Animation-assisted CPRII program as a reminder tool in achieving effective one-person-CPR performance

Objective

The objective of this study is to compare the skill retention of two groups of lay persons, six months after their last CPR training. The intervention group was provided with animation-assisted CPRII (AA-CPRII) instruction on their cellular phones, and the control group had nothing but what they learned from their previous training.

Methods

This study was a single blind randomized controlled trial. The participants’ last CPR trainings were held at least six months ago. We revised our CPR animation for on-site CPR instruction content emphasizing importance of chest compression. Participants were randomized into two groups, the AA-CPRII group (n = 42) and the control group (n = 38). Both groups performed three cycles of CPR and their performances were video recorded. These video clips were assessed by three evaluators using a checklist. The psychomotor skills were evaluated using the Resusci^®Anne SkillReporter™.

Results

Using the 30-point scoring checklist, the AA-CPRII group had a significantly better score compared to the control group (p < 0.001). Psychomotor skills evaluated with the AA-CPRII group demonstrated better performance in hand positioning (p = 0.025), compression depth (p = 0.035) and compression rate (p < 0.001) than the control group.

Conclusion

The AA-CPRII group resulted in better checklist scores, including chest compression rate, depth and hand positioning. Animation-assisted CPR could be used as a reminder tool in achieving effective one-person-CPR performance. By installing the CPR instruction on cellular phones and having taught them CPR with it during the training enabled participants to perform better CPR.     

Pre-recorded instructional audio vs. dispatchers’ conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study

BACKGROUND: To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation.METHODS: It was a prospective, blind, randomised controlled study involving 109 medical students without previous CPR training. In a standardized mannequin scenario, after the step of dispatcher-assisted cardiac arrest recognition, the participants performed compression-only resuscitation guided over the telephone by either: (1) the pre-recorded instructional audio (n=57); or (2) verbal dispatcher assistance (n=52). The simulation video records were reviewed to assess the CPR performance using a 13-item checklist. The interval from call reception to the first compression, total number and rate of compressions, total number and duration of pauses after the first compression were also recorded.RESULTS: There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score (5.6±2.2 vs. 5.1±1.9, P>0.05) or individual criteria of the CPR performance checklist. The recording-assisted group demonstrated significantly shorter time interval from call receipt to the first compression (86.0±14.3 vs. 91.2±14.2 s, P<0.05), higher compression rate (94.9±26.4 vs. 89.1±32.8 min^-1) and number of compressions provided (170.2±48.0 vs. 156.2±60.7).CONCLUSION: When provided by untrained persons in the simulated settings, the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR. Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.     

调度员指导的心肺复苏对院前心脏骤停生存率影响的Meta分析北大核心CSCD

目的评价第一目击者在对院前心脏骤停(out-of-hospital cardiac arrest,OHCA)患者进行心肺复苏(cardiopulmonary resuscitation,CPR)时是否接受调度员指导(dispatcher-assisted cardiopulmonary resuscitation,DA-CPR)对OHCA患者结局是否有影响。方法通过检索在中文及英文各大数据库公开发表的临床研究,筛选出关于对院前心脏骤停患者心肺复苏时是否进行DA-CPR的文献,按照Cochrane Handbook5.1.0标准,对纳入文献质量进行评价,并提取出相关有效数据,应用Review Manager 5.3软件,对三个结局指标(自主循环恢复、存活至出院、神经功能良好)分别进行Meta分析。结果共纳入21项研究,共计349822例患者,其中DA-CPR组182125人,CPR-Only组167697人。分析结果显示:在美国、日本、韩国,DA-CPR相比CPR-Only未能提高OHCA停患者的ROSC率,RR=1.10,95%CI:0.94~1.29,P=0.24;未能提高OHCA患者的出院存活率,RR=1.10,95%CI:0.90~1.34,P=0.34;未能提高OHCA患者的神经功能良好率,RR=1.01,95%CI:0.79~1.28,P=0.97。而在中国,DA-CPR相比CPR-Only,能提高OHCA患者的ROSC率,RR=2.61,95%CI:1.53~4.46,P=0.0005;能提高OHCA患者的出院存活率,RR=6.08,95%CI:1.84~20.04,P=0.003;能提高OHCA患者的神经功能良好率,RR=9.76,95%CI:1.87~51.02,P=0.007。结论DA-CPR在世界总体范围内的效果无统计学意义。但因发现DA-CPR在不同国家的效果差别较大,所以需具体而言:在发达国家,DA-CPR与无调度员指导的BCPR相比,不能明显提高OHCA患者的ROCS率、出院生存率和神经功能良好率。而在提高我国OHCA患者的ROCS率、出院生存率和神经功能良好率方面,DA-CPR优于无调度员指导的BCPR,有统计学意义。     

The effects of different instructional methods on students’ acquisition and retention of cardiopulmonary resuscitation skills

Background

The need was evident for the evaluation of applicability and effectiveness of different types of instructional strategies to teach CPR skills. Therefore, the aim of this study was to evaluate the effects of traditional, case-based, and web-based instructional methods on acquisition and retention of CPR skills.

Methods

Ninety university students (52 female, 48 male) who selected the first aid course as an elective were assigned randomly to traditional, case-based, and web-based instruction groups. The students were tested three times (pre-test, post-test and retention test) for their measurable and observable CPR skills by using a skill reporter manikin and skill observation checklist.

Results

Based on the CPR chest compression performance measurements by the skill reporter manikin, the web-based instruction group performed poorer than the traditional and case-based instruction groups in “average compression rate, percentage of correct chest compressions, the number of too low hand positions, the number of wrong hand positions, the number of incomplete releases, the average number of ventilations, the average volume of ventilations, the minute volume ventilations, the number of too fast ventilations, the total number of ventilations, and the percentage of correct ventilations” (p < .05). Additionally, 18-week time interval negatively affected students’ performance on “the percentage of correct chest compressions, and total number of compressions”. Similar poor performance by web-based instruction group was also detected by the skill observation checklist.

Conclusion

The students in traditional and case-based instruction groups showed better CPR performance than students in web-based instruction group that used video self-instruction as a learning tool.     

Impact of adding video communication to dispatch instructions on the quality of rescue breathing in simulated cardiac arrests--a randomized controlled study

OBJECTIVE: Both ventilations and compressions are important for victims of prolonged cardiopulmonary resuscitation (CPR) and asphyxial arrest. Dispatch assistance increases bystander CPR, but the quality of dispatcher-assisted CPR (DA-CPR), especially rescue breathing, remains unsatisfactory. This study was conducted to assess the impact of adding interactive video communication to dispatch instructions on the quality of rescue breathing in simulated cardiac arrests. METHODS: In this simulation-based study, adults without CPR training within 5 years were recruited between April and July 2007 and randomized to receive dispatch assistance with either voice instruction alone (voice group, n=53) or interactive voice and video instruction (video group, n=43) via a video cell phone. The quality of rescue breathing was evaluated by reviewing the videos and mannequin reports. RESULTS: Subjects in the video group were more likely to open the airway correctly (95.3% vs. 58.5%, P<0.01) and to lift the chin properly (95.3% vs. 62.3%, P<0.01), but had similar rates of head-tilt (95.3% vs. 84.9%, P=0.10). Volunteers in the video group had larger volume of ventilation (median volume 540ml vs. 0ml, P<0.01), greater possibility to sustain an open airway (88.4% vs. 60.4%, P<0.01) and a tendency towards better nose-pinch (97.7% vs. 86.8%, P=0.06). The video group spent longer time to open the airway (59s vs. 56s, P<0.05) and to give the first rescue breathing (139s vs. 102s, P<0.01). CONCLUSION: Adding video communication to dispatch instructions improved the quality of bystander rescue breathing, including higher proportion of airway opened, and larger volume of ventilation delivered, in simulated cardiac arrests.     

Should dispatchers instruct lay bystanders to undress patients before performing CPR? A randomized simulation study

Objective

Dispatch-assisted CPR instructions frequently direct bystanders to remove a cardiac arrest patient's clothing prior to starting chest compressions. Removing clothing may delay compressions and it is uncertain whether CPR quality is influenced by the presence of clothing. We measured how instructions to remove clothing impacted the time to compressions and CPR performance by lay responders in a simulated arrest.

Subjects and methods

We conducted a randomized dispatch-assisted CPR simulation trial. Fifty two lay participants were instructed to remove the manikin's clothing (3 layers: a t-shirt, button-down shirt, and fleece vest) prior to starting chest compressions as part of dispatcher instructions, while 47 individuals received no instruction about clothing removal. Instructions were otherwise identical.

Results

The two groups were comparable with regard to demographic characteristics and prior CPR training. Time to first compression was 109 s among the group randomized to instruction to remove clothing and 79 s among those randomized to forgo instruction regarding clothing removal, (p < 0.001). Among those randomized to remove clothing instructions, mean compression depth was 41 mm, compression rate was 97 per minute, and the percentage with complete compression release was 95%. Among those randomized to forgo clothing removal instruction, mean compression depth was 40 mm, compression rate was 99 per minute, and the percentage with complete compression release was 91% (p > 0.05 for each CPR metric comparison).

Conclusion

These findings suggest that eliminating instruction to remove a victim's clothing in dispatcher-assisted CPR will save time without compromising performance, which may improve survival from cardiac arrest.     

Impact of dispatcher assisted CPR on ROSC rates: A National Cohort Study

IntroductionOut of hospital cardiac arrest (OHCA) is a leading cause of mortality. Bystander CPR is associated with increased OHCA survival rates. Dispatcher assisted CPR (DA-CPR) increases rates of bystander CPR, shockable rhythm prevalence, and improves ROSC rates. The aim of this article was to quantify and qualify DA-CPR (acceptance/rejection), ROSC, shockable rhythms, and associations between factors as seen in MDA, Israel, during 2018.MethodsAll 2018 OHCA incidents in Israel's national EMS database were studied retrospectively. We identified rates and reasons for DA-CPR acceptance or rejection. Reasons DA-CPR was rejected/non-feasible by caller were categorized into 5 groups. ROSC was the primary outcome. We created two study groups: 1) No DA-CPR (n = 542). 2) DA-CPR & team CPR (n = 1768).ResultsDA-CPR was accepted by caller 76.5% of incidents. In group 1, ROSC rates were significantly lower compared to patients in group 2 (12.4% vs. 21.3% p < .001). Group 1 had 12.4% shockable rhythms vs. 17.1% in group 2 (DA-CPR and team CPR). Of the total 369 shockable cases, 42.3% (156) achieved ROSC, in the non-shockable rhythms only 14.8% achieved ROSC.ConclusionsOHCA victims receiving dispatcher assisted bystander CPR have higher rates of ROSC and more prevalence of shockable rhythms. MDA dispatchers offer DA-CPR and it is accepted 76.5% of the time. MDA patients receiving DA-CPR had higher ROSC rates and more shockable rhythms. MDA's age demographic is high, possibly affecting ROSC and shockable rhythm rates.     

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.     

The voice advisory manikin (VAM): an innovative approach to pediatric lay provider basic life support skill education

AIM: To determine the efficacy of immediate, standardized, corrective audio feedback training as supplied by the voice advisory manikin (VAM) compared to high quality standardized instructor feedback training for the initial acquisition of 1-rescuer lay provider pediatric BLS skills. MATERIALS AND METHODS: Lay care providers of hospitalized children 8-18 years were randomized to VAM (n=23) or standardized human instruction (SHI, n=27) training in one-rescuer pediatric BLS. After an identical video/instructor introduction to CPR and 20 min of training in their respective group, quantitative CPR psychomotor skill data was recorded during 3-min CPR testing epochs. All manikins used in training and testing sessions were identical in outside appearance and feel of doing CPR. The primary outcome measure was CPR psychomotor skill success defined prospectively as 70% correct chest compressions (CC) and ventilations (V). Subjects not attaining these success goals retrained for 5 min in their respective training group and were retested. Data analysis using student t-test and chi2-tests as appropriate. RESULTS: VAM trainees delivered more total CC/min (58.7+/-7.9 versus 47.6+/-10.5, p<0.001), correct CC/min (47.9+/-15.7 versus 31.2+/-16.0, p<0.001), total V/min (7.8+/-1.2 versus 6.4+/-1.4, p<0.001), and correct V/min (5.4+/-1.9 versus 3.1+/-1.6, p<0.001). Overall error rates per individual were lower in VAM trainees for chest compressions (18.1+/-23.2% versus 34.9+/-28.8%, p<0.03) and ventilations (32.0+/-19.7% versus 50.7+/-24.1%, p<0.005). More VAM (12/23, 52%) than SHI (1/26, 4%) trainees passed the initial skill tests (p相似文献   

Instructions to "put the phone down" do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation

OBJECTIVE: The quality of early bystander CPR appears important in maximizing survival. This trial tests whether explicit instructions to "put the phone down" improve the quality of bystander initiated dispatch-assisted CPR. METHODS: In a randomized, double-blinded, controlled trial, subjects were randomized to a modified version of the Medical Priority Dispatch System (MPDS) version 11.2 protocol or a simplified protocol, each with or without instruction to "put the phone down" during CPR. Data were recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions. Primary outcome measures included chest compression rate, depth, and the proportion of compressions without error, with correct hand position, adequate depth, and total release. Time was measured in two distinct ways: time required for initiation of CPR and total amount of time hands were off the chest during CPR. Proportions were analyzed by Wilcoxon rank sum tests and time variables with ANOVA. All tests used a two-sided alpha-level of 0.05. RESULTS: Two hundred and fifteen subjects were randomized-107 in the "put the phone down" instruction group and 108 in the group without "put the phone down" instructions. The groups were comparable across demographic and experiential variables. The additional instruction to "put the phone down" had no effect on the proportion of compressions administered without error, with the correct depth, and with the correct hand position. Likewise, "put the phone down" did not affect the average compression depth, the average compression rate, the total hands-off-chest time, or the time to initiate chest compressions. A statistically significant, yet trivial, effect was found in the proportion of compressions with total release of the chest wall. CONCLUSIONS: Instructions to "put the phone down" had no effect on the quality of bystander initiated dispatcher-assisted CPR in this trial.     

Skill mastery in cardiopulmonary resuscitation training classes

The authors evaluated skill levels of trainees (n = 48) who were taught cardiopulmonary resuscitation (CPR) in “American Red Cross: Adult CPR” classes offered at a work site. The evaluation used a validated skill checklist and a Lærdal Skillmeter mannequin to assess trainee competence. Only 1 in 10 of the trainees could correctly perform all 12 CPR skills assessed by the skill checklist. Fewer than 12% of all compressions met published standards, and fewer than 25% of the ventilations met the standards as evaluated by the Skillmeter mannequin. All trainees felt confident they could use their CPR skills in an actual emergency; 64% were “very confident.” Videotape recordings of the practice sessions showed that instructors overlooked many errors in CPR performance and that trainees provided little corrective feedback to one another. The role of instructors in assisting CPR skill practice and in evaluating skill mastery is questioned.     

Does dispatcher-assisted CPR generate the same outcomes as spontaneously delivered bystander CPR in Japan?

Aim

We investigated whether DA-CPR would have the same effect as spontaneously-delivered bystander CPR.

Theoretical knowledge and psychomotor skill acquisition of basic life support training programme among secondary school students

BACKGROUND: The aim of the study is to evaluate the theoretical knowledge and psychomotor skill acquisition of basic life support (BLS) by a group of secondary school students in Nigeria pre and post BLS training. METHODS: This was quasi-experimental study design with 210 participants. They were taught on adult BLS and all the participants practiced BLS on a Resusci-Anne manikin immediately after the training. Data were collected using American Heart Association (AHA) structured questionnaire and psychomotor skills checklist for BLS at baseline, and post BLS training. RESULTS: The pre-training knowledge score was 1.9±1.4. This increased after the BLS training to 11.4±2.4, and the mean difference between the pre and post BLS training scores was 9.48571. Pre-training psychomotor skill score was 0.00±0.00, this increased to 8.9±1.9 after the training, and the mean difference was 8.90000. The knowledge and psychomotor skill difference between pre and post BLS training was significant (P<0.000). CONCLUSION: Most Nigerian secondary school students were not knowledgeable about BLS. Therefore, there is need for the creation of more awareness among the students.     

心肺复苏时佩戴N95口罩对胸外按压质量的影响

目的 评估医务人员佩戴N95 口罩进行心肺复苏(cardiopulmonary resuscitation,CPR)对胸外按压质量及疲劳情况的影响.方法 纳入武汉大学中南医院近两年内获得美国心脏协会基础生命支持认证的医护人员80名,复习按压要点并熟悉模型后,通过随机数字法分为两组:佩戴外科口罩组(SM组),佩戴N95 ...     

Temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts

Purpose

To investigate temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts and their association with survival after bystander-witnessed out-of-hospital cardiac arrests (OHCAs).

Rescuer Fatigue: Standard versus Continuous Chest-Compression Cardiopulmonary Resuscitation

Objectives Continuous chest‐compression cardiopulmonary resuscitation (CCC‐CPR) has been advocated as an alternative to standard CPR (STD‐CPR). Studies have shown that CCC‐CPR delivers substantially more chest compressions per minute and is easier to remember and perform than STD‐CPR. One concern regarding CCC‐CPR is that the rescuer may fatigue and be unable to maintain adequate compression rate or depth throughout an average emergency medical services response time. The specific aim of this study was to compare the effects of fatigue on the performance of CCC‐CPR and STD‐CPR on a manikin model. Methods This was a prospective, randomized crossover study involving 53 medical students performing CCC‐CPR and STD‐CPR on a manikin model. Students were randomized to their initial CPR group and then performed the other type of CPR after a period of at least two days. Students were evaluated on their performance of 9 minutes of CPR for each method. The primary endpoint was the number of adequate chest compressions (at least 38 mm of compression depth) delivered per minute during each of the 9 minutes. The secondary endpoints were total compressions, compression rate, and the number of breaks taken for rest. The students' performance was evaluated on the basis of Skillreporter Resusci Anne (Laerdal, Wappingers Falls, NY) recordings. Primary and secondary endpoints were analyzed by using the generalized linear mixed model for counting data. Results In the first 2 minutes, participants delivered significantly more adequate compressions per minute with CCC‐CPR than STD‐CPR, (47 vs. 32, p = 0.004 in the 1st minute and 39 vs. 29, p = 0.04 in the 2nd minute). For minutes 3 through 9, the differences in number of adequate compressions between groups were not significant. Evaluating the 9 minutes of CPR as a whole, there were significantly more adequate compressions in CCC‐CPR vs. STD‐CPR (p = 0.0003). Although the number of adequate compressions per minute declined over time in both groups, the rate of decline was significantly greater in CCC‐CPR compared with STD‐CPR (p = 0.0003). The mean number of total compressions delivered in the first minute was significantly greater with CCC‐CPR than STD‐CPR (105 per minute vs. 58 per minute, p < 0.001) and did not change over 9 minutes in either group. There were no differences in compression rates or number of breaks between groups. Conclusions CCC‐CPR resulted in more adequate compressions per minute than STD‐CPR for the first 2 minutes of CPR. However, the difference diminished after 3 minutes, presumably as a result of greater rescuer fatigue with CCC‐CPR. Overall, CCC‐CPR resulted in more total compressions per minute than STD‐CPR during the entire 9 minutes of resuscitation.