Quality of BLS decreases with increasing resuscitation complexity

OBJECTIVE: Multiple procedures performed in parallel may cause each procedure to be performed less effectively than if performed in isolation. BLS performed by prehospital providers potentially includes artificial ventilations, chest compressions, and application of an automated external defibrillator (AED). This study examines the effectiveness of artificial ventilation and chest compressions both with and without an AED. METHODS: Thirty-six prehospital providers participated in a prospective observational study. Tested in pairs (n=18), subjects randomly completed three, 6-min scenarios [apneic patient with a pulse (VENT), a pulseless patient (CPR), and a pulseless patient with an AED available (CPR+AED)]. A full-torso manikin capable of generating a carotid pulse was connected to a computer to record number of ventilations, tidal volume, flow rate, number of compressions, and compression depth. Data were analyzed by t-test, ANOVA, and Mann-Whitney U-test. RESULTS: Artificial ventilation performed in isolation provided more correct ventilations than during CPR or CPR+AED (25.7%, 14.2%, 13.7%, p=0.02). Fewer ventilations were delivered during CPR and CPR+AED (p=0.03). More compressions were delivered with CPR alone vs. CPR+AED (51.9, 35.7 min(-1), p=0.00). More correct compressions were delivered during CPR alone vs. CPR+AED (p=0.05). CONCLUSIONS: Both the quality and quantity of BLS decreases as the number of procedures performed simultaneously increases. Further decrements might occur when ALS skills enter into resuscitation. These results suggest a need to automate and/or prompt the performance of BLS to optimize resuscitation.     

Eighth grade students become proficient at CPR and use of an AED following a condensed training programme

OBJECTIVE: To evaluate a new, 1-h, condensed training programme to teach continuous chest compression cardiopulmonary resuscitation (CCC-CPR) and automated external defibrillator (AED) skills to a cohort of eight grade public school students. METHODS: RESULTS: Thirty-three eligible subjects completed the programme; mean age 13.7 years; 48.5% female. Eight participants reported some prior training in CPR and AED use. Following initial training, 29/33 (87.8%) subjects demonstrated proficiency at CCC-CPR and AED application/operation in a mock adult cardiac arrest scenario. At four-weeks, 28/33 (84.8%) subjects demonstrated skill retention in similar scenario testing. Subjects also showed improvement in written knowledge regarding AED use as shown by scores on an AHA based written exam (60.9% versus 77.3%; p<0.001). CONCLUSION: With our focused, condensed training program, eighth grade public school students became proficient in CCC-CPR and AED use. This is the first study to document the ability of middle school students to learn and retain CCC-CPR and AED skills for adult sudden cardiac arrest victims with such a curriculum.     

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.     

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.     

An evaluation of the effectiveness of the Opportunities for Resuscitation and Citizen Safety (ORCS) defibrillator training programme designed for older school children

OBJECTIVES: The aim of our study was to evaluate the effect of an automated external defibrillation (AED) training programme on the knowledge, attitudes and application of BLS and AED use in young people of secondary school age in Manchester, United Kingdom. METHOD: Students from two schools who had piloted Opportunities for Resuscitation and Citizen Safety (ORCS) in the academic year 2004/2005 volunteered to partake in the study. This 'ORCS intervention' group was compared against a control group, which consisted of students who had no formal training in resuscitation nor, to our knowledge, any other form of life support training during their time at secondary school. All students were assessed and scored on their knowledge and performance of the BLS algorithm (in accordance with the UK Resuscitation Council ('Resuscitation Guidelines for the Citizen') and the use of a trainer defibrillator on a fictional cardiac arrest scenario. RESULTS: We compared 34 ORCS-trained students with 25 control students, all aged between 13 and 16 years. Approximately, twice as many ORCS-trained students than the control students performed many parts of the algorithm correctly, such as checking for danger, checking for response, opening the airway and checking for breathing. More than three times as many ORCS-trained students than controls correctly performed CPR (50% versus 12% of students). As expected, the use of the AED was the part of the algorithm performed worst, but was performed correctly by six times as many ORCS students as controls (27% versus 4% of students). CONCLUSIONS: This study demonstrates that training through the ORCS scheme has a positive influence on the ability of secondary school teenagers to perform emergency life support (ELS), but particularly in their ability to deploy an AED and perform CPR.     

Automated External Defibrillator Program Does Not Impair Cardiopulmonary Resuscitation Initiation in the Public Access Defibrillation Trial

Objectives: To evaluate whether automated external defibrillator (AED) training and AED availability affected the response of volunteer rescuers and performance of cardiopulmonary resuscitation (CPR) in presumed out‐of‐hospital cardiac arrest (OOH‐CA) during the multicenter Public Access Defibrillation Trial. Methods: The Public Access Defibrillation Trial recruited 1,260 facilities in 24 North American regional sites to participate in a trial addressing survival from OOH‐CA when AED training and availability were added to a volunteer‐based emergency response team. Volunteers at each facility were trained to perform either CPR alone (CPR) or CPR in conjunction with AED use (CPR+AED) according to randomized assignments. This study reports the frequency of response and initiation of CPR actions (chest compressions and/or ventilations) by volunteers in the CPR and CPR+AED study groups. Results: A total of 314 presumed OOH‐CA episodes occurred in CPR facilities, and 308 occurred in CPR+AED facilities. The volunteers were matched well for age, gender, and other features. Overall, ventilations (23.1% vs. 13.1%), chest compressions (24.4% vs. 12.1%), and both actions (19.8% vs. 10.5%; all p < 0.05) were more commonly performed in OOH‐CA cases in the CPR+AED group. However, when only OOH‐CA cases with volunteers responding were analyzed, the rates of CPR actions were similar. In the subgroup of CPR+AED cases with a responding volunteer, the AED was turned on for only 47% of cases. Volunteers initiated a CPR action more commonly when the AED was turned on (60.7% vs. 39.3%; p = 0.003). Conclusions: In the Public Access Defibrillation Trial, rates of CPR actions for presumed OOH‐CA victims were low but similar for CPR and CPR+AED responding volunteer rescuers. Factors associated with volunteer response, CPR action initiation, and AED activation warrant further investigation.     

高仿真模拟人在大学生心肺复苏术培训中的应用效果研究

[目的]评价高仿真模拟人在大学生心肺复苏术培训中的应用效果。[方法]对113名非医学专业大一本科生进行心肺复苏教学,随机分为实验组(高仿真模拟人)56名和对照组(传统模拟人)57名,培训结束即刻和1个月后进行理论和操作测试,并用视觉模拟评分(VAS)评估急救自信心和教学满意度。[结果]培训结束即刻,两组理论成绩相近,但是实验组胸外按压(t=30.49,P0.01)和人工呼吸(t=14.97,P0.01)成绩明显优于对照组,此外,实验组学生表现出更强的急救信心(t=30.49,P0.01),且对教学效果更为满意(t=13.23,P0.01),1个月后实验组理论知识和人工呼吸技能保留较好,而对照组理论和操作成绩均下降显著。[结论]采用高仿真模拟人进行大学生心肺复苏术教学培训可有效提高学生操作能力。     

Retention of knowledge and skills in first aid and resuscitation by airline cabin crew

The study was conducted to investigate the retention of CPR and AED skills, first aid knowledge and perceived levels of confidence for a sample of 35 cabin crew 12 months after recurrent training. The 35 cabin crew undertook a mock resuscitation scenario using the AED and bag-valve-mask carried in the medical kit. Of the 35 subjects, 33 subjects failed to use the bag-mask correctly, 18 performed chest compressions at the incorrect site, only 13 achieved the correct compression depth, only 20 placed the AED pads correctly, and the average time to first shock was 110 s after commencement of the resuscitation. While theoretical first aid knowledge was high, the participants held low levels of self-confidence in their CPR and AED skills. The results of this study indicate that cabin crew may not have sufficiently high levels of skill to manage a cardiac arrest adequately. This suggests that existing approaches to training of cabin crew require further investigation and modification.     

Effectiveness of Basic Life Support Instruction in Physical Education Students—A Pilot Study

Background: According to the literature, 40% of injuries affecting school-age children are sports related. The role of physical education students, as future teachers, seems to be of high importance in terms of protecting children's safety during sports classes. Purposes: The aim is to evaluate the level of basic life support (BLS) knowledge and skills in physical education students instructed with the use of different methods. Methods: Second-year physical education students (n = 104, M age = 20 ± 0.6 years) were randomly assigned to three groups: experimental 1 (E1), experimental 2 (E2), and control (C). Group E1 students participated in a 2-hour BLS course based on computer-assisted presentations. Group E2 trainees practiced BLS algorithm in pairs during a 2-hour course. No manikins were used in both intervention groups. Students of Group C were asked to learn BLS algorithm on their own. All groups fulfilled a 10-question multiple-choice test on BLS at the beginning and the end of the experiment. After completing the course participants performed BLS on a manikin. Results: The results of knowledge test were not significant before an experiment but differed essentially among the groups afterward (analysis of variance contrast analysis, p <.05). Regardless of teaching method used, no significant differences were found among the students in preparatory BLS actions and cardiopulmonary resuscitation (CPR) performance on a manikin. The level of CPR performance was very low in all groups. Conclusions: Students of both intervention groups improved their BLS knowledge after the training. Teaching methods used in the current study seemed to be ineffective in terms of practical CPR skills. Access to greater number of modern manikins should improve the BLS training in physical education students. Moreover, permanent consultation on instructional methods with emergency medicine experts is recommended for university teachers.     

Peer evaluation in reciprocal learning with task cards for acquiring Basic Life Support (BLS)

Background

Research emphasises the need for instructional methods and tools which can improve Basic Life Support (BLS) performance or reduce instructional time.

Aim

To investigate the effect of peer evaluation to improve reciprocal learning with task cards as instructional tools for acquiring BLS.

Methods

A total of 78 kinesiology students from a Belgian university were paired and randomised across two groups to learn BLS in 20 min with task cards. In the control group, students worked together in a defined doer–helper relationship and switched roles every 5 min. In the peer evaluation group, students followed the same co-operation procedure as in the control group. In addition, 1 min before every switching of roles, the helper evaluated the doer's performance. All BLS skills were individually assessed on a Laerdal AED Resusci Anne mannequin (Laerdal Medical, Vilvoorde, Belgium) using the Laerdal PC-Skill reporting system. A total BLS score was calculated and performance was measured before training (baseline), immediately after training (intervention) and 2 weeks later (retention).

Results

Significantly more students from the evaluation group remembered and consequently performed all BLS skills at intervention (P = 0.03). No significant differences were found between groups for main cardiopulmonary resuscitation (CPR) variables and total BLS scores at baseline, intervention and retention. Both groups achieved more than 70% of the maximum BLS score at intervention and retention.

Conclusions

This study demonstrated that 20 min reciprocal-learning setting with task cards is an effective method to learn BLS. The implementation of peer evaluation in this setting has an immediate, however small, positive impact on BLS skill learning.     

Increasing first responder CPR during resuscitation of out-of-hospital cardiac arrest using automated external defibrillators

OBJECTIVE: Evidence supports that increasing the balance of "hands-on" CPR may improve survival in ventricular fibrillation out-of-hospital cardiac arrest (OHCA). We assessed whether training and/or AED reconfiguration was associated with an increase in the proportion of time during which CPR was performed between first and second stacks of shocks. METHODS: The investigation was a cohort study of 291 persons who suffered ventricular fibrillation OHCA and were treated with at least two stacks of AED shocks by emergency medical services (EMS) first-tier responders. In January 2003, first-tier providers were retrained regarding the importance of CPR. In addition, a subset of AEDs was reconfigured to remove continuous fibrillation detection and its associated voice prompts as to be comparable with other AED models. The amount of time spent on CPR was assessed through review of AED electronic and audio recordings to compare the pre-intervention (n = 241) and post-intervention periods (n = 50). RESULTS: The proportion of time spent performing hands-on CPR between first and second stacks of shocks was 0.40 in the pre-intervention period compared to 0.51 in the post-intervention period (p = 0.001). The difference was greatest for AEDs where EMS was retrained and the AED reconfigured (0.33 versus 0.50, p = 0.01). No difference in survival was detected between the pre- and post-intervention periods (24.9% versus 28.0%, p = 0.65). CONCLUSIONS: An intervention consisting of retraining and AED reconfiguration was associated with an increase in the proportion of time spent performing CPR between first and second stacks of shocks by first-tier EMS. Whether this increase improves patient outcomes requires additional study.     

The 'ABC for life' programme - teaching basic life support in schools

BACKGROUND: Less than 1% of the general public know how to assess or manage someone who has collapsed. It has been estimated that if 15-20% of the population were capable of performing cardiopulmonary resuscitation (CPR), mortality of out of hospital cardiac arrest could be decreased significantly. Training basic life support (BLS) skills to school children would be the most cost effective way of achieving this goal and ensuring that a large proportion of the population acquire basic life saving skills. AIMS: To assess retention of knowledge of basic life support 6 months after a single course of instruction in cardiopulmonary resuscitation designed specifically for school children. SETTING: School pupils in a rural location in one region of the United Kingdom. METHODS: A course of instruction in cardiopulmonary resuscitation - the 'ABC for life' programme - specifically designed to teach 10-12-year-old school children basic life support skills. The training session was given to school pupils in a rural location in Northern Ireland. A 22 point questionnaire was used to assess acquisition and retention of basic life support knowledge. RESULTS: Children instructed in cardiopulmonary resuscitation showed a highly significant increase in level of knowledge following the training session. While their level of knowledge decreased over a period of 6 months it remained significantly higher than that of a comparable group of children who had never been trained. CONCLUSION: A training programme designed and taught as part of the school curriculum would have a significant impact on public health.     

The effectiveness of repeated cardiopulmonary resuscitation training in a school population

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.     

The quality of chest compressions by trained personnel: the effect of feedback, via the CPREzy, in a randomized controlled trial using a manikin model

Even after training, the ability to perform effective cardiac compressions has been found to be poor and to decrease rapidly. We assessed this ability with and without a non-invasive feedback device, the CPREzy, during a 270s CPR session in an unannounced, single-blinded manikin study using 224 hospital employees and staff chosen at random and using a non-cross over design. The two groups self-assessed their knowledge and skills as adequate. However, the control group (N=111) had significantly more difficulty in delivering chest compressions deeper than 4 cm (25 versus 1 candidate in the CPREzy group), P=0.0001. The control group compressed ineffectively in 36% (+/-41%) of all compressions as opposed to 6+/-13% in the CPREzy group (N=112, P=0.0001). If compressions were effective initially, the time until >50% of compressions were less than 4 cm deep was 75+/-81s in the control group versus 194+/-87 s in the CPREzy group (P=0.0001 [-180 to -57.5]). After a few seconds of training in its use, our candidates used the CPREzy effectively. Against the background knowledge that estimation of compression depth by the rescuer or other team members is difficult, and that performing effective compressions is the cornerstone of any resuscitation attempt, our data suggests that a feedback device such as the CPREzy should be used consistently during resuscitation.     

How Well are Cardiopulmonary Resuscitation and Automated External Defibrillator Skills Retained over Time? Results from the Public Access Defibrillation (PAD) Trial

Background: The current standard for cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) retraining for laypersons is a four‐hour course every two years. Others have documented substantial skill deterioration during this time period. Objectives: To evaluate 1) the retention of core CPR and AED skills among volunteer laypersons and 2) the time required to retrain laypersons to proficiency as a function of time since initial training. Methods: This was an observational follow‐up study evaluating CPR and AED skill retention and testing/retraining time up through 17 months after initial training. The study took place at 1,260 facilities recruited by 24 North American clinical research centers, and included 6,182 volunteer laypersons participating in the Public Access Defibrillation (PAD) Trial. Training to proficiency in either CPR only (N= 2,426) or CPR+AED (N= 3,756) was followed by testing/retraining provided three to 17 months later. Retraining was done in brief, one‐on‐one, individualized, interactive sessions. The outcome studied was instructors' global assessments of performance of CPR and AED skill adequacy, i.e., whether CPR actions would likely result in perfusion (yes/no) and whether AED actions would result in a shock through the heart (yes/no). Results: For global CPR performance, 79%, 73%, and 71% of volunteers tested for the first time since initial training three to five, six to 11, and 12 to 17 months after initial training, respectively, were judged by their instructors as having adequate performance (p < 0.001, chi‐square for linear trend). For global AED performance, 91%, 86%, and 84% of volunteers, respectively, were judged as having adequate performance (p < 0.001). The mean (± standard deviation) times required to test and retrain volunteers to proficiency were 5.7 (± 4.0) minutes for CPR skills and 7.7 (± 4.6) minutes for CPR+AED skills. Conclusions: Among PAD Trial volunteer laypersons participating in a simulated resuscitation, the proportions of volunteers judged by instructors to have adequate CPR and AED skills demonstrated small declines associated with longer intervals between initial training and subsequent testing. However, based on instructors' judgment, large majorities of volunteers still retained both CPR and AED core skills through 17 months after initial training. Furthermore, individual testing and retraining for CPR and AED skills were usually accomplished in less than 10 minutes per volunteer. Additional research is essential to identify training and evaluation techniques that predict adequate CPR and AED skill performance of laypersons when applied to an actual cardiac arrest.     

心脏猝死高危者家属心肺复苏知识与技能培训的重点和难点

目的 通过对心脏猝死高危者家属进行心肺复苏知识与技能的培训,以探讨公众掌握心肺复苏知识与技能的重点和难点.方法 应用方便取样方法,选取首都医科大学附属宣武医院、中国医学科学院阜外心血管病医院住院的心脏猝死(sudden cardiac death.SCD)高危人群的家属集中进行心肺复苏(cardiopulmonary resuscitation,CPR)培训.培训结束后对研究对象进行CPR知识和技能测试.结果 培训后即刻对受训家属进行知识与技能的测试,98.4%的家属CPR知识测试通过,但是只有34.3%的家属技能测试合格,65.7%都需要多次反复指导才能做到技能达标.结论 公众对CPR知识与技能的掌握程度不一致,CPR技能是公众CPR培训的重点与难点.     

Quality of chest compressions during continuous CPR; comparison between chest compression-only CPR and conventional CPR

Objectives

This study aimed to compare the time-dependent deterioration of chest compressions between chest compression-only cardiopulmonary resuscitation (CPR) and conventional CPR.

Methods

This study involved 106 and 107 participants randomly assigned to chest compression-only CPR training and conventional CPR training, respectively. Immediately after training, participants were asked to perform CPR for 2 min and the quality of their CPR skills were evaluated. The number of chest compressions in total and those with appropriate depth were counted every 20-s CPR period from the start of CPR. The primary outcome was the CPR quality index calculated as the proportion of chest compressions with appropriate depth among total chest compressions.

Results

The total number of chest compressions remained stable over time both in the chest compression-only and the conventional CPR groups. The CPR quality index, however, decreased from 86.6 ± 25.0 to 58.2 ± 36.9 in the chest compression-only CPR group from 0-20 s through 61-80 s. The reduction was greater than in the conventional CPR group (85.9 ± 25.5 to 74.3 ± 34.0). The difference in the CPR quality index reached statistical significance (p = 0.003) at 61-80 s period.

Conclusions

Chest compressions with appropriate depth decreased more rapidly during chest compression-only CPR than conventional CPR. We recommend that CPR providers change their roles every 1 min to maintain the quality of chest compressions during chest compression-only CPR. (UMIN-CTR C0000000321)     

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。     

Comparison of hands-off time during CPR with manual and semi-automatic defibrillation in a manikin model

BACKGROUND: Rhythm analysis with current semi-automatic external defibrillators (AEDs) requires mandatory interruptions of chest compressions that may compromise the outcome after cardiopulmonary resuscitation (CPR). We hypothesised that interruptions would be shorter when the defibrillator was operated in manual mode by trained and certified ambulance personnel. MATERIALS AND METHODS: Sixteen pairs of ambulance personnel operated the defibrillator (Lifepak((R))12) in both semi-automatic (AED) and manual (MED) mode in a randomised, cross-over manikin CPR study, following the ERC 2000 Guidelines. RESULTS: Median time from last chest compression to shock delivery (with interquartile range) was 17s (13, 18) versus 11s (6, 15) (mean difference (95% CI) 6s (2, 10), p=0.004). Similarly, median time from shock delivery to resumed chest compressions was 25s (22, 26) versus 8s (7, 12) (median difference 13s, p=0.001) in the AED and MED groups, respectively. While sensitivity for identifying ventricular fibrillation (VF) in both modes and specificity in the AED mode were 100%, specificity was 89% in manual mode. Thus, some unwarranted shocks resulting in hands-off time (time without chest compressions) were given in manual mode. However, mean hands-off-ratio (time without chest compressions divided by total resuscitation time) was still lower, 0.2s (0.1, 0.3) versus 0.3s (0.28, 0.32) in manual mode, mean difference 0.10s (0.05, 0.15), p=0.001. CONCLUSION: Paramedics performed CPR with less hands-off time before and after shocks on a manikin with manual compared to semi-automatic defibrillation following the 2000 Guidelines. However, 12% of the shocks given manually were inappropriate.     

Ability of citizens in a senior living community to perform lifesaving cardiac skills and appropriately utilize AEDs

The objective of this study was to assess the ability of citizens in a senior living community (SLC) to perform adequate cardiopulmonary resuscitation (CPR) and appropriately utilize an automated external defibrillator (AED) in a simulated cardiac arrest scenario (SCAS). This study was a prospective, observational study; a convenience sample of SLC residents aged > 54 years was enrolled. Subjects were presented with a SCAS (adult mannequin, bystander available to assist, AED visible). Subjects’ skills were rated in standardized fashion. For statistical analysis, 95% confidence intervals (CIs) were calculated as appropriate. There were 51 subjects; 69% were female; mean age was 64 years; 86% were without disabilities. Pre-retirement professions included: medical (13.7%), office/sales (41.2%), and engineer/science (15.7%). Subjects had previous American Heart Association first-responder training (CPR and AED use) as follows: none (22%), within 0 to 6 months (47%), 7–12 months (4%), > 12 months (27%). During the SCAS, subjects performed inconsistently on the various links in the chain of survival. Although most subjects (94%; 95% CI 84–99%) checked for unresponsiveness, only 62.8% (95% CI 48–76%) also specified “call 911 and bring me the AED.” Most subjects (88%; 95% CI 76–96%) started chest compressions, however, only a minority provided high quality chest compressions (29%; 95% CI 17–44%). With respect to AED skill performance, we noted the following: 94% (95% CI 84–99%) of subjects removed the patient’s clothing, 90% (95% CI 79–97%) turned the device on, 94% delivered a shock as directed, and 82% continued CPR if “no shock indicated” by AED (95% CI 69–92%). Performance was less satisfactory for the following: only 39.2% (95% CI 26–54%) continued chest compressions after AED arrival, 60.8% (95% CI 46–74%) of subjects correctly attached electrodes, and 6% (95% CI 1–16%) verbalized “clear” in advance of shock. Although many members of our sample SLC had prior training, they frequently failed to adequately perform some key steps in the SCAS. Recent efforts to place AEDs in SLCs should be augmented by a plan to adequately train residents and other available individuals (e.g., staff) in CPR/AED use.