Cardiff Test Research Articles

Retention of Knowledge and Skills After a Basic Life Support Course for Schoolchildren: A Prospective Study.

Courses on basic life support (BLS) and automated external defibrillator (AED) in schools lead to increase in knowledge but its retention is less well explored. We aimed to explore the long-term retention of knowledge and practical skills among schoolchildren after a BLS and AED course to be able to tailor future courses accordingly. Study was conducted in 3 parts and included 823 seventh and ninth graders from different elementary schools in Maribor, Slovenia. In Study 1 (n=611) we assessed students' baseline knowledge and immediate knowledge gain after our BLS and AED course with a validated questionnaire; in Study 2 (n=116) we assessed retention of gained knowledge and skills after 5 months with a modified Cardiff test and Little Anne QCPR manikin; in Study 3 (n=96) we assessed retention of knowledge 2 years after the course. Mean differences in knowledge before and after the course in Study 1 and between studies were analyzed using paired t-tests and independent t-tests. Differences between individual question scores at different time points were compared using Mann – Whitney U test. A two-sided P<0,05 was considered significant. Practical skills retention was presented with descriptive statistics. Knowledge gain was significant immediately after the course with 83% correct answers compared to 60% at baseline. Scores dropped significantly after 5 months (73%) and after 2 years (75%), but remained significantly better than at baseline (P<0.001). Practical skills perfomance score as per Cardiff test after 5 months was 63%. Overall BLS performance score as per QCPR app was 59%, with an overall cardio score of 77% (average compression rate: 124/min and depth: 52 mm) and ventilation score of 44%. This study showed that long term retention of theoretical knowledge was satisfying whereas poor practical skills performance after 5 months calls for a more intense practical training on repeat courses.

Can Video Assistance Improve the Quality of Pediatric Dispatcher-Assisted Cardiopulmonary Resuscitation?

This study aimed to evaluate the impact of adding video conferencing to dispatcher-assisted telephone cardiopulmonary resuscitation (CPR) on pediatric bystander CPR quality. We conducted a prospective, randomized manikin study among volunteers with no CPR training and among bachelor nurses. Volunteers randomly received either video or audio assistance in a 6-minute pediatric cardiac arrest scenario. The main outcome measures were the results of the Cardiff Test to assess compression and ventilation performance. Of 255 candidates assessed for eligibility, 120 subjects were randomly assigned to 1 of the 4 following groups: untrained telephone-guided (U-T; n = 30) or video-guided (U-V; n = 30) groups and trained telephone-guided (T-T; n = 30) or video-guided (T-V; n = 30) groups. Cardiac arrest was appropriately identified in 86.7% of the U-T group and in 100% in the other groups (P = 0.0061). Hand positioning was adequate in 76.7% of T-T, 80% of T-V, and 60% of U-V, as compared with 23.4% of the U-T group (P = 0.0001). Fewer volunteers managed to deliver 2 rescue breaths/cycle (P = 0.0001) in the U-T (16.7%) compared with the U-V (43.3%), the T-T (56.7%), and the T-V groups (60%).Subjects in the video groups had a lower fraction of minute to ventilate as compared with the telephone groups (P = 0.0005). In dispatcher-instructed children CPR simulation, using video assistance improves cardiac arrest recognition and CPR quality with more appropriate chest compression technique and ventilation delivering. The long interruptions in chest compression combined with the mixed success rate to deliver proper ventilation raise question about ventilation quality and its effectiveness.

Challenges in basic life support and automated external defibrillator training of deaf individuals

Objectives: Basic life support (BLS) with the use of an automated external defibrillator (AED) is linked to survival of patients with out-of-hospital cardiac arrest (OHCA). However, the BLS protocol is not tailored to specific needs of the deaf who encounter many challenges during BLS training. Methods: The BLS and AED protocol was modified according to the challenges faced by deaf people. Pre-course BLS and AED knowledge was tested using a questionnaire. After completion of a practical course, each participant was presented with an OHCA scenario using a manikin. Qualitative and quantitative data on BLS and AED performance were collected with a modified Cardiff test and the QCPR mobile application. Results of the knowledge test and performance scores are presented with values and frequencies. Correlations between pre- and post-course BLS and AED knowledge and performance were analyzed and presented with Spearman’s rho. Results: 51 deaf volunteers from seven Slovenian deaf associations participated in the study. The pre-course knowledge test scores were 3.5 points out of 10 and considered low. The rest of the results were also poor. BLS performance using the modified Cardiff test post-course was as follows: 52.9% of the participants used a safe approach, 58.8%checked responsiveness and 51.0% sent a text message to the rescue service. Only 43.1% opened the airway and 49.0% checked initial breathing. 80.4% of deaf rescuers performed chest compressions on the lower half of the sternum and 52.9% compressed with adequate depth. According to the QCPR application the best performance was achieved with a compression score of 61.1% and flow fraction 74.9%. Conclusions: This study shows that a comprehensive and assiduous approach is needed for effective BLS and AED training courses for deaf individuals.

Learning Outcome After Different Combinations of Seven Learning Activities in Basic Life Support on Laypersons in Workplaces: a Cluster Randomised, Controlled Trial

BackgroundThe goal for laypersons after training in basic life support (BLS) is to act effectively in an out-of-hospital cardiac arrest situation. However, it is still unclear whether BLS training targeting laypersons at workplaces is optimal or whether other effective learning activities are possible.AimThe primary aim was to evaluate whether there were other modes of BLS training that improved learning outcome as compared with a control group, i.e. standard BLS training, six months after training, and secondarily directly after training.MethodsIn this multi-arm trial, lay participants (n = 2623) from workplaces were cluster randomised into 16 different BLS interventions, of which one, instructor-led and film-based BLS training, was classified as control and standard, with which the other 15 were compared. The learning outcome was the total score for practical skills in BLS calculated using the modified Cardiff Test.ResultsFour different training modes showed a significantly higher total score compared with standard (mean difference 2.3–2.9). The highest score was for the BLS intervention including a preparatory web-based education, instructor-led training, film-based instructions, reflective questions and a chest compression feedback device (95% CI for difference 0.9–5.0), 6 months after training.ConclusionBLS training adding several different combinations of a preparatory web-based education, reflective questions and chest compression feedback to instructor-led training and film-based instructions obtained higher modified Cardiff Test total scores 6 months after training compared with standard BLS training alone. The differences were small in magnitude and the clinical relevance of our findings needs to be further explored.Trial RegistrationClinicalTrials.gov Identifier: NCT03618888. Registered August 07, 2018—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03618888

Effects of native language on CPR skills and willingness to intervene in out-of-hospital cardiac arrest after film-based basic life support training: a subgroup analysis of a randomised trial

ObjectivesThe aim was to investigate whether the students’ native language, Swedish as native language (SNL) versus other native language (ONL), affects cardiopulmonary resuscitation (CPR) skills or willingness to act after...

Self-learning training versus instructor-led training for basic life support: A cluster randomised trial

AimTo compare the effectiveness of two basic life support (BLS) training interventions. MethodsThis experimental trial enrolled 1301 lay people in BLS training. The participants were cluster randomised to either self-learning training or to traditional instructor-led training. Both groups used the Mini-Anne Kit (Laerdal Medical, Stavanger, Norway) and standardised film instructions. After training, the participants practical skills were measured on a Resusci Anne manikin and an AED trainer with the PC SkillReporting system (Laerdal Medical, Stavanger, Norway). The primary outcome was the total score from the modified Cardiff Test of basic life support with automated external defibrillation (19–70 points), six months after training. The secondary outcomes were total score directly after training and quality of individual variables, self-assessed knowledge, confidence and willingness to act, directly and six months after training. ResultsFor primary outcome six months after training there was no statistically significant difference (p = 0.44) between the total score for the self-learning group (n = 670; median 59, IQR 55–62) compared with the instructor-led group (n = 561; median 59, IQR 55–63). The instructor-led training resulted in a statistically significant higher total score (median 61 versus 59, p < 0.0001), self-assessed knowledge and willingness to act, directly after training (secondary outcomes) compared with the self-learning training. ConclusionsThere was no statistically significant difference in practical skills or willingness to act when comparing self-learning training with instructor-led training six months after training in BLS. However, directly after the intervention, practical skills were better when the training was led by an instructor.

The role of a checklist for assessing the quality of basic life support performance: an observational cohort study

BackgroundTraining lay rescuers in Basic Life Support (BLS) is essential to improve bystander cardiopulmonary resuscitation (CPR) rates; in addition, simple methods are needed to provide feedback on CPR performance. This study evaluated whether a simple observational checklist can be used by BLS instructors to adequately measure the quality of BLS performance as an alternative to other feedback devices.MethodsThe BLS performances of 152 first-year medical students (aged 21.4 ± 3.9 years) were recorded on video, and objective data regarding the quality of the BLS were documented using Laerdal PC SkillReporting software. The performances were categorized according to quality. Ten BLS instructors observed the videos and completed a ten-point checklist based on the Cardiff Test of BLS (version 3.1) to assess the performances. The validity of the checklist was reviewed using interrater reliability as well as by comparing the checklist-based results with objective performance data.ResultsMatching the checklist-based evaluation with the objective performance data revealed high levels of agreement for very good (82%) and overall insufficient (75%) performances. Regarding the checklist-based evaluation, interrater reliability depended on the checklist item; thus, some items were more easily identified correctly than others. The highest and lowest levels of agreement were observed for the items “undressed torso” and “complete release between compressions” (mean joint-probability 95 and 67%, respectively).ConclusionsThe observational checklist adequately distinguished sufficient from insufficient BLS performances and offered an assessment of items not incorporated by SkillReporting software such as the initial assessment or undressing the chest. Although its usefulness was reduced for scaling intermediate performance groups, the checklist may be overall a useful rating tool in BLS-training if objective feedback devices are not available, for example, due to large groups of participants or limited training time.

A nationwide investigation of CPR courses, books, and skill retention

IntroductionSurvival from Out-of-Hospital Cardiac Arrest is highly associated with bystander cardiopulmonary resuscitation. The quality of bystander CPR is influenced by citizens attending Basic Life Support (BLS) courses and the quality of these courses. The purpose of the study was to investigate content, quality and compliance with the European Resuscitation Council (ERC) guidelines in national Danish BLS courses and the skill retention. MethodsBooks from 16 different course providers were analyzed for compliance with guidelines using the principle of mutually exclusive and collectively exhaustive questioning. Observation of 56 BLS courses were conducted using an evaluation sheet, with a five-point Likert scale including theoretical, technical, and non-technical skills. BLS skills of participants were assessed with a follow-up test 4–6 months after a course using a modified Cardiff Test. ResultsAnalysis of the books, showed compliance with ERC guidelines of 69% on the examined items. Courses using ERC educational structure and having maximum six participants per instructor were associated with high quality in the course observations and a better follow-up test. Especially, the use of automated external defibrillator showed significant odds ratio (OR) of 21.8 (95% CI 4.1–114.7) to 31.3 (95% CI 3.7–265.1) of achieving high quality on courses with similar results in the follow-up test. ConclusionNational BLS courses had significant variation in the content of books, and compliance to ERC guidelines during courses and in skills retention 4–6 months after the courses. This study can be used to further improve and standardize BLS courses.

Dispatcher-Assisted Telephone Cardiopulmonary Resuscitation Using a French-Language Compression-Ventilation Pediatric Protocol.

Out-of-hospital cardiac arrest (OHCA) in pediatrics is a devastating event associated with poor survival rates. Although telephone dispatcher-assisted cardiopulmonary resuscitation (CPR; T-CPR) instructions improve the frequency and quality of bystander CPR for OHCA in adults, this support remains undeveloped in children. Our objective was to assess the effectiveness of a pediatric T-CPR protocol in untrained and trained bystanders. Secondarily, we sought to determine the feasibility and the effectiveness of ventilation in such a protocol. Eligible adults with no CPR experience were recruited in a movie theater in Liege, as well as bachelor nursing students in Liege. All volunteers were randomly assigned either to T-CPR or to no-T-CPR using randomization. The volunteers were exposed to a pediatric manikin model cardiac arrest. On the basis of Cardiff evaluation test, data were collected to evaluate CPR performance. A total of 115 volunteers were assigned to 4 groups: untrained nonguided group (n = 27), untrained guided group (n = 32), trained nonguided group (n = 26), and trained guided group (n = 30). We found an improvement in CPR performance in the guided groups. Most volunteers (81.2%) in untrained guided group and 83.3% in the trained guided group were able to give 2 ventilations after each compressions cycle. In a pediatric manikin model of OHCA, T-CPR instructions including mouth-to-mouth ventilations and chest compressions produced a significant increase in resuscitation performance not only among previously untrained but also among trained volunteers.

The effect of a national web course \u201cHelp-Brain-Heart\u201d as a supplemental learning tool before CPR training: a cluster randomised trial

BackgroundThe effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation.MethodsClasses with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention). Data were collected (practical test and a questionnaire) directly after training and at 6 months. CPR skills were evaluated using a modified Cardiff test (12–48 points). Knowledge on stroke symptoms (0–7 points), AMI symptoms (0–9 points) and lifestyle factors (0–6 points), and willingness to act were assessed by the questionnaire. The primary endpoint was CPR skills at 6 months. CPR skills directly after training, willingness to act and theoretical knowledge were secondary endpoints. Training and measurements were performed from December 2013 to October 2014.ResultsFour hundred and thirty-two students were included in the analysis of practical skills and self-reported confidence. The mean score for CPR skills was 34 points after training (control, standard deviation [SD] 4.4; intervention, SD 4.0; not significant [NS]); and 32 points at 6 months for controls (SD 3.9) and 33 points for intervention (SD 4.2; NS). At 6 months, 73% (control) versus 80% (intervention; P = 0.05) stated they would do compressions and ventilation if a friend had a cardiac arrest, whereas 31% versus 34% (NS) would perform both if the victim was a stranger. One thousand, two hundred and thirty-two students were included in the analysis of theoretical knowledge; the mean scores at 6 months for the control and intervention groups were 2.8 (SD 1.6) and 3.2 (SD 1.4) points (P < 0.001) for stroke symptoms, 2.6 (SD 2.0) and 2.9 (SD 1.9) points (P = 0.008) for AMI symptoms and 3.2 (SD 1.2) and 3.4 (SD 1.0) points (P < 0.001) for lifestyle factors, respectively.DiscussionUse of online learning platforms is a fast growing technology that increases the flexibility of learning in terms of location, time and is available before and after practical training.ConclusionsA web course before CPR training did not influence practical CPR skills or willingness to act, but improved the students’ theoretical knowledge of AMI, stroke and lifestyle factors.

Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students’ practical skills and willingness to act: a cluster randomised trial

ObjectivesThe aim of this research is to investigate if two additional interventions, test and reflection, after standard cardiopulmonary resuscitation (CPR) training facilitate learning by comparing 13-year-old students’ practical skills and...

Medical students and physical education students as CPR instructors: an appropriate solution to the CPR-instructor shortage in secondary schools?

BackgroundIntegrating cardiopulmonary resuscitation (CPR) training in secondary schools will increase the number of potential CPR providers. However, currently too few certified instructors are available for this purpose. Training medical students and physical education student teachers to become CPR instructors could decrease this shortage.AimExamine whether medical students and physical education student teachers can provide CPR training for secondary school pupils as well as (i. e., non-inferior to) registered nurses.MethodsA total of 144 secondary school pupils were randomly assigned to CPR training by a registered nurse (n = 12), a medical student (n = 17) or a physical education student teacher (n = 15). CPR performance was assessed after training and after eight weeks in a simulated cardiac arrest scenario on a resuscitation manikin, using manikin software and video recordings.ResultsNo significant differences were found between the groups on the overall Cardiff Test scores and the correctness of the CPR techniques during the post-training and retention test. All pupils showed sufficient CPR competence, even after eight weeks.ConclusionTraining by medical students or physical education student teachers is non-inferior to training by a registered nurse, suggesting that school teachers, student teachers and medical students can be recruited for CPR training in secondary schools.

Effect of mobile application-based versus DVD-based CPR training on students’ practical CPR skills and willingness to act: a cluster randomised study

ObjectivesThe aim was to compare students’ practical cardiopulmonary resuscitation (CPR) skills and willingness to perform bystander CPR, after a 30 min mobile application (app)-based versus a 50 min DVD-based training.SettingsSeventh...

Effects of two retraining strategies on nursing students’ acquisition and retention of BLS/AED skills: A cluster randomised trial

AimTo determine and compare the effects of two different retraining strategies on nursing students’ acquisition and retention of BLS/AED skills. MethodsNursing students (N=177) from two European universities were randomly assigned to either an instructor-directed (IDG) or a student-directed (SDG) 4-h retraining session in BLS/AED. A multiple-choice questionnaire, the Cardiff Test, Laerdal SkillReporter® software and a self-efficacy scale were used to assess students’ overall competency (knowledge, psychomotor skills and self-efficacy) in BLS/AED at pre-test, post-test and 3-month retention-test. GEE, chi-squared and McNemar tests were performed to examine statistical differences amongst groups across time. ResultsThere was a significant increase in the proportion of students who achieved competency for all variables measuring knowledge, psychomotor skills and self-efficacy between pre-test and post-test in both groups (all p-values<0.05). However, at post-test, significantly more students in the SDG achieved overall BLS/AED competency when compared to IDG. In terms of retention at 3 months, success rates of students within the IDG deteriorated significantly for all variables except ≥70% of chest compressions with correct hand position (p-value=0.12). Conversely, the proportion of students who achieved competency within the SDG only decreased significantly in ‘mean no flow-time≤5s’ (p-value=0.02). Furthermore, differences between groups’ success rates at retention-test also proved to be significantly different for all variables measured (all p-values<0.05). ConclusionThis study demonstrated that using a student-directed strategy to retrain BLS/AED skills has resulted in a higher proportion of nursing students achieving and retaining competency in BLS/AED at three months when compared to an instructor-directed strategy.

Basic life support skill improvement with newly designed renewal programme: cluster randomised study of small-group-discussion method versus practice-while-watching method

BackgroundFor the basic life support (BLS) renewal course, we have devised a new educational programme entitled a small-group-discussion (SGD) programme using personalised video-based debriefing.ObjectiveWe compared the efficacy in BLS skill...

Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-only protocol in volunteers with or without prior life support training: A randomized trial

ObjectivesDue to the recent interest in hands-only protocols for dispatcher-assisted cardiopulmonary resuscitation (CPR) and the lack of any validated algorithms in French, our primary objective was to evaluate a new French-language protocol in terms of its efficacy to help previously untrained volunteers in performing basic life support efforts of appropriate quality, and secondarily to investigate its potential utility in subjects with previous training. MethodsUntrained volunteers were recruited among adults in a public movie centre and previously trained volunteers among undergraduate nursing students. Participants were randomly assigned to ‘phone CPR’ versus ‘no phone CPR’ by drawing sets of envelopes. Primary outcome measures were the results of the Cardiff evaluation test; the secondary measures were global scoring of a complete 5min period of CPR, in a manikin model of cardiac arrest. ResultsOut of 146 volunteers assessed for eligibility, 36 previously untrained candidates declined participation. 110 participants, distributed into four groups, completed the study: the previously untrained non-guided group (group A, n=30), the previously untrained guided group (group B, n=30), the previously trained non-guided group (group C, n=25) and the previously trained guided group (group D, n=25).Results of the Cardiff test and global evaluation of CPR performance revealed a significant improvement in group B as compared with group A, approaching the level of the group C. Previously trained guided bystanders had the best CPR scores, notably because of an improvement in the quality of airway management. ConclusionWhen used by dispatchers, this new French-language algorithm offers the opportunity to help previously untrained bystanders initiate CPR. The same protocol may serve to guide volunteers with prior basic life support training to reach their best CPR performance.

Necesidad de evaluar la competencia profesional con instrumentos validados

Perales N, editores. Avances en emergencias y resucitacion, Vol. 3. Barcelona: EdikaMed; 1998. 2. American Heart Association, in collaboration with the International Liaison Committee on Resuscitation (ILCOR). Introduction to the International Guidelines 2000 for CPR and ECC. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Resuscitation. 2000;46:1–447. 3. European Resuscitation Council (ERC). Guidelines for resuscitation 2005. Resuscitation. 2005;67S1:S1–2. 4. Chamberlain D, Smith A, Woollard M, Colquhoun M, Handley AJ, Leaves S, et al. Trials of teaching methods in basic life support (3): Comparison of simulated CPR performance after first training and at 6 months, with a note on the value of retraining. Resuscitation. 2002;53:179–87. 5. International Liaison Committee on Resuscitation (ILCOR). Education in resuscitation. Resuscitation. 2003;59:11–43. 6. Jansen JJ, Berden HJ, Van der Vleuten CP, Grol RP, Rethans J, Verhoeff CP, et al. Evaluation of cardiopulmonary resuscitation skills of general practitioners using different methods. Resuscitation. 1997;34:35–41. 7. Wik L, Twosen J, Steen PA. An automated voice advisory manikin system for training in basic life support without an approach to CPR training. Resuscitation. 2001;50:167–72. 8. Lester CA, Morgan CL, Donnelly PD, Assar D, et al. Assessing with CARE: An innovative method of testing the approach and casualty assessment components of basic life support, using video recording. Resuscitation. 1997;34:43–9. 9. Whitfield RH, Newcombe RG, Woollard M. Reliability of the Cardiff test of basic life support and automated external defibrillation. Resuscitation. 2003;59:291–314. 10. Byrt T, Bishop J, Carlin JB. Bias, prevalence and kappa. J Clin Epidem. 1993;46:423–9.

Test Raval Sud para medir habilidades de soporte vital básico y desfibrilación en médicos y enfermeras de atención primaria

Objective To prepare and validate a tool to measure Basic Life Support (BLS) and semi-automatic defibrillator (SAD) skills adapted for use by health professionals in Primary Care Teams (PCT). To propose an updated version and demonstrate self-sufficiency of the team to use it in a training evaluation. Design Validation of measurement tools. Study of reliability with repeated measurements after a training course. Setting Drassanes Primary Care Centre. Raval Sud Basic Health Area. Barcelona. Spain. Participants A total of 37 voluntary resuscitators (all doctors/nurses), professional camera, medical controller, computerised mannequin, 6 evaluators. Interventions Test preparation methodology. Cardiff Model 3.1. Implementation: 2 filmed series (professional+domestic), of 26-25 “station type” simulations, separated by 1 month. A training workshop between series. Retrospective evaluation of DVD recordings (5 evaluators). 2nd series scored again at 3 weeks with a blind and random order filmed version. Main measurements Variables: performances classified from worse to best execution. Psychometric analysis: Validity (content/apparent). Test-retest reliability, between-observer and sensitivity to change. Results Compared to the Cardiff test (46 items) our 83 item test contained 38(46%) new, 34(41%) modified and 11(13%) similar. Between-evaluator reliability, excellent/good in 51/62 items analysed; Within-evaluator and between-filming reliability, excellent/good in all except 1 item; the test score doubled after the training course. A version of the test according to BLS-SAD recommendations is proposed. Conclusions On there not being useful tools available for Primary Care doctors and nurses, one has been prepared with adequate psychometric guarantees and proven self-sufficient evaluation. We propose the immediate application of the updated version for training evaluation purposes.

Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation

Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during individual training. To compare a VAM (ResusciAnne CPR skills station, Laerdal Medical A/S, Norway) with IF training in CPR using a bag-valve-mask (BVM) in terms of skills retention after 3 months. Forty-three second year medical students were included and CPR performance (ERC Guidelines for Resuscitation 2005) was assessed in a 2 min test before randomisation to either IF training in groups of 8 or individual VAM training. Immediately after training and after 3 months, CPR performance was assessed in identical 2 min tests. Laerdal PC Skill Reporting System 2.0 was used to collect data. To quantify CPR performance a scoring system based on the Cardiff test was used. Groups were compared with a Mann Whitney rank sum test. There was no statistically significant difference between the two groups when considering change in overall CPR performance score from before training to 3 months after training (P=0.12). However, the IF group performed significantly better than the VAM group in the total score, both immediately after (P=0.0008) and 3 months after training (P=0.02). This difference was primarily related to the BVM skills. Skill retention in CPR using a bag-valve-mask was better after 3 months when training with an instructor than with an automated voice advisory manikin.

A web-based micro-simulation program for self-learning BLS skills and the use of an AED: Can laypeople train themselves without a manikin?

Various methods, including self-instruction, have been used to try to improve the acquisition of basic life support skills. This is a preliminary report of the effectiveness of a web-based self-training program for BLS and the use of an AED. Sixteen volunteers completed on-line training in their own time over a period of 8 weeks. The program included theory, scenario training and self-testing, but without practice on a manikin, or any instructor input. The volunteers were assessed, without prior warning, in a scenario setting. A recording manikin, expert assessors and video recording were used with a modified version of the Cardiff Test. All 16 volunteers performed the assessed skills in the use of an AED correctly. Most of the skills of BLS assessed were performed well. Chest compression depth and rate were performed less well (59% and 67% of participants, respectively, performed correctly). Opening the airway and lung inflation were performed poorly (38% and 13% of participants performed correctly), as was checking for safety (19% participants performed correctly). There was no significant correlation between the time a participant spent on-line and the quality of performance. Only 5 of the volunteers had ever attended a BLS course or used a resuscitation manikin before the assessment; their performance scores were not significantly better than those of the other 11 volunteers. These results suggest that it may be possible to train people in BLS and AED skills using a micro-simulation web-based interactive program but without any practice on a manikin. This seems to be particularly the case for the use of an AED, where performance achieved a uniformly high standard.