuers counted from 1 to 30.

Conclusions

Counting from 1 to 10 three times in Chinese as opposed to 1–30 results in better quality chest compressions. Counting from 1 to 10 three times was associated with less user feelings of fatigue, and a longer time to peak heart rate. These findings support the teaching of counting compressions 1–10 three times during CPR.     

Predictive Factors of Successful Telephone-assisted Cardiopulmonary Resuscitation

Background

Our emergency medical service developed a telephone (phone)-assisted cardiopulmonary resuscitation (PACPR) procedure.

Objectives

To describe this procedure and study the factors modulating its implementation.

Methods

We conducted a single-center prospective study of telephone calls to our emergency medical communication center for cardiac arrest, for which PACPR was initiated.

Results

Thirty-eight patients were included in the study. In six cases, cardiopulmonary resuscitation (CPR) had been started before the call. When PACPR was initiated, CPR was performed until the rescue team arrived in 27 cases. One-third (n = 9) of the bystanders in these cases knew first-aid interventions, and all of these bystanders continued CPR until the rescue team arrived. The absence of a familial relationship between bystander and patient facilitated the continuation of CPR (100% vs. 37% with family ties, p = 0.01). CPR was continued more often if the bystander immediately agreed to PACPR than when he or she did not agree at first (88% vs. 45%, respectively, p = 0.01). When an obstacle to performing CPR was encountered, CPR was then performed in 57% of cases vs. 100% of cases with no obstacle (p = 0.003). These obstacles were associated with either the bystander (panic, apprehension, feelings of inadequacy, physical inability, indirect witness, tiredness) or the victim (morphotype, physical position). The presence of an obstacle, compared to no obstacle, associated with the bystander lowered the CPR performance rate (58% vs. 94%, respectively, p = 0.01). The presence of an obstacle, compared to no obstacle, associated with the victim also lowered CPR performance rate (50% vs. 85%, respectively, p = 0.04).

Conclusion

Our study demonstrates the feasibility of PACPR. The results may lead to a better understanding of facilitating factors and obstacles to telephone-assisted CPR, with the goal of improving its implementation. Good command of communication tools, identification of an appropriate bystander, and appropriate victim positioning are three fundamental factors of success.     

The utility of the HeartSaver Sticker for maintaining correct hand position during chest compressions

Background

The importance of attaining correct hand position in cardiopulmonary resuscitation (CPR) instruction has not been emphasized as much as the significance of the compression performance. Study Objectives: This pilot study was performed to investigate the utility of a HeartSaver Sticker for maintaining correct hand position during chest compressions.

Methods

Fifty-one sophomore college students, training to become emergency medical technicians, were recruited. The students, having no previous experience using HeartSaver stickers, participated in this prospective, randomized simulation-based controlled study, which consisted of two groups: 1) with sticker (n = 26), 2) without sticker (n = 25). The 4 × 4-cm HeartSaver sticker marked with both vertical and horizontal center lines was used in this study. Proper sticker placement was such that the vertical line coincided with the mid-sternum of the chest, and the horizontal line aligned with the nipples. Participants performed adult basic life support by single rescuer according to the 2005 American Heart Association resuscitation guidelines. Skill assessment was also performed by these guidelines.

Results

Group 1 participants placed the HeartSaver sticker on the correct landmark within 10 s of approaching the model. The compression rate and depth were not significantly different between the two groups. However, significant improvement in correct hand position was noticed when using the HeartSaver sticker. Correct hand position was 97.1% ± 7.4% in group 1 and 85.9% ± 21.5% in group 2 (p = 0.002).

Conclusion

The HeartSaver sticker was useful in maintaining correct hand position during the single-rescuer CPR scenario because it provided easy recognition of that position when compressing after ventilations.     

2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival

Aim

Gaps exist in pediatric resuscitation knowledge due to limited data collected during cardiac arrest in real children. The objective of this study was to evaluate the relationship between the 2010 American Heart Association (AHA) recommended chest compression (CC) depth (≥51 mm) and survival following pediatric resuscitation attempts.

Methods

Single-center prospectively collected and retrospectively analyzed observational study of children (>1 year) who received CCs between October 2006 and September 2013 in the intensive care unit (ICU) or emergency department (ED) at a tertiary care children's hospital. Multivariate logistic regression models controlling for calendar year and known potential confounders were used to estimate the association between 2010 AHA depth compliance and survival outcomes. The primary outcome was 24-h survival. The primary predictor variable was event AHA depth compliance, prospectively defined as an event with ≥60% of 30-s epochs achieving an average CC depth ≥51 mm during the first 5 min of the resuscitation.

Results

There were 89 CC events, 87 with quantitative CPR data collected (23 AHA depth compliant). AHA depth compliant events were associated with improved 24-h survival on both univariate analysis (70% vs. 16%, p < 0.001) and after controlling for potential confounders (calendar year of arrest, gender, first documented rhythm; aOR 10.3; CI⁹⁵: 2.75–38.8; p < 0.001).

Conclusions

2010 AHA compliant chest compression depths (≥51 mm) are associated with higher 24-h survival compared to shallower chest compression depths, even after accounting for potentially confounding patient and event factors.     

Reduced effectiveness of vasopressin in repeated doses for patients undergoing prolonged cardiopulmonary resuscitation

Introduction

The efficacy of repeated administration of vasopressin alone during prolonged cardiopulmonary resuscitation (CPR) remains unconfirmed. This study was conducted to estimate the effectiveness of the repeated administration of vasopressin vs. epinephrine for cardiopulmonary arrest (CPA) patients receiving prolonged CPR.

Methods

We conducted a prospective randomized controlled study on patients who experienced out-of-hospital CPA. The patients were randomly assigned to receive a maximum of four injections of either 40 IU of vasopressin (vasopressin group) or 1 mg of epinephrine (epinephrine group) immediately after emergency room (ER) admission. Patients who received vasopressors before ER admission or suffered non-cardiogenic CPA were excluded after randomization.

Results

In total, 336 patients were enrolled (vasopressin group, n = 137; epinephrine group, n = 118). No differences were found between these groups (vasopressin group vs. epinephrine group) in the rates of return of spontaneous circulation (ROSC) (28.7% vs. 26.6%), 24-h survival (16.9% vs. 20.3%), or survival to hospital discharge (5.6% vs. 3.8%). In a subgroup analysis by the Fisher's exact test, the rate of ROSC was higher in the vasopressin group than in the epinephrine group, among the patients whose arrests were witnessed (48.1% vs. 27.8%, p = 0.010) or who received bystander CPR (68.0% vs. 38.5%, p = 0.033). When the independent predictors of ROSC were calculated in the subgroup analysis, however, vasopressin administration (Odds ratio: 0.87–0.28) did not affect the outcome.

Conclusions

This is the first report of a possible vasopressin-alone resuscitation without additional epinephrine. However, repeated injections of either vasopressin or epinephrine during prolonged advanced cardiac life support resulted in comparable survival.     

A Simple Audio-visual Prompt Device Can Improve CPR Performance

Background

An adjunct to assist cardiopulmonary resuscitation (CPR) might improve the quality of CPR performance.

Study Objectives

This study was conducted to evaluate whether a simple audio-visual prompt device improves CPR performance by emergency medical technicians (EMTs).

Methods

From June 2008 to October 2008, 55 EMTs (39 men, mean age 34.9 ± 4.8 years) participated in this study. A simple audio-visual prompt device was developed. The device generates continuous metronomic sounds for chest compression at a rate of 100 beats/min with a distinct 30^th sound followed by two respiration sounds, each for 1 second. All EMTs were asked to perform a 2-min CPR series on a manikin without the device, and one 2-min CPR series with the device.

Results

The average rate of chest compressions was more accurate when the device was used than when the device was not used (101.4 ± 12.7 vs. 109.0 ± 17.4/min, respectively, p = 0.012; 95% confidence interval [CI] 97.2–103.8 vs. 104.5–113.5/min, respectively), and hands-off time during CPR was shorter when the device was used than when the device was not used (5.4 ± 0.9 vs. 9.2 ± 3.9 s, respectively, p < 0.001; 95% CI 5.2–5.7 vs. 8.3–10.3 s, respectively). The mean tidal volume during CPR with the device was lower than without the device, resulting in the prevention of hyperventilation (477.6 ± 60.0 vs. 636.6 ± 153.4 mL, respectively, p < 0.001; 95% CI 463.5–496.2 vs. 607.3–688.9 mL, respectively).

Conclusion

A simple audio-visual prompt device can improve CPR performance by emergency medical technicians.     

Are trained individuals more likely to perform bystander CPR? An observational study

Background

This study aimed to evaluate the association of cardiopulmonary resuscitation (CPR) training with bystander resuscitation performance and patient outcomes after out-of-hospital cardiac arrest (OHCA).

Methods

This was a prospective, population-based cohort study of all persons aged 18 years or older with OHCA of presumed intrinsic origin and their rescuers from January through December 2008 in Takatsuki, Osaka prefecture, Japan. Data on resuscitation of OHCA patients were obtained by emergency medical service (EMS) personnel in charge based on the Utstein style. Rescuers’ characteristics including experience of CPR training were obtained by EMS personnel interview on the scene. The primary outcome was the attempt of bystander CPR.

Results

Data were collected for 120 cases out of 170 OHCAs of intrinsic origin. Among the available cases, 60 (50.0%) had previous CPR training (trained rescuer group). The proportion of bystander CPR was significantly higher in the trained rescuer group than in the untrained rescuer group (75.0% and 43.3%; p = 0.001). Bystanders who had previous experience of CPR training were 3.40 times (95% confidence interval 1.31-8.85) more likely to perform CPR compared with those without previous CPR training. The number of patients with neurologically favorable one-month survival was too small to evaluate statistical difference between the groups (2 [3.3%] in the trained rescuer group versus 1 [1.7%] in the untrained rescuer group; p = 0.500).

Conclusions

People who had experienced CPR training had a greater tendency to perform bystander CPR than people without experience of CPR training. Further studies are needed to prove the effectiveness of CPR training on survival.     

Evaluation of telephone-cardiopulmonary resuscitation advice for paediatric cardiac arrest

Introduction

Telephone-cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR, one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current paediatric telephone protocol (AMPDS v11.1) to assess the effectiveness of verbal CPR instructions in paediatric cardiac arrest.

Methods

Consecutive emergency calls classified by the AMPDS as cardiac arrests in children <8 years old, over an 11 month period, were compared with their corresponding patient report forms (PRFs) to confirm the diagnosis. Audio recordings and PRFs were then evaluated to assess whether bystander CPR was given, and when it was, the time taken to perform CPR interventions, before paramedic arrival.

Results

Of the 42 calls reviewed, 19 (45.2%) were confirmed as cardiac arrest. CPR was already underway in two cases (10.5%). Of the remaining callers, 11 (64.7%) agreed to attempt T-CPR, resulting in an overall bystander-CPR rate of 68.4%. The median time to open the airway was 126 s (62-236 s, n = 11), deliver the first ventilation was 180 s (135-360 s, n  = 11), and perform the first chest compression was 280 s (164-420 s, n  = 9).

Conclusion

Although current telephone-CPR instructions improve the numbers of children in whom bystander CPR is attempted, effectiveness is likely to be limited by the significant delays in actually delivering basic life support.     

CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway

Background

Early bystander cardiopulmonary resuscitation (CPR) is essential for survival from out-of-hospital cardiac arrest (OHCA). Young people are potentially important bystander CPR providers, as basic life support (BLS) training can be distributed widely as part of the school curriculum.

Methods

Questionnaires were distributed to nine secondary schools in North Norway, and 376 respondents (age 16-19 years) were included. The completed questionnaires were statistically analysed to assess CPR knowledge and attitude to performing bystander CPR.

Results

Theoretical knowledge of handling an apparently unresponsive adult person was high, and 90% knew the national medical emergency telephone number (113). The majority (83%) was willing to perform bystander CPR in a given situation with cardiac arrest. However, when presented with realistic hypothetical cardiac arrest scenarios, the option to provide full BLS was less frequently chosen, to e.g. a family member (74%), a child (67%) or an intravenous drug user (18%). Students with BLS training in school and self-reported confidence in their own BLS skills reported stronger willingness to perform BLS. 8% had personally witnessed a cardiac arrest, and among these 16% had performed full BLS. Most students (86%) supported mandatory BLS training in school, and three out of four wanted to receive additional training.

Conclusion

Young Norwegians are motivated to perform bystander CPR, but barriers are still seen when more detailed cardiac arrest scenarios are presented. By providing students with good quality BLS training in school, the upcoming generation in Norway may strengthen the first part of the chain of survival in OHCA.     

Aspects on the increase in bystander CPR in Sweden and its association with outcome

Aim

To describe changes in the proportion of bystanders performing cardiopulmonary resuscitation (CPR) in out of hospital cardiac arrest (OHCA) in Sweden and to study the impact of bystander CPR on ventricular fibrillation and on survival during various times.

Patients and methods

All patients who suffered from OHCA in Sweden in whom CPR was attempted and who were included in the Swedish cardiac arrest register (SCAR) between 1992 and 2005. Crew witnessed cases were excluded.

Results

In all 34,125 patients were included in the survey. Among witnessed OHCA the proportion of patients receiving bystander CPR increased from 40% in 1992 to 55% in 2005 (p < 0.0001). In non-witnessed OHCA the corresponding proportion increased from 22% to 44% (p < 0.0001). There was a significant increase in bystander CPR regardless of age, sex and place. The increase was only found when CPR was performed by lay persons (21% in 1992 to 40% in 2005; p < 0.0001). Bystander CPR was associated with an increased proportion of patients found in a shockable rhythm and a lower number of shocks to receive return of spontaneous circulation. Bystander CPR was associated with a similar increase in survival early and late in the evaluation.

Conclusion

There was a marked increase in bystander CPR in OHCA, when performed by lay persons, during the last 14 years in Sweden. Bystander CPR was associated with positive effects both on ventricular fibrillation and survival.