The retention of cardiopulmonary resuscitation skills

Although a great emphasis has recently been placed on training both the medical profession and the general public in cardiopulmonary resuscitation (CPR), studies have demonstrated that retention of resuscitation skills is poor. Although CPR certification is generally valid for a 1- to 2-year period, evaluation of trainees at all levels has demonstrated a marked lack of proficiency over this course of time. This paper reviews the studies that have disclosed this lack of skills retention, as well as proposed solutions and reinforcement techniques. CPR course content and certification criteria must be appropriate to maximize retention as well as learning. To this end a simplification of basic life-support training curricula is recommended.     

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.     

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.     

Cardiopulmonary resuscitation skills retention in family members of cardiac patients

The purpose of this study was to determine if the use of a retention strategy would maintain cardiopulmonary resuscitation (CPR) skills in family members of cardiac patients. Thirty-one subjects trained in CPR received retention packets 3 and 6 months after CPR training. Sixteen subjects were tested for CPR retention at 7 months after initial training, and 15 at 12 months. Likelihood chi 2 was used to compare the 7- and 12-month groups. There were no differences between the 7- and 12-month groups, because CPR retention overall was poor. Only 19.4% of subjects reported using the retention packet; therefore, subjects were regrouped into practice and no practice groups for purposes of further statistical analysis. There were significant differences in retention in subjects who practiced compared with subjects who did not. These findings underscore the importance of promoting practice/review after initial CPR training for family members of cardiac patients.     

The effect of time since training on house officers' retention of cardiopulmonary resuscitation skills

Currently, the American Heart Association (AHA) recommends that physicians be certified in cardiopulmonary resuscitation (CPR) every two years. This study was undertaken to determine the effects of time since training on retention of CPR skills of physicians and to identify at what point performance deteriorates to a level requiring retraining with supervised practice. The physicians' performance of CPR one year or less after training was compared with that of more than one year after training. Thirty-three medical residents who had been taught CPR by the same instructor were tested without warning for one-person CPR on a recording mannikin. Performance was evaluated according to AHA Heartsaver criteria. The data were analyzed by organizing all CPR steps or behavioral objectives into three categories: assessment, skills (which included ventilation and compression), and sequence (which included calls for assistance). The data suggest that the knowledge of CPR sequence remains stable and that assessment improves while skill performance deteriorates after one year. This apparent contradiction in overall CPR performance may relate to the effect of experience. Assessment may improve because of involvement in actual resuscitations in the hospital. Deterioration of skills may reflect the fact that senior residents do not actually perform CPR, but become team leaders and thereby lose their skills, or that poor performance is not corrected in actual "code" situations. If a two-year certification standard is maintained, CPR skill testing at least every 12 months should be considered. If skills have deteriorated, hands-on-practice should be undertaken at that time.     

A meta-analysis of cardiopulmonary resuscitation with and without the administration of thrombolytic agents

OBJECTIVE: To pool data on the role of thrombolytic agents in cardiopulmonary resuscitation (CPR) and evaluate the efficacy and safety of thrombolysis. MATERIALS AND METHODS: The clinical studies in MEDLINE database from 1966 to August 2004 that studied the efficacy and safety in CPR with and without treatment with thrombolytic agents were assessed by a meta-analysis performed to evaluate the effect of the treatment. RESULTS: A total of eight papers evaluating the effect of thrombolysis in CPR were identified. This meta-analysis showed that thrombolytic agents significantly improved the rate of return of spontaneous circulation, 24 h survival rate, survival to discharge and long-term neurological function in patients treated with CPR (p < 0.01). However, the patients receiving thrombolysis had a risk of severe bleeding (p < 0.01). CONCLUSION: Thrombolytic agents during CPR can improve the survival rate to discharge and neurological function.     

广州东部地区公众徒手心肺复苏术掌握现状调查及培训分析

目的了解广州东部地区公众对徒手心肺复苏术（CPR）掌握现状,探讨对公众进行CPR培训的方法。方法对广州东部地区738人进行CPR培训,培训前后理论和操作考试。结果广州东部地区公众普遍缺乏心肺复苏知识和技能。培训后操作考试合格率从培训前12．0％提高到100．0％。结论广州东部地区公众普遍缺乏心肺复苏基本知识和技能,规范培训能有效提高公众心肺复苏技能。     

甲泼尼龙对心肺复苏后患者血清细胞因子的影响

目的 探讨甲泼尼龙对心肺复苏后患者血清细胞因子表达的影响.方法 将2005年5月至2007年5月上海市闸北区中心医院心肺复苏恢复自主循环(ROSC)30例患者,经心电监护或心电图证实院内心跳呼吸骤停,即刻心肺复苏恢复自主循环、生存≥48 h、年龄≥18岁患者;入选病例排除因各种疾病终末期、晚期肿瘤、自然死亡因素所致心跳呼吸停止者,及发病前一周内伴有各种感染、休克、严重创伤者.随机分为A组(甲泼尼龙组,n=14):复苏后加用甲泼尼龙每日3 mg/kg,分两次静脉滴注,连续3 d;B组(对照组,n=16):采用常规心肺复苏治疗.两组患者原发病因基本相仿.ELISA法检测两组心肺复苏即刻、ROSC后24 h、48 h、72 h、7 d的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)水平.资料数据采用SPSS11.5版统计软件进行分析处理,计量资料以均数±标准差(-x±s)表示,两组各不同时间点计量资料两两比较采用成组t检验,两组心肺复苏后SIRS患病率和病死率采用Chi-square test,以P＜0.05为差异有统计学意义.结果 两组心跳骤停至心肺复苏恢复自主循环平均间期[(8.9±4.6)min,(9.6±5.0)min]及心肺复苏即刻血清TNF-α、IL-1β、IL-6、IL-8、IL-10水平差异无统计学意义(P＞0.05).与B组比较,A组ROSC后24 h、48 h血清TNF-α、IL-1β、IL-6、IL-8水平明显降低(P＜0.05～0.01),ROSC后72 h A组血清IL-8水平(114.33±149.72)仍低于B组(332.09±277.45)(P＜0.05),ROSC后7 d两组血清各细胞因子水平差异无统计学意义(P＞0.05).血清IL-10水平两组在不同时间点差异均无统计学意义(P＞0.05).结论 早期应用甲泼尼龙可降低心肺复苏后患者血清TNF-α、IL-1β、IL-6、IL-8释放,对复苏患者有保护作用.     

Available ventilation monitoring methods during pre-hospital cardiopulmonary resuscitation

High quality cardiopulmonary resuscitation (CPR) in the pre-hospital setting has been associated with improved survival rates during cardiopulmonary arrest (CPA). Recent documentation of hyperventilation associated deterioration in hemodynamics during CPR, suggests that guided or controlled ventilation strategies may contribute to improved hemodynamics and increased survival. This article briefly reviews the mechanical methods, advantages, and disadvantages of the available ventilation monitoring methods currently available for clinical use, with an emphasis on pre-hospital implementation. We recommend that more objective measurement of ventilation during CPR be performed, with emphasis on a strategy for measuring both attempted ventilation frequency (f) and delivered tidal volume (VT). The use of improved thoracic impedance pneumography and capnography are appealing for such monitoring because of the widespread availability, but modifications to existing software and clinical data compared to a clinical standard would be required before general acceptance is possible. Other methods listed may offer advantages over these in select circumstances.     

Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: a meta-analysis

INTRODUCTION: Cardiopulmonary resuscitation is thought to be a low-yield intervention in cancer patients. In patients with metastatic disease the procedure is thought to be futile. Comprehensive data on survival to discharge in subsets of cancer patients undergoing in-hospital cardiopulmonary resuscitation, however, are lacking. OBJECTIVE: To determine the rate of survival to discharge for adult cancer patients undergoing in-hospital cardiopulmonary resuscitation. METHOD: A systematic search of MEDLINE and our primary sources' references was performed for studies involving in-hospital cardiac arrest, in clearly defined subsets of adult cancer patients, with outcomes that included survival to hospital discharge. RESULTS: Forty-two studies from 1966-2005, comprising 1707 patients met our minimal inclusion criteria. Overall survival to discharge was 6.2%. Survival in patients with localized disease was 9.5%, and in patients with metastatic disease was 5.6%. Analysis of data reported since 1990 reveals a narrowing of the survival gap, with survival rates in patients with localised disease of 9.1%, and in patients with metastatic disease of 7.8%. Survival in patients resuscitated on the general medical/surgical wards was 10.1%, while survival in patients resuscitated on intensive care units (ICUs) was 2.2%. CONCLUSIONS: Overall survival of CPR to hospital discharge in cancer patients compares favorably to survival rates in unselected inpatients. Improved outcomes in recent years in patients with metastatic disease are likely to reflect more selective use of CPR in cancer patients, with the sickest patients deselected.     

急诊护士心肺复苏术培训的新进展

心肺复苏术是一项具有社会普遍价值的、在发病现场实用性很强的医疗急救技术。虽然已经在全社会进行推广培训,但现今在实际推广培训过程中存在很多不足,远未达到预期目标。本文就急诊护士培训内容和方法的新进展进行综述。     

Willingness and obstacles of healthcare professionals to perform bystander cardiopulmonary resuscitation in China

BackgroundBystander CPR (B-CPR) is crucial to increase survival of out-of-hospital cardiac arrest (OHCA), and this study is performed to assess the willingness and obstacles of Chinese healthcare professionals (HCPs) to perform B-CPR on strangers, as well as the factors associated with the willingness.MethodsAn internet-based questionnaire surveying demographic information, CPR training, CPR knowledge, willingness, and obstacles to perform B-CPR among 10,393 HCPs. A multivariate logistic regression analysis was used to evaluate the factors associated with the willingness.ResultsHere, 73.9% of HCPs were willing to perform B-CPR on strangers in China. The factors associated with the willingness were as follows: female, senior, working in Third-class hospitals, working in Pre-hospital emergency and Cardiology or Cardiac surgery, receiving current training, having adequate CPR knowledge. The main obstacles were fear of infection via mouth-to-mouth ventilations (MMV), fear of being blackmailed and fear of legal liability.ConclusionAbout three quarters of HCPs are willing to perform B-CPR. Female HCPs, those who have more CPR experience, adequate knowledge, and recent training are more likely to perform B-CPR. Reform of the legal and credit system are needed, and recommendation of hands-only CPR is a possibility to encourage HCPs to perform B-CPR on strangers.     

情景模拟在急诊护士心肺脑复苏技能培训中的应用

目的:探讨情景模拟在急诊护士心肺脑复苏技能培训中的效果。方法:选择57名急诊护士作为培训对象,采用技术要点复习(理论讲解与分项技术练习)、建立模拟现场、情景设计、角色分配、现场模拟与总结的综合模式,进行临床心肺脑复苏技能培训。培训前后,予以理论、技能、急救综合能力测试,比较两次成绩差异;并发放反馈调查问卷分析对教学方法的评价。结果:急诊护士培训后再次考核成绩均高于初步测试成绩(P<0.05),培训对象均认为该培训方式收获大、效果好、实用性强。结论:情景模拟应用于急诊护士心肺脑复苏技能的培训方式,不仅增强了专业培训的吸引力,激发了急诊护士技术练习的积极性,更加深了理论知识的理解和记忆,提升了护理人员的团队意识和专业综合能力,具有重要的应用价值。     

Outcomes of cardiopulmonary resuscitation for patients on vasopressors or inotropes: A pilot study

Hypothesis

Outcomes of critically ill patients who receive cardiopulmonary resuscitation (CPR) are poor, and the subgroup on vasopressors or inotropes before cardiopulmonary arrest (CPA) rarely survives.

Setting

The setting of the study was a critical care unit of a 350-bed community teaching hospital.

Study Design

This was a retrospective, cohort study.

Methods

A retrospective review was performed of medical records of all patients, identified through medical billing and hospital committee records, who received CPR for CPA in a critical care unit.

Results

Of 83 patients, with an average age of 66 years, 14 (17%) survived to hospital discharge. Patients with pulseless electrical activity and asystole were significantly less likely to survive (9% and none, respectively; P = .0001). Only 2 (4%) of 55 critically ill patients receiving vasopressors before CPR survived, whereas 12 of 28 patients not on vasopressors survived (P < .0001). Although mechanical ventilation just before CPR was highly associated with administration of vasopressors, ventilation was not significantly associated with mortality (P = .13). Mortality of patients on vasopressors was higher for both mechanically ventilated (95% vs 33%, P < .001) and spontaneously breathing (100% vs 64%, P = .02) patients. In multiple logistic regression analyses, administration of vasopressors was the only variable independently associated with in-hospital mortality (odds ratio, 35.1; 95% confidence interval = 4.1-304.3).

Conclusions

Survival of patients requiring CPR during critical care admission was 17%. Very few patients survived who required vasopressors or inotropes immediately before CPA. This study is limited significantly by its retrospective design and small cohort, and so this question should be reexamined in a larger study.     

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.     

The attitudes of Japanese high school students toward cardiopulmonary resuscitation

BACKGROUND AND OBJECTIVES: It is essential to have a clear understanding of the present condition of cardiopulmonary resuscitation (CPR) training courses and the associated problems. The present study was performed to identify the current conditions of CPR training in Japanese high schools and the attitudes of students toward CPR. METHODS AND RESULTS: We distributed a questionnaire study to the students of 12 cooperating high schools regarding their willingness to perform CPR in 5 hypothetical scenarios of cardiopulmonary arrest: a stranger, a trauma patient, a child, an elderly person, and a relative. Between February and March 2006, a total of 3316 questionnaires were completed. Across all scenarios, only 27% of respondents from general high schools reported willingness to perform chest compression (CC) plus mouth-to-mouth ventilation (MMV), and 31% reported willingness to perform CC alone. Fifty-nine percent of students had previous CPR training, and only 35% were willing to perform CC plus MMV. Most of the respondents who reported that they would decline to perform full CPR, stated that poor knowledge and/or fear of incomplete performance of CPR were deciding factors. CONCLUSIONS: Japanese high school students are reluctant to perform CC plus MMV, despite having received training. The present educational system in Japan has limitations in encouraging high school students to perform CC plus MMV.     

连续性血液净化治疗对心肺复苏术后患者脑复苏效果的影响

目的探讨连续性血液净化治疗（CBP）对心肺复苏术（CPR）后患者脑复苏效果的影响及其可能的机制。方法选取CPR术后脑复苏未成功的患者60例随机分为两组，每组30例，采用CBP＋原发病的综合治疗30例作治疗组。采用常规脱水、头部低温＋原发病的综合治疗的30例患者作对照组。观察两组患者脑复苏成功的时间、成功率。结果治疗组患者的脑复苏成功的时间较对照组明显缩短、脑复苏成功率明显高于对照组（P〈0．01），两组患者的死亡率无明显差异（P〉0．05）。结论连续性血液净化治疗对心肺复苏后患者能明显减轻脑水肿，缩短脑水肿的时间，提高脑复苏的成功率。     

心肺复苏教学及实践智能化辅助技术的研究进展

心肺复苏(cardiopulmonary resuscitation,CPR)是抢救生命的关键技术之一。本文旨在多方面探究CPR培训的智能化研究现状,并为未来CPR教学和实践的智能化发展方向提供建议。在web of science核心库近五年的文章中搜索CPR训练和CPR智能化设备,获得31篇相关文献。CPR智能化涉及教学、辅助、统计和监测等多方面。现实增强(AR)技术满足了CPR培训互动中环境模拟等新需求。智能设备及新算法提高CPR的培训质量。本文简述了应对心脏骤停一些需要注意的问题。健全的急救保障系统对提高心脏骤停患者的生存率具有很大帮助。     

纳洛酮在心肺复苏中疗效的系统评价

目的 评价纳洛酮在心肺复苏中的疗效.方法 计算机检索中国期刊全文数据库、中文科技期刊全文数据库、数字化期刊全文数据库、中国生物医学文献数据库、EMBASE、PubMed、Cochrane Library、SCI等并辅以手工检索,按照纳入标准,两名研究者独立筛选文献并提取资料,采用Jadad评分标准评价纳入文献的质量,采用RevMan5.0软件进行统计学处理.结果 纳入14篇文献(953例患者).Meta分析结果显示,纳洛酮联合常规心肺复苏在复苏成功率(P<0.00001)、自主循环恢复成功率(P=0.0001)、自主呼吸恢复成功率(P<0.00001)、从呼吸心跳恢复到脑复苏的时间(P<0.00001)等方面均有统计学意义.结论 纳洛酮对部分患者可以提高心肺复苏的成功率,并有促进脑复苏作用.由于纳入研究样本的地域性限制,尚需要高质量、大样本、多中心的随机双盲对照试验加以证实.     

心肺复苏教学及实践智能化辅助技术的研究进展

心肺复苏(cardiopulmonary resuscitation,CPR)是抢救生命的关键技术之一。本文旨在多方面探究CPR培训的智能化研究现状,并为未来CPR教学和实践的智能化发展方向提供建议。在web of science核心库近五年的文章中搜索CPR训练和CPR智能化设备,获得31篇相关文献。CPR智能化涉及教学、辅助、统计和监测等多方面。现实增强(AR)技术满足了CPR培训互动中环境模拟等新需求。智能设备及新算法提高CPR的培训质量。本文简述了应对心脏骤停一些需要注意的问题。健全的急救保障系统对提高心脏骤停患者的生存率具有很大帮助。