A randomized controlled trial of chest compression only CPR for older adults-a pilot study

Older people are trained infrequently in cardiopulmonary resuscitation (CPR), yet are more likely to witness a cardiac arrest. Older people who are CPR trained perform CPR when witnessing a cardiac arrest. OBJECTIVE: To assess whether elderly adults (>55 years) who receive chest-compression only cardiopulmonary resuscitation (CC-CPR) training display equivalent skill retention rates compared with those who receive traditional CPR instruction. We also identified factors associated with 3 months skill retention at 3 months in both groups. METHODS: Older adults in a suburban hospital Older Adult Services program were invited to participate in an experimental CPR course. The 2 h course was modelled after the AHA Friends and Family course, and used one of two standardized video scenarios. Seventy four subjects were randomized to CC-CPR (n=36) or traditional CPR (n=38) training. Participation consisted of initial training, followed by a 3 months return videotaped assessment. Three months skill competence was assessed either by consensus between two video evaluators, or the on-site evaluator. Chi square and Kappa tests were used for analysis, and unadjusted odds ratios and 95% confidence intervals are reported. RESULTS: Skill retention assessments were completed on 29 (81%) CC-CPR and 26 (68%) CPR trainees. Subjects were elderly (71.5+/-6.69 years), and had a high rate of previous CPR training (58.0%). Groups were similar in demographic characteristics. After training, participants exhibited high rates of perceived competence (86.4%), although the overall 3 months skill retention was low (43.6%). CC-CPR training resulted in equivalent skill retention rates as compared with traditional CPR training (51.7 vs. 44.4%; P=0.586). No participant factors were associated with skill retention, including age, previous CPR training, education level, medical history, or perceived physical ability to perform. CONCLUSION: We identified low rates of CPR skill retention in this elderly population. CC-CPR instruction was associated with equivalent skill retention rates compared with traditional CPR instruction. No demographic factors were associated with successful skill retention.     

Teaching cardiopulmonary resuscitation to CEGEP students in Quebec--a pilot project

In order to increase CPR training in Quebec, we designed a pilot study to test out the efficacy of training CEGEP (junior college) students in CPR. We tried out four different methods of teaching CPR on students (Group A 'control', 4 h course, manikin to student ratio 1:4; Group B, 4 h course, manikin to student ratio 1:1; Group C, 2 h course, manikin to student ratio 1:1; Group D, video-assisted CPR instruction, manikin to student ratio 1:1). CPR skills were tested on a computerized manikin at the end of the initial course and again at the end of the semester in order to evaluate short and long-term retention of skills. There were no significant differences between the test groups and the control group in terms of compressions or ventilations at the beginning and end of the semester, however groups C and D performed significantly better primary surveys (Airway, Breathing, Circulation - ABC sequences) during the initial testing. The most common reasons reported by students for not taking CPR courses were the cost of courses (49.2%) and the inconvenience of courses (26.2%), similarly the two most common incentives which could get students to take CPR courses were; free courses (65.6%) and greater accessibility of courses (54.1%). Video-assisted CPR training appears to be feasible, enjoyable and as, if not more effective than traditional CPR courses. Instituting a mandatory video-assisted CPR program in the CEGEP system in Quebec and in high schools and colleges throughout the world, would be a cost-effective way to train massive amounts of young people in CPR.     

A randomized controlled trial comparing traditional training in cardiopulmonary resuscitation (CPR) to self-directed CPR learning in first year medical students: The two-person CPR study

Study Aim

The primary purpose of this study was to compare two, shorter, self-directed methods of cardiopulmonary resuscitation (CPR) education for healthcare professionals (HCP) to traditional training with a focus on the trainee's ability to perform two-person CPR.

Methods

First-year medical students with either no prior CPR for HCP experience or prior training greater than 5 years were randomized to complete one of three courses: 1) HeartCode BLS System, 2) BLS Anytime, or 3) Traditional training. Only data from the adult CPR skills testing station was reviewed via video recording by certified CPR instructors and the Laerdal PC Skill Reporter software program (Laerdal Medical, Stavanger, Norway).

Results

There were 180 first-year medical students who met inclusion criteria: 68 were HeartCode BLS System, 53 BLS Anytime group, and 59 traditional group Regarding two-person CPR, 57 (84%) of Heartcode BLS students and 43 (81%) of BLS Anytime students were able to initiate the switch compared to 39 (66%) of traditional course students (p = 0.04). There were no significant differences in the quality of chest compressions or ventilations between the three groups. There was a trend for a much higher CPR skills testing pass rate for the traditional course students. However, failure to “clear to analyze or shock” while using the AED was the most common reason for failure in all groups.

Conclusion

The self-directed learning groups not only had a high level of success in initiating the “switch” to two-person CPR, but were not significantly different from students who completed traditional training.     

Retention of CPR skills learned in a traditional AHA Heartsaver course versus 30-min video self-training: a controlled randomized study

BACKGROUND: Bystander CPR improves outcomes after out of hospital cardiac arrest. The length of current 4-h classes in cardiopulmonary resuscitation (CPR) is a barrier to more widespread dissemination of CPR training and older adults in particular are underrepresented in traditional classes. Training with a brief video self-instruction (VSI) program has shown that this type of training can produce short-term skill performance at least as good as that seen with traditional American Heart Association (AHA) Heartsaver training, although it is unclear whether there is comparable skill retention. METHODS AND RESULTS: Two hundred and eight-five adults between the ages of 40 and 70 who had no CPR training within the past 5 years were assigned at random to a no-training control group, Heartsaver (HS) training, or one of three versions of brief VSI (i.e., self-trained-ST subjects). Post-training performance of CPR skills was assessed in a scenario format by human examiners and by sensored manikin at Time 1 (immediately post-training) and again at Time 2 (2 months post-training). Performance by controls was assessed only once. Significant (P<.001) decline was observed in the three measures recorded by examiners; assess responsiveness (from 72% to 60% for HS subjects and from 90% to 77% for ST subjects), call 911 (from 82% to 74% for HS subjects and from 71% to 53% for ST subjects), and overall performance (from 42% to 30% for HS subjects and from 60% to 44% for ST subjects). Significant (P<.001) decline was observed in two of three skills measured by a sensored manikin: ventilation volume (from 40% to 36% for HS subjects and from 61% to 41% for ST subjects, with a significant [P=.028] interaction) and correct hand placement (from 68% to 59% for HS subjects and from 80% to 64% for ST subjects). Heartsaver and self-trained subjects generally showed similar rates of decline. At Time 2, examiners rated trained subjects better than untrained controls in all skills except calling 911, where self-trained subjects did not differ from controls; manikin data revealed that trained subjects' performance was better than that of controls for ventilation volume, but had declined to the level of controls for both hand placement and compression depth. CONCLUSIONS: Adults between 40 and 70 years of age who participated in a CPR VSI program experienced performance decline in their CPR skills after a post-training interval of 2 months. However, this decline was no greater than that seen in subjects who took Heartsaver training. The VSI program produced retention performance at least as good as that seen with traditional training. Additional effort is needed to improve both initial performance and retention of CPR skills. CONDENSED ABSTRACT: Retention of CPR skills was compared 2 months post-training for adults between 40 and 70 years old who had taken either a traditional Heartsaver CPR course or a 22-min video self-directed training course. Although performance declines occurred in the 2-month interval, self-trained subjects generally demonstrated CPR skill retention equivalent to that of Heartsaver-trained subjects, although for both groups skill decline on some measures reached the level of untrained controls.     

A paediatric cardiopulmonary resuscitation training project in Honduras

Objectives

It is possible that the exportation of North American and European models has hindered the creation of a structured cardiopulmonary resuscitation (CPR) training programme in developing countries. The objective of this paper is to describe the design and present the results of a European paediatric and neonatal CPR training programme adapted to Honduras.

Materials and methods

A paediatric CPR training project was set up in Honduras with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The programme was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching.

Results

During the first phase, 24 Honduran doctors from paediatric intensive care, paediatric emergency and anaesthesiology departments attended the paediatric CPR course and 16 of them the course for preparation as instructors. The Honduran Paediatric and Neonatal CPR Group was formed. In the second phase, workshops were given by Honduran instructors and four of them attended a CPR course in Spain as trainee instructors. In the third phase, a CPR course was given in Honduras by the Honduran instructors, supervised by the Spanish team. In the final phase of independent teaching, eight courses were given, providing 177 students with training in CPR.

Conclusions

The training of independent paediatric CPR groups with the collaboration and scientific assessment of an expert group could be a suitable model on which to base paediatric CPR training in Latin American developing countries.     

Resuscitating an idea: prone CPR

Cardiopulmonary resuscitation (CPR) is widely recognized as an essential part of the medical response to cardiac arrest. Traditional ('basic') CPR has remained essentially unchanged for 40 years despite major problems with training and performance, and survival rates from out-of-hospital cardiac arrest remain disappointingly low, despite massive resources devoted to CPR training and public awareness. More than a decade ago, an article described an alternative method-prone CPR-which offered many potential advantages over traditional CPR, including much simpler training and increased likelihood of actual performance by bystanders. The article received little notice at the time; however, the method of prone CPR merits further consideration based on a number of subsequent supporting studies and case reports. Prone CPR may represent a superior alternative to traditional CPR; research into its effectiveness should be given high priority.     

Possibilities for, and obstacles to, CPR training among cardiac care patients and their co-habitants

AIM: To investigate the level of cardiopulmonary resuscitation (CPR) training among cardiac patients and their co-habitants and to describe the possibilities for, and obstacles to, CPR training among this group. METHODS: All patients admitted to a coronary care unit during a four-month period were considered for participation in an interview study. Out of 401 patients, 268 were co-habiting. This study deals with these subjects. RESULTS: According to the answers given by the patients, 46% of the patients and 33% of the co-habitants had attended a CPR course at some time. Among those who had not previously attended a course, 58% were willing to attend, and 60% of the patients whose co-habitant had not received CPR education, wanted him or her to attend a course. The major obstacle to CPR training was the patient's own medical status. The major obstacle to the co-habitant's participation was the patient's doubts concerning their partner's physical ability or willingness to participate. Younger persons were more often willing to undergo training than older persons (p < 0.0001). Of those patients who had previously attended a course or who were willing to undergo training, 72% were prepared to do so together with their co-habitant. A course specially designed for cardiac patients and their relatives was a possible alternative for 75% of those willing to participate together with their co-habitant. CONCLUSIONS: Two-thirds of the patients did not believe that their co-habitant had taken part in CPR training. More than half of these would like their co-habitant to attend such a course. Seventy-two percent were willing to participate in CPR instruction together with their co-habitant. Major obstacles to CPR training were doubts concerning the co-habitant's willingness or physical ability and their own medical status.     

Motivation and adult learning: a survey among hospital personnel attending a CPR course

AIM OF THE STUDY: A massive cardiopulmonary resuscitation (CPR) training programme is continued in most hospitals to make hospital personnel ready to take action in cases of cardiac arrest. Motivated course participants learn more and perform better than unmotivated course participants. This study investigates whether hospital personnel are motivated to participate in CPR courses and whether motivation correlates with important assumptions in adult learning. MATERIALS AND METHODS: A survey measuring learning motivation via the MSLQ instrument was performed among 361 hospital personnel before attending a CPR course. Assumptions of adult learning were identified and data were analysed in relation to these assumptions. RESULTS: Hospital personnel are generally motivated for learning CPR. Respondents who had been prepared for the course, who had participated in the decision about attending the course, who were working in high-risk area for cardiac arrest or were nursing personnel working in long-time close contact with patients were more motivated to CPR training than other hospital personnel. It seems like motivation correlates with adult learning assumptions such as the learners need to know, the learners self-concept, readiness to learn and orientation to learning. CONCLUSION: This study supports the assumption that CPR training should be based on an adult learning model. As preparedness, participation, readiness and relevance seem to be key factors, we may want to include these factors when training hospital personnel in CPR skills.     

动态病例情景模拟在急诊不同层次护士CPR培训中的应用

目的 探索动态病例情景模拟培训对急诊不同层次护士CPR培训的效果.方法 将156名护士随机分成试验组和对照组,分别采用动态病例情景模拟和传统培训方法进行CPR培训,比较两组的理论成绩和病例情景模拟成绩,并统计护士培训后的自评情况.结果 试验组理论成绩与对照组比较差异无统计学意义(P>0.05),但病例情景模拟成绩明显高于对照组,差异有统计学意义(P<0.05),试验组不同层次护士的病例情景模拟考试成绩也好于对应对照组.自评结果显示,培训后在提高临床应急能力、提高评判性思维能力等方面试验组好于对照组,差异有统计学意义,而在提高风险防范意识方面两组差异无统计学意义.结论 动态病例情景模拟培训是提高不同层次护士CPR水平的有效方法.     

对中学生进行心肺复苏技能培训的方法与效果

目的探讨对中学生进行心肺复苏知识和技能培训的方法及意义。方法采用多种培训形式相结合的方法对不同年级的200名中学生进行心肺复苏技能培训,在培训前后对中学生心肺复苏知识和技能进行测评。结果200名中学生普遍缺乏心肺复苏知识和技能,通过培训,心肺复苏理论知识考核合格率从培训前7％上升到94．5％,差异有统计学意义（P〈0．05）;心肺复苏操作考核合格率达100％;低年级与高年级的中学生培训后心肺复苏技能考核首次合格率比较,差异无统计学意义（P〉0．05）。结论中学生心肺复苏知识普遍缺乏,建议从初中生抓起,将急救知识及技能纳入九年义务教育课程体系,合适的培训方法能有效地提高中学生心肺复苏技能,同时,争取行政支持,学校与医院联合培训是普及中学生心肺复苏技能的有效途径。     

社区护士心肺复苏技能3种培训方法的效果比较

目的寻找对社区护士进行心肺复苏技能培训的最佳方法。方法选取参加培训的社区护士162名,随机分成3组,分别采用传统讲授练习、多媒体指导练习和自我指导练习方法培训;测试培训前、后的成人单人心肺复苏技能操作成绩,并比较3种方法培训前、后组内和组问的成绩。结果经3种方法培训后,社区护士的心肺复苏技能操作成绩均有显著提高,其中多媒体指导练习方法培训效果最好。结论社区护士有必要接受统一的心肺复苏培训;就该组研究对象而言,以多媒体指导练习方法培训效果最好,但在实际工作中可根据具体情况选择多种培训方式,以达到最佳培训效果。     

院内分层次模拟情景心肺复苏培训模式及效果研究

目的探讨院内分层次模拟情景心肺复苏(CRP)培训模式的应用价值。方法依据岗位职责和专业水平不同,将医院全体职工分为三个层次:临床科室医护人员、医技科室医护人员、行政及后勤人员;以"国际心肺复苏和心血管急救指南"为标准,对其制定不同要求、不同情景模式的分层次理论及技能培训,比较经传统模式与分层次模拟情景模式培训后理论及技能考核成绩、院内急救反应时间、开始心肺复苏时间及抢救成功率。结果与传统培训模式相比,采用院内分层次模拟情景CPR培训模式,理论及技能考核成绩合格率显著升高(P<0.01),院内急救反应时间和开始心肺复苏时间显著缩短(P<0.05),抢救成功率显著提高(P<0.05)。结论分层次模拟情景CPR培训可有效提升院内各层次人员综合技能,提高心脏骤停抢救成功率,为各级医院CPR培训提供一种新的模式。     

心肺复苏计算机教学辅助训练系统的研究与应用

心肺复苏是急救护理学的重要内容之一。传统的教学方法存在课堂与临床、理论课与操作课相脱节的问题。心肺复苏计算机教学辅助训练系统模拟临床抢救心搏骤停患的基本程序，培养、训练学员在紧急情况下，迅速地作出判断和决策的能力。该系统分为心肺复苏训练模块和心电监护学习模块，采取人机对话的方式，可进行反复学习和训练。本系统具有模拟的实效性、评估的特异性和训练的可重复性等优点，并可以在使用中不断修改、丰富和完善，成本较低。     

Impact of cardiopulmonary resuscitation training on resuscitation.

Restoration of adequate spontaneous circulation after "arrest" and cardiopulmonary resuscitation (CPR) of 546 patients before and 460 patients after initiation of a CPR training course in a 500-bed city hospital is reported. Between January 1972 and June 1976, adequate circulation after CPR was present in 38.6% of patients before and 50.4% after training ICU nurses and house physicians in modern resuscitation techniques. Factors crucial to resumption of adequate circulation are: (1) CPR training of all hospital personnel so that effective CPR can be started immediately after recognition of an arrest situation, (2) production of a palpable pulse with closed chest cardiac massage, and (3) prompt effective therapy so that the time interval between arrest and resumption of adequate spontaneous circulation is short.     

Comparison of two instructional modalities for nursing student CPR skill acquisition

Aims

The purpose of the study was to compare performance based measures of CPR skills (compressions, ventilations with bag-valve-mask (BVM), and single rescuer CPR) from two types of CPR courses: a computer-based course (HeartCode™ BLS) with voice advisory manikin (VAM) feedback and instructor-led (IL) training with traditional manikins.

Methods

604 nursing students from 10 schools of nursing throughout the United States were randomized by school to course type. After successful course completion, students performed 3 min each of compressions; ventilations with BVM; and single rescuer CPR on a Laerdal Resusci Anne^® SkillReporter™ manikin. The primary outcome measures were: (1) compression rate, (2) percentage of compressions performed with adequate depth, (3) percentage of compressions performed with correct hand placement, (4) number of ventilations/min, and (5) percentage of ventilations with adequate volume.

Results

There were no differences in compression rates between the two courses. However, students with HeartCode BLS with VAM training performed more compressions with adequate depth and correct hand placement and had more ventilations with adequate volume than students who had IL courses particularly when learning on hard molded manikins. During single rescuer CPR, students who had HeartCode BLS with VAM training had more compressions with adequate depth and ventilations with adequate volume than students with IL training.

Conclusion

Students who trained using HeartCode BLS and practiced with VAMs performed more compressions with adequate depth and ventilations with adequate volume than students who had IL courses. Results of this study provide evidence to support use of HeartCode BLS with VAM for training nursing students in CPR.     

Cardiopulmonary resuscitation skills of medical professionals

This study examined the theoretical knowledge and practical skills of different medical profession personnel and medical students in Basic Cardiac Life Support (BCLS). Two hundred twenty-four candidates who attended a BCLS course were tested in their theoretical knowledge of BCLS with 15 multiple choice questions (MCQs) as a pre-test. The same questions were included in the post-test but with a different sequence. We also evaluated each candidate during performance of single-rescuer CPR on a recording manikin, using a checklist and the recording strip from the manikin for evaluation of CPR steps and manikin performance respectively. Anesthesiologists and cardiologists demonstrated the best performance in the theoretical knowledge test followed by GPs and paramedics. In contrast, physicians, surgeons, pediatricians and medical students had comparable scores. No candidate performed all CPR steps correctly in the proper sequence. In addition, the manikin performance of all groups was poor. Nevertheless, the course significantly improved the theoretical knowledge (P less than 0.0001) and performance in both CPR steps (P less than 0.0005) and manikin performance (P less than 0.0005). The multivariate discriminant analysis identified that experience and prior CPR training influenced significantly (P less than 0.001) the degree of retention of theoretical knowledge only, but not the actual performance of basic resuscitation. It is concluded that no assumption based on previous clinical knowledge should be made for the expected CPR performance of all doctors, regardless of speciality. Formal training programs in medical schools should be considered. Our data also indicate that training is the only objective way to improve performance of all the candidates including the medical students.     

不同心肺复苏培训模式在大学生中应用效果的研究

目的评价不同心肺复苏（CPR）培训模式在大学生中的应用效果。 方法将接受CPR培训的大学生随机分为传统教学模式组（346人）、视频指导自学模式组（354人）和模拟急救场景模式组（348人）。对比三组培训时长、理论考核成绩以及操作考核成绩等综合运用能力。 结果传统教学模式组、视频指导自学模式组和模拟急救场景模式组每次培训时间分别为（1.12 ± 0.11）、（0.80 ± 0.00）和（2.32 ± 0.26）h,三组比较,差异有统计学意义（F=31.673,P<0.05）;且传统教学模式组与视频指导自学模式组,模拟急救场景模式组与视频指导自学模式组培训时长比较,差异均有统计学意义（P均<0.05）。传统教学模式组、视频指导自学模式组和模拟急救场景模式组的理论考核成绩分别为（80.1 ± 2.6）、（79.2 ± 4.4）和（81.4 ± 3.1）分,以模拟急救场景模式组较高,但三组比较,差异无统计学意义（F=1.424,P=0.525）;操作考核成绩中传统教学模式组、视频指导自学模式组和模拟急救场景模式组分别为（80.1 ± 2.3）、（81.3 ± 5.0）和（78.9 ± 3.5）分,以视频指导自学模式组较高,但同样三组比较,差异无统计学意义（F=1.200,P=0.439）。三组学员的考核通过率分别为72.6%、69.8%和75.4%,三组比较,差异无统计学意义（χ²=0.718,P>0.05）。 结论通过视频指导自学模式进行CPR培训,大学生能有效掌握CPR技能,并能节省培训时间,简化培训流程,值得在大学生CPR培训中推广应用。     

Cardiopulmonary resuscitation training for family members of patients on cardiac rehabilitation programmes in Scotland.

Existing cardiopulmonary resuscitation (CPR) training programmes have failed to reach those most likely to witness a cardiac arrest, such as families of cardiac patients. In 1993, the Scottish Health Service Advisory Committee suggested that CPR training could be offered as part of cardiac rehabilitation programmes. A survey was carried out to identify the current extent and nature of such training and factors influencing its provision. Questionnaires were mailed to all the 45 Scottish cardiac rehabilitation programmes on the British Heart Foundation's register. A 93% response rate was achieved. Only 37% of programmes provided information to families about attending a CPR course and 37% actually provided CPR training The numbers trained by these programmes were very small. Hospital programmes were significantly more likely than community programmes to provide CPR training (chi2 = 6.65, P < 0.01) as were those which included an exercise component (chi2 = 7.63, P < 0.01). Reasons for not providing training ranged from lack of resources and lack of staff training, to not having considered it. CPR training is provided as part of cardiac rehabilitation programmes to a limited extent. Ways of recruiting and increasing the number of family members of cardiac patients who are trained in CPR need to be found.     

Effects of cardiopulmonary resuscitation training for Mozambican nursing students in a low-resource setting: An intervention study

BackgroundThere is an increasing incidence of cardiovascular diseases in Africa. Nurses' ability to undertake cardiopulmonary resuscitation (CPR) can significantly impact the survival of patients who experience cardiac arrest.ObjectivesWe aimed to identify the effects of CPR training among Registered Nurse-Bachelor of Science in Nursing (RN-BSN) students in Mozambique.DesignA one-group pretest–posttest repeated-measures quasi-experimental design.SettingAuditorium of a general hospital and 2 Anne manikins, but no automatic external defibrillator.ParticipantsThirty-two RN-BSN students.MethodsStudents' attitudes and self-efficacy on CPR were measured by self-reported questionnaires three times (before, immediately after, and 20 weeks post intervention). Data were analyzed by the paired t-test and repeated-measures analysis of variance.ResultsAttitude and self-efficacy scores of students on CPR significantly increased immediately after CPR training, but decreased 20 weeks after the intervention (p < .001). Sociodemographic characteristics did not significantly differ throughout the measurements of attitude or self-efficacy.ConclusionsCPR manikin training positively affected attitude and self-efficacy in CPR among RN-BSN nursing students immediately, but not at 20 weeks, after the training. There is a need for research to repeatedly quantify parameters in a controlled study at different intervals and develop an instructor-training course customized to Mozambique.