Cardiopulmonary Resuscitation Course Research Articles

Revisiting CPR knowledge and skills among registered nurses.

The purpose of this investigation was to explore facets involved in the retention of the cognitive knowledge and psychomotor skills of cardiopulmonary resuscitation (CPR) by 73 RNs from three general hospitals. Data analysis indicated that cognitive knowledge was adequately retained but that skills were not. Product-moment correlation coefficients showed that the number of CPR courses taken, certification as a CPR instructor, the number of years certified, and time since last certification were significantly related to skill scores. Findings prompt questions of appropriateness of the usual certification procedures for hospital-based RNs.

Cardiopulmonary Resuscitation Training and Risk of Infection

To the Editor.— The American Heart Association has failed to address the key issue related to infection and cardiopulmonary resuscitation in the supplemental guidelines published in the November 17 issue ofThe Journal. 1 If good cardiopulmonary resuscitation training can be done without risk, there is no moral or ethical justification for exposing trainees to any risk. Adequate ventilation practice can be given during cardiopulmonary resuscitation courses using a bag-valve-mask apparatus. Practice and testing of this ventilation skill during cardiopulmonary resuscitation training combined with instruction about other more risky ventilation methods (mouth-to-mouth and mouth-to-mask) would provide a risk-free teaching situation. The students I teach would be willing to take the minuscule risk of contracting a serious infection to save a life. They are unwilling to take this risk to practice on a mannequin. The guidelines state that requests for individual mannequins should be honored, within reason. Since there is no

An integrated anatomy and cardiopulmonary resuscitation course

An integrated anatomy and cardiopulmonary resuscitation course

Medical aspects of lay resuscitations in Rotterdam.

In the Rotterdam system of prehospital care for patients with circulatory failure, the cardiopulmonary resuscitation (CPR) training programme for lay persons contributes to the first link in the chain of care, i.e. the period of time spent awaiting the arrival of professional staff. In this paper we describe some of the medical aspects of this programme. The material used was obtained in a study of 5312 trainees who had followed a CPR course. Case histories were reconstructed of 91 victims who had been resuscitated by 109 respondents. At least 20% of resuscitated persons had collapsed as a result of non-cardiac causes. In this category the longer term survival rates were relatively the most favourable. In several instances the indication for resuscitation had been incorrect, while the technical proficiency in the delivery of CPR was often inadequate. We conclude that one course is insufficient for the development of the required 'skill'. We also conclude that the courses should dwell more elaborately on the non-cardiac causes of collapse, particularly in training programmes addressing the public at large. Attention is drawn to the need of designing and implementing special courses for family members and relatives of persons known to be cardiac patients. The need for continuing evaluation, involving active contributions from lay resuscitators, is underlined.

A Safe Approach to Respiratory Resuscitation

To the Editor.— The number of human immunodeficiency virus—positive men and women is steadily increasing. The Surgeon General has recommended using appropriate precautions on every patient. Therefore, gloves are now worn not only for withdrawal of blood and insertion of intravenous catheters but also for endotracheal intubation and routine care of newborns. Goggles have been issued to emergency department, surgical, obstetric, and anesthesia personnel. Yet, mouth-to-mouth resuscitation is still taught in cardiopulmonary resuscitation courses. As a concerned physician, I strongly believe that mouth-to-mouth resuscitation should be abandoned, except for family members, in favor of a mechanical device. A mask-valve-bag setup is most effective and, although its proper use is difficult to learn, should be taught to all health professionals. However, mask-valve-bag setups are bulky and therefore suitable for use only in hospitals, emergency vehicles, and lifeguard stations. In the early days of cardiopulmonary resuscitation, resuscitubes provided acceptable results. This tube

Evaluation of lay skills in cardiopulmonary resuscitation.

The theoretical knowledge and practical performance of 166 lay people attending a short cardiopulmonary resuscitation course were evaluated according to the American Heart Association standards. Before tt course no participant was able to perform even a bad attempt at cardiopulmonary resuscitation. Theoretical knowledge was good at the end of the course and at the refresher course six months later. At the end of the initial course 65% (57/88) of the participants examined could adequately compress and ventilate the manikin. After six months 44% (30/68) could perform resuscitation adequately. Women were as proficient as men, and elderly people in general were as proficient as the younger ones. The skill of carotid artery palpation was surprisingly well retained after six months. Data on pulmonary ventilation and cardiac massage were recorded simultaneously on a recording resuscitation manikin. When these objective data were compared with the American Heart Association standards only a few participants were able to perform correct cardiopulmonary resuscitation. The number of compressions and ventilations per minute were often insufficient. A large discrepancy between self, subjective, and objective assessment of cardiopulmonary resuscitation knowledge and performance was found. The importance of a rapid diagnosis, an immediate call for help, an adequate rate of cardiac massage, and a reduction in the time needed for ventilation should be emphasised at these courses. Refresher courses should be provided at least twice a year.

Layperson CPR — are we training the right people?

A case-control study was undertaken to examine differences in the extent of cardiopulmonary resuscitation (CPR) training among family members of patients with and without coronary heart disease. There were no significant differences in the proportion of family members of patients with coronary disease (22.0%) who had ever taken a CPR course compared to family members of patients seen in a primary care clinic (25.6%) or in randomly selected neighborhood controls (28.7%). Family members of patients with coronary disease, however, had not only taken fewer CPR courses but had taken these courses considerably further in the past than had respective comparison groups. Moreover only 9% of these family members had taken CPR due to their family member's coronary disease.

CPR instruction: Modular versus lecture course

A randomized prospective study was done to examine long-term cardiopulmonary resuscitation (CPR) cognitive and motor skills retention and to compare the "self-taught" modular course with the standard lecture course. Both cognitive and motor skills were tested at one-, two- and four-year intervals after the initial course. Approximately half the students in both the modular and standard lecture courses also took a refresher course after one year. While there was no significant difference (P greater than .05) in retention based on the method of teaching (modular vs lecture course), students who took the refresher course after one year performed significantly better (P less than .01) at the two-year interval. Results four years after the initial CPR course (three years after the refresher course) were uniformly poor in both groups. Only three of 104 students were able to meet American Heart Association standards for the performance of CPR. Refresher courses are vital if CPR is to be performed effectively and competently. They should be available on a continuing basis with self-taught courses providing a good alternative to the formal didactic course as a means of providing instruction.

Pediatric cardiopulmonary resuscitation. A review of 130 cases.

Cardiopulmonary resuscitation (CPR) records of 130 pediatric patients with cardiac arrest were reviewed. Ninety-six resuscitations were performed on patients hospitalized on the Medical and Surgical units of the Children's Hospital of Philadelphia (HP) and 34 on Emergency Department patients (EDPs). In HP, initial survival was 90%. In 27% of HPs, airway and breathing techniques alone were life saving. A mean of 2.45 drugs per patient were used for HP. In EDP, initial survival was 56%. There had been advanced CPR during the prehospital transport phase for the EDPs. All but two EDPs required drug management. The mean was 4.25 drugs per patient. Lidocaine and direct current defibrillation were used only rarely. Glucose was used frequently (33%) and should be considered in the list of essential resuscitation drugs. The necessity for resuscitation was most commonly associated with pulmonary diseases. These findings reflect differences between pediatric CPR and adult CPR, and suggest limitations in applying adult standards to infants and children. It is suggested that the medical community develop separate pediatric CPR courses as independent modules for those who assume responsibility for resuscitating children.

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 cardio-pulmonary 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 pilot study of effects of cardiopulmonary resuscitation training on participants' self-concepts.

The administration of cardiopulmonary resuscitation (CPR) was taught to a group of 12 adults. The Tennessee Self-concept Scale Form-C and the Fundamental Interpersonal Relations Orientation-Behavior Scale (FIRO-B) were administered before and after their training. A control group of 12 was administered both scales twice with one day between administrations. Analysis indicated both groups showed significant differences between the pre- and posttest administrations on expressed affection on the FIRO-B. However, participants in a brief CPR course did not score significantly differently from a control group on these measures, as expected.

An analysis of selected instructional methods on cardiopulmonary resuscitation retention competency of deaf and non-deaf college students.

Deaf college students were randomly assigned to three separate instructional conditions for a cardiopulmonary resuscitation (CPR) course. One group received the standard course presented through signed instruction. A second group received the same instruction with the addition of a captioned videocassette, "The New Pulse of Life—Revised." The third group received the standard instruction and viewed the uncaptioned videocassette, signed by an interpreter. These groups were compared with a non-deaf group who received the standard 4-hour course. The results revealed that the deaf group which viewed the uncaptioned videocassette signed by an interpreter retained a significantly greater amount of performance skills than the other groups.

A first aid and CPR course for first-year medical students.

A 24-hour course in first aid and cardiopulmonary resuscitation (CPR) has been developed for the first-year medical students at the Mount Sinai School of Medicine. The objective of the course was to train students to handle common emergencies out of a hospital setting and with no special equipment. It was expected that students would become competent to perform CPR at a level equal to or better than that required by the American Red Cross (ARC) for certification. In the past three years approximately 99% of each first-year class has been certified. The majority of the course is taught by medical students who are certified ARC Instructors in Advanced First Aid and Emergency Care and CPR.

Evaluation of a cardiopulmonary resuscitation course for secondary schools retention study.

A retention study was implemented in Marshfield, Massachusetts in May 1974 in order to ascertain if cardiopulmonary resuscitation (CPR) skills could be retained by secondary school students who had 15 months previously received training in mouth to mouth resuscitation and cardiac compression. The retention study also addressed itself to the question whether a 28-minute "refresher" film on CPR skills prior to the test would serve to improve performance of CPR skills. (In the initial study, the students had been divided into two groups: those that received both didactic and practice sessions and those who received didactic training only.) All the initial practice group students (178 students who had received both didactic and practical CPR training) were divided equally into "film" and "no film" groups. A small sample of students (38) who had initially learned CPR skills from didactic materials only were also tested. These students were also divided into "film" and "no film" groups. Retention of continuous CPR skills, breaths anc compressions, showed very little loss. Retention of discrete CPR skills which included checking for breathing, opening the airway by tilting the head and lifting the neck, giving three quick breaths, feeling the pulse, and examining the pupil showed considerable loss of learning overtime. The film intervention did little to improve performance of CPR skills. No significant differences in performance were observed between "film" and "no film" groups. The findings of this study with respect to retention of continuous and discrete psychomotor sills closely parallel findings of the three-month retention study. In summary, this study would indicate that training of secondary students in CPR leads to good retention of essential skills. As indicated in the previous study, retention of the ancillary decision-making skills was not satisfactory. Methods for teaching these skills so that they will be retained over time need further development.