Automated External Defibrillator Skills Research Articles

Attitudes and willingness toward out-of-hospital CPR and AED: A questionnaire study among Chinese middle school students

ObjectivesThis study's purpose was to assess the attitudes and willingness of middle school students to perform cardiopulmonary resuscitation (CPR) and to use automated external defibrillator (AED) in emergencies, and to evaluate the overall effects of first aid training. ResultsMiddle school students demonstrated a high willingness to learn CPR (95.87%) and AED (77.90%). However, the rate of CPR (9.87%) and AED (3.51%) training was relatively low. These trainings could improve their confidence while facing emergencies. Their main concerns were “Lack of first aid knowledge”, “Lack of confidence in rescue skills” and “Fear of hurting the patient”. ConclusionsChinese middle school students are willing to learn CPR and AED skills, but relative trainings are insufficient and should be reinforced.

A non-inferiority randomised controlled trial comparing self-instruction with instructor-led method in training of layperson cardiopulmonary resuscitation

Our study aimed to compare the effect of self-instruction with manikin feedback to that of instructor-led method on cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skill performance. In our randomized non-inferiority trial, 64 non-healthcare providers were randomly allocated into self-instruction and instructor-led groups. Both groups watched a 27-min standardized teaching video. Participants in the self-instruction group then performed hands-on practice on the Resusci Anne QCPR with a device-driven feedback, while those in the instructor-led group practiced manikins; feedback was provided and student’s questions were answered by instructors. Outcomes were measured by blinded evaluators and SkillReporter software. The primary outcome was the pass rate. Secondary outcomes were scores of the knowledge test and items of individual skill performance. The baseline characteristics of the two groups were similar. The pass rates were 93.8% in both group (absolute difference 0%, p = 0.049 for noninferiority). The knowledge test scores were not significantly different. However, the self-instruction group performed better in some chest compression and ventilation skills, but performed worse in confirming environmental safety and checking normal breathing. There was no difference in AED skills between the two groups. Our results showed the self-instruction method is not inferior to the instructor-led method.

Can tablets be used as a simulator for automated external defibrillation during cardiopulmonary resuscitation courses?

Background. A novel, tablet-based auto-mated external defibrillator (AED) simu-lator has been developed to facilitate AED training.Objective. To evaluate if the tablet AED simulator (an AED simulator based on mobile technology (M-AED)) can be suc-cessfully used during cardiopulmonary re-suscitation (CPR) courses. To test medical and dental students’ CPR attitudes, knowl-edge and skills, and evaluate the impact of a one day CPR course.Methods. One hundred and twenty-four medical and dental students of University of Zagreb participated in a basic life sup-port and automated external defibrillator (BLS/AED) course. All students filled out demographic, CPR attitudes and knowl-edge questionnaires before and after the course. Half of the students practised AED skills during the course on a conventional AED trainer (C-AED), and half on M-AED. All underwent assessment of CPR skills after the course with C-AED. Those that used M-AED during training, rated its use.Results. All students successfully complet-ed the assessment of skills after the course, with no significant difference in the num-ber of those who had to be retested be-tween C-AED and M-AED. A significant improvement in CPR attitudes and knowl-edge was noted after the course among all students, with no difference between C-AED and M-AED groups. M-AED as an AED trainer was highly rated.Conclusions. Tablet based AED simula-tors can be effectively utilized during BLS/AED courses as a substitute for conven-tional AED trainers.

Evidence-based recommendations on automated external defibrillator training for children and young people in Flanders-Belgium

ObjectiveThe aim of the study was to identify the most relevant literature on skills, attitude and behaviour of children and young people towards the use of an automated external defibrillator (AED) and then develop recommendations according to the principles of evidence-based practice. These recommendations were to serve as a basis for educational materials which would ensure that the implementation of AED-training within schools and youth organisations would be a simple process. MethodsA systematic literature search was performed using a specific research question: “Are children of different ages able/willing to use an AED after a training compared to another/no training?”. A guideline development panel meeting was organised to formulate practice guidelines. The panel consisted of experts from different fields (medicine, education and psychology) and representatives of the end users (teachers and youth leaders). ResultsThe systematic literature search identified five studies concerning AED skills by children and young people, and two studies concerning the attitudes and behaviour of children and young people towards the use of an AED. The guideline development panel carefully examined the available scientific evidence, took into consideration the skills and attitudes of children and young people, including the psychological consequences of managing a potentially life-saving situation and formulated evidence-based recommendations and good practice points. ConclusionBased on these recommendations, an education programme and new educational materials have been developed by the Belgian Red Cross-Flanders. In this way school staff and youth leaders are properly supported to teach first aid techniques to children and young people (6–18 years).

Effect of a reminder video using a mobile phone on the retention of CPR and AED skills in lay responders

Background Skills related to cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use by lay responders decay rapidly after training, and efforts are required to maintain competence among trainees. We examined whether repeated viewing of a reminder video on a mobile phone would be an effective means of maintaining CPR and AED skills in lay responders. Methods In a single-blind case–control study, 75 male students received training in CPR and AED use. They were allocated either to the control or to the video-reminded group, who received a memory card containing a video clip about CPR and AED use for their mobile phone, which they were repeatedly encouraged to watch by SMS text message. CPR and AED skills were assessed in scenario format by examiners immediately and 3 months after initial training. Results Three months after initial training, the video-reminded group showed more accurate airway opening ( P < 0.001), breathing check ( P < 0.001), first rescue breathing ( P = 0.004), hand positioning ( P = 0.004), AED electrode positioning ( P < 0.001), pre-shock safety check ( P < 0.001), defibrillation within 90 s ( P = 0.010), and resuming CPR after defibrillation ( P < 0.001) than controls. They also showed significantly higher self-assessed CPR confidence scores and increased willingness to perform bystander CPR in cardiac arrest than the controls at 3 months ( P < 0.001, P = 0.024, respectively). Conclusion Repeated viewing of a reminder video clip on a mobile phone increases retention of CPR and AED skills in lay responders.

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An essential aim of so-called public access defibrillation (PAD) is to enable lay rescuers to carry out defibrillation as soon as possible. However, there are different PAD strategies and concepts concerning, for example the automated external defibrillator (AED) users, their qualifications and the localization of the PAD program. A Bavarian study, in which the feasibility of the PAD was investigated, showed that dispatchable and mobile PAD concepts, meaning that a rescuer equipped with an AED can be alerted and sent to the emergency by the emergency medical service (EMS) dispatch center, are suitable strategies to improve the outcome of sudden cardiac arrest. Another result of this study was that lay rescuers showed a high degree of willingness to use an AED but knew only little about what to do in basic life support and how to use an AED. Therefore appropriate knowledge and skills have to be taught to as many lay persons as possible to achieve a successful implementation of the PAD concepts.A 2-hour (maximum 4-hour) course seems to be sufficient to gain cardiopulmonary resuscitation (CPR) and AED skills and a brief refresher course should take place after 6-12 months to retain the knowledge.

Public access resuscitation program including defibrillator training for laypersons: A randomized trial to evaluate the impact of training course duration

Time to cardiopulmonary resuscitation (CPR) is a main determinant of survival after out-of-hospital cardiac arrest. Only widespread implementation of training courses for laypersons can decrease response time. In this prospective randomized trial, we evaluated how laypersons retained CPR skills and skills in using the automated external defibrillator (AED). A total of 1095 volunteers were randomly assigned to receive CPR/AED-training courses of 2h (375 persons), 4h (378 persons) or 7h (342 persons) duration. Courses were held in accordance with the guidelines for CPR. All trainees were tested immediately after the initial class in a standardized test scenario using an AED and a manikin. Either at 6 or at 12 months, retests were given to 164 and 206 volunteers, respectively. In 479 volunteers, retesting was completed at both 6- and 12-month intervals. At the immediate tests, the 7-h training group showed a slightly higher rate of correct responses (7h: 96%, 4h: 94%, 2h: 92%) (p<0.001). Skill retention decreased significantly in the three groups and was lowest after 12 months if no 6-month retests were done. In trainees who did undergo retesting at 6 months, skills did not deteriorate at 12 months. There were no significant differences between the three groups (overall correct responses: 2h: 72%, 4h: 73%, 7h: 74%) (ns). A 2-h class is sufficient to acquire and retain CPR and AED skills for an extended time period provided that a brief re-evaluation is performed after 6 months.

The effect of time on CPR and automated external defibrillator skills in the Public Access Defibrillation Trial

The time to skill deterioration between primary training/retraining and further retraining in cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) for lay-persons is unclear. The Public Access Defibrillation (PAD) trial was a multi-center randomized controlled trial evaluating survival after CPR-only versus CPR+AED delivered by onsite non-medical volunteer responders in out-of-hospital cardiac arrest. This sub-study evaluated the relationship of time between primary training/retraining and further retraining on volunteer performance during pretest AED and CPR skill evaluation. Volunteers at 1260 facilities in 24 North American regions underwent training/retraining according to facility randomization, which included an initial session and a refresher session at approximately 6 months. Before the next retraining, a CPR and AED skill test was completed for 2729 volunteers. Primary outcome for the study was assessment of global competence of CPR or AED performance (adequate versus not adequate) using chi(2)-test for trends by time interval (3, 6, 9, and 12 months). Confirmatory (GEE) logistic regression analysis, adjusted for site and potential confounders was done. The proportion of volunteers judged to be competent did not diminish by interval (3, 6, 9, and 12 months) for either CPR or AED skills. After adjusting for site and potential confounders, longer intervals to further retraining was associated with a slightly lower likelihood of performing adequate CPR but not with AED scores. After primary training/retraining, the CPR skills of targeted lay responders deteriorate nominally but 80% remain competent up to 1 year. AED skills do not deteriorate significantly and 90% of volunteers remain competent up to 1 year.

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

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. 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). 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.

Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students

To evaluate new instructional methods for teaching high school students cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, actions and skills. We conducted a cluster-controlled trial of 3 instructional interventions among Seattle area high school students, with random allocation based on classrooms, during 2003-04. We examined two new instructional methods: interactive-computer training and interactive-computer training plus instructor-led (hands-on) practice, and compared them with traditional classroom instruction that included video, teacher demonstration and instructor-led (hands-on) practice, and with a control group. We assessed CPR and AED knowledge, performance of key AED and CPR actions, and essential CPR ventilation and compressions skills 2 days and 2 months after training. All outcomes were transformed to a scale of 0-100%. For all outcome measures mean scores were higher in the instructional groups than in the control group. Two days after training all instructional groups had mean CPR and AED knowledge scores above 75%, with use of the computer program scores were above 80%. Mean scores for key AED actions were above 80% for all groups with training, with hands-on practice enhancing students' positive outcomes for AED pad placement. Students who received hands-on practice more successfully performed CPR actions than those in the computer program only group. In the 2 hands-on practice groups the scores for 3 of the outcomes ranged from 57 to 74%; they were 32 to 54% in the computer only group. For the outcome of continuing CPR until the AED was available scores were high, 89 to 100% in all 3 training groups. Mean CPR skill scores were low in all groups. The highest mean score for successful ventilations was 15% and for compressions, 29%. The pattern of results was similar after 2 months. We found evidence that interactive computer based self instruction alone was sufficient to teach CPR and AED knowledge and AED actions to high school students. All forms of instruction were highly effective in teaching AED use. In contrast to AED skills, CPR remains a set of difficult psychomotor skills that is challenging to teach to high school students as well as other members of the lay public.

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

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. 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. 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). 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. 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.

Predictors of cardiopulmonary resuscitation and automated external defibrillator skill retention

Few data exist regarding the retention of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills over time in relationship to characteristics of lay volunteer responders, training, or risk of exposure to victims. The purpose of this study was to describe the characteristics associated with adequate CPR and AED skill retention. Skill retention was tested 3 to 18 months (mean 6.9 +/- 3.5 months) after initial training. Instructors judged adequacy of performance of essential CPR or AED skills and provided an overall assessment (adequate/inadequate), which was used as the outcome. Data on 7261 laypersons trained in CPR (4358 also received AED training) in 24 sites across the United States and Canada were available from the Public Access Defibrillation (PAD) Trial. Characteristics of the volunteers, classes, and facilities were evaluated as predictors of performance adequacy. Adjusting for site, intervention assignment (CPR-only or CPR + AED), and time since initial training, volunteer characteristics associated with adequate CPR performance were age (OR 0.78 per 10-year increment), male sex (OR 1.44), minority (OR 0.62), married (OR 1.35), prior emergency experience (OR 1.66), prior CPR class (OR 1.68), prior advanced training (OR 1.59), and extracurricular CPR training (OR 1.91) (all P < .05). Characteristics associated with AED performance included age (OR 0.69), college education (OR 1.34), and native language other than English (OR 0.51) (all P < .05). Certain subgroups of lay volunteers may need targeted outreach programs in CPR and AED use, classes with longer training time, more practice, or more intense retraining to maintain their CPR and/or AED skills.

Modeling instructor preferences for CPR and AED competence estimation

Introduction: Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills competency can be tested using a checklist of component skills, individually graded “pass” or “fail.” Scores are typically calculated as the percentage of skills passed, but may differ from an instructor's overall subjective assessment of simulated CPR or AED adequacy. Objective: To identify and evaluate composite measures (methods for scoring checklists) that reflect instructors’ subjective assessments of CPR or AED skills performance best. Methods: Associations between instructor assessment and lay-volunteer skill performance were made using 6380 CPR and 3313 AED skill retention tests collected in the Public Access Defibrillation Trial. Checklists included CPR skills (e.g., calling 911, administering compressions) and AED skills (e.g., positioning electrodes, shocking within 90 s of AED arrival). The instructor's subjective overall assessment (adequate/inadequate) of CPR performance (perfusion) or AED competence (effective shock) was compared to composite measures. We evaluated the traditional composite measure (assigning equal weights to individual skills) and several nontraditional composite measures (assigning variable weights). Skills performed out of sequence were further weighted from 0% (no credit) to 100% (full credit). Results: Composite measures providing full credit for skills performed out of sequence and down-weighting process skills (e.g., calling 911, clearing oneself from the AED) had the strongest association with the instructor's subjective assessment; the traditional CPR composite measure had the weakest association. Conclusion: Our findings suggest that instructors in public CPR and AED classes may tend to down-weight process skills and to excuse step sequencing errors when evaluating CPR and AED skills subjectively for overall proficiency. Testing methods that relate classroom performance to actual performance in the field and to clinical outcomes require further research.

A UTOMATED E XTERNAL D EFIBRILLATOR T RAINING AND S KILL R ETENTION AT A S KI P ATROL

Objectives: To determine whether members of a ski patrol, most of whom have no off-season medical responsibilities, can successfully complete an automated external defibrillator (AED) training program prior to the ski season, and retain AED skills at the end of the season and at the beginning of the following season. Methods: A prospective educational study was conducted with 61 ski patrol personnel: 51 (84%) had no other medical training, 44 (72%) had no off-season medical duties, and 57 (93%) had no prior exposure to AEDs. Prior to the ski season (December 1, 1998), all members were trained and tested using the standard American Heart Association (AHA) AED training package and a Life-Pak 500 AED and AED Trainer donated by the Medtronic Physio-Control Corporation. Both after the ski season (April 1, 1999) and prior to the following season (October 30, 1999), with no refresher training, participants were retested with the same written and practical exams. Cochrane's linear trend test was used to compare scores on the practical and written tests over time. Results: For the three testing sessions, practical test pass rates were 95%, 92%, and 97%, and written test pass rates were 100%, 98%, and 98%. There was no change in individuals' scores on either the written test (p = 0.914) or the practical test (p = 0.413) over time. Conclusions: A heterogeneous group of ski patrollers can successfully complete an AED training course, with good skill retention both after the ski season and at the beginning of the following season.

Training seniors in the operation of an automated external defibrillator: A randomized trial comparing two training methods

Study Objective: This study evaluated the differences in efficacy of 2 methods for training seniors in the use of an automated external defibrillator (AED). We tested the hypothesis that each training method (face-to-face instruction compared with video-based instruction) would result in similar AED performance on a manikin. Methods: Two hundred ten seniors from various senior centers were randomized to receive face-to-face or video-based instruction on AED skills. Seniors were assessed individually and tested on the speed and quality of AED performance. We retested 177 of these initial trainees 3 months after initial training. Similar performance measures were assessed. Results: Although there were statistically significant differences between the 2 training methods in terms of average time to shock at both evaluations, the results in general demonstrate that there were no clinically meaningful distinctions (time differences of <20 seconds) between the AED performance of seniors trained with a video and seniors trained in a face-to-face setting at the initial training or at the retention assessment. At the initial evaluation, overall performance was satisfactory, with greater than 98% trained with either method delivering a shock. However, at the 3-month follow-up, almost one fourth of trainees were not able to deliver a shock, and almost half were not able to correctly place the pads on the manikin. Conclusion: We believe that seniors can be trained equally well in AED performance with video-based self-instruction or face-to-face instruction. How to maintain acceptable AED performance skills over time remains a challenge. [Meischke HW, Rea T, Eisenberg MS, Schaeffer SM, Kudenchuk P. Training seniors in the operation of an automated external defibrillator: A randomized trial comparing two training methods. Ann Emerg Med. September 2001;38:216-222.]