Cardiopulmonary Resuscitation Education Research Articles

Identification of cardiac arrest by emergency dispatchers

Prompt identification of cardiac arrest by emergency dispatchers can save valuable time and increase the likelihood of successful resuscitation. The authors reviewed 516 cardiac and 146 non-cardiac calls to identify features of a probable cardiac arrest call. The results indicate that information about sex, location, and activity is of little use in the identification of cardiac arrest. When the patient is over 50 years old and the caller is emotional, the possibility of cardiac arrest is high, suggesting that questions about consciousness and breathing should be asked immediately. Additional information can be obtained or telephone cardiopulmonary resuscitation (CPR) instructions can be given after dispatch of an emergency vehicle.

Dispatcher cardiopulmonary resuscitation instruction via telephone.

Dispatcher cardiopulmonary resuscitation instruction via telephone.

CPR training in the community

To provide a profile of potential rescuers of cardiac arrest victims, 1,271 randomly selected subjects were interviewed by telephone. Thirty-nine percent had formal instruction in cardiopulmonary resuscitation (CPR), 90% knew the emergency telephone number (911), and 5% had performed CPR. Subjects with training were significantly younger than those without (36 vs 48 years old) (P less than .001), and they had a lower incidence of known heart disease in family members (7% vs 15%) (P less than .001). More men than women were trained in CPR (44% vs 37%) (P less than .015). We recommend that efforts be undertaken to reach target groups of middle-age and older women for CPR training, and that physicians assume an active role in encouraging families of cardiac patients to learn this procedure.

Emergency CPR instruction via telephone.

We initiated a program of telephone CPR (cardiopulmonary resuscitation) instruction provided by emergency dispatchers to increase the percentage of bystander-initiated CPR for out-of-hospital cardiac arrest. Cardiac arrests in King County, Washington were studied for 20 months before and after the telephone CPR program began. Bystander-initiated CPR increased from 86 of 191 (45 per cent) cardiac arrests before the program to 143 of 255 (56 per cent) cardiac arrests after the program. During the after period, 58 patients received CPR as a result of telephone instruction, 12 of whom were discharged. We estimate that four lives may have been saved by the program. A review of hospital records revealed no excess morbidity in the group of patients receiving dispatcher-assisted CPR.

Cardiopulmonary Resuscitation: The Essentials

Cardiopulmonary resuscitation (CPR) techniques are intended to revive those who experience an unexpected respiratory or circulatory catastrophe. The skills of CPR are reviewed for the surgeon, whose patients may need this assistance. Advances in the basic understanding, techniques, teaching, and practice of CPR have led to the saving of countless lives.

The Potential Impact of Cardiopulmonary Cerebral Resuscitation (CPCR) Education

This is an introduction for a one-day CPCR course for intended instructors-coordinators. The course is a pilot project using a new manual. Its goal is to explore the feasibility of instructors using semi-self-training modes to acquire the necessary knowledge and skills for the organization of basic and advanced life support courses in CPR for all types of personnel, ranging from the lay public via ambulance personnel and nurses to physician generalists and physician specialists. The American Heart Association (AHA) CPR courses for instructors-to-be were originated in Pittsburgh in the early 1960s; this present course, sponsored by the World Federation of Societies of Anesthesiologists (WFSA) CPR Committee was given in 1981. The traditional 2 to 3 days CPR instructors' courses for physicians have spread knowledge and skills slowly. We believe that the dissemination and uniformity of resuscitation training could be enhanced by wider use of self-training systems, not only for doers but also instructors-to-be.

Automatic external defibrillation: Evaluations of its role in the home and in emergency medical services

Many recent efforts to improve emergency medical services (EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. In the 1960s physicians traveled in mobile coronary care units to bring the defibrillator to cardiac arrest patients. Later, paramedics, rather than physicians, were used. During the late 1970s the concept of early out-of-hospital defibrillation expanded as emergency medical technicians (EMTs) learned to defibrillate. Researchers in several settings confirmed the effectiveness of early defibrillation by EMTs. The automatic detection of ventricular fibrillation (VF) creates new opportunities for the early defibrillation concept. This includes both automatic implantable defibrillators and automatic external defibrillators (AED). The King County, Washington, EMS is conducting two projects to evaluate AEDs. One is a randomized, controlled crossover study in which EMTs use either an AED or a standard manual defibrillator. Outcome measurements include time to countershock, conversion rates, and survival rates. In the second project family members of patients who have survived out-of-hospital VF randomly receive an AED and cardiopulmonary resuscitation (CPR) instruction, or CPR instruction alone. This study was designed to determine whether family members can be trained adequately to use the device effectively. Psychological tests measure the effect of learning about, living with, and using such technology. These studies may help define the role of AEDs in the future management of out-of-hospital VF.

Development and implementation of emergency CPR instruction via telephone

We developed a cardiopulmonary resuscitation (CPR) message that can be given via telephone by emergency dispatchers directly to an individual reporting a cardiac arrest. The message was developed and evaluated on the basis of empirical observation of CPR performance of 203 community volunteers during simulated cardiac arrest events. The majority of volunteers were women, aged 30 to 80 years, who had not had previous CPR training. An average of five ventilation and compression cycles were given within five minutes using telephone instruction. We judged the quality of CPR to be comparable to the performance of individuals who have received formal training. The specific words used in the message directly determined adequacy of performance, and resulted in significantly better CPR performance than did impromptu instruction offered by professional dispatchers (P less than or equal to .02).

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.

A national survey of cardiopulmonary resuscitation training for the deaf.

A national survey of cardiopulmonary resuscitation (CPR) training services for deaf individuals was conducted by contacting regional directors of the American Heart Association, the American National Red Cross, and continuing education programs for the deaf. The results revealed that very little is being done in the way of a CPR training for the deaf. The American National Red Cross appears to be more active in this area than the other two organizations. Communication barriers and lack of adequate training resources (e.g., captioned films and sign interpreters) were identified as the major reasons why so few deaf people are being given CPR instruction.

Prescribing CPR: a survey of physicians.

We interviewed 55 cardiologists, internists, and family practitioners to determine attitudes and practices regarding cardiopulmonary resuscitation (CPR) counseling. There was unanimous support for citizen-CPR. However, only 40 per cent of the physicians interviewed recommended CPR training to spouses of patients with coronary heart disease and 42 per cent did not provide counseling about cardiac arrest. This suggests that the doctor's office can be better utilized in the promotion of CPR education.

Hospital based cardiopulmonary resuscitation: it could be better.

The frequency and duration of interruptions of cardiopulmonary resuscitation (CPR) were evaluated in a hospital to determine whether or not CRP was being performed properly according to American Heart Association (AHA) standards. The frequency of interruptions were 0.41 per min. Interruptions of greater than 20 s duration occurred in 17.12% of all interruptions. Eighty percent of these interruptions of greater than 20 s duration were of unjustified duration. CPR education should reflect these unjustified deviations and their reasons in an attempt to limit such interruptions in future patient CPR.

Complications Among CPR Trainees

To the Editor.— The enthusiastic training of lay persons in cardiopulmonary resuscitation (CPR) is a legitimate national priority. Some inherent complications of such instruction might be averted by slight modifications of the teaching techniques. Most instructors are familiar with muscle sprains in the lower area of the back and in the neck and infection from improperly cleaned mannikins used for demonstrating mouth-to-mouth respiration. More recently, I have encountered acute temporomandibular arthropathy occurring several days after CPR instruction and vigorous simulated mouth-to-mouth breathing. The patient required several lidocainesteroid injections for relief. Other side effects of CPR training undoubtedly have been encountered, especially among relatively sedentary volunteers. In view of the highly litiginous nature of our society, such complications could have medicolegal ramifications—notwithstanding the altruistic intent underlying CPR instruction.

Modular teaching of cardio-pulmonary resuscitation for nursing service personnel

Hospital accrediting agencies are becoming increasingly concerned that all nursing service personnel should be proficient in the administration of cardiopulmonary resuscitation. In response, our department had instituted a modular, self-learning CPR course, based on American Heart Association standards, which yields a high quality performance and decreases instruction time.

The mobile coronary care unit and the decision to seek medical care during acute episodes of coronary artery disease.

The mobile coronary care unit (MCCU) as a means of reducing coronary artery disease (CAD) morbidity and mortality cannot be realized unless patients, lay others, and medical personnel use it. The initial medical care decision of 1,102 patients who experienced acute cardiac symptomatology was studied to determine factors contributing to expedient care-seeking and the decision to use emergency medical services (EMS), direct emergency room services, or physician consultation. An expedient decision to utilize the EMS, the only means of obtaining the MCCU, occurred when symptoms began suddenly and were incapacitating, lay others advised the EMS, and patients relinquished and lay others usurped control of care-seeking process. To increase MCCU utilization and effectiveness, it is suggested that public education about CAD be refined and the teaching of cardiopulmonary resuscitation expanded, physicians be encouraged to educate patients realistically as to CAD prognosis, and a cardiac crisis center be instituted that incorporates a registery for patients at high risk of myocardial infarction or sudden cardiac death.

Importance of using proper techniques to teach cardiopulmonary resuscitation to laymen.

Immediate attempts to resuscitate patients with cardiac arrest by lay bystanders distinctly increase the chances of survival in such patients. In the present study we investigated possibilities of intensifying the cardiopulmonary resuscitation (CPR) training of laymen. A group of 46 young conscripts (test group) was given 2 hours of CPR instruction in what was considered the most efficient way. The procedures included showing a film on the theory and practice of CPR, a discussion of the film, and then 3 to 5 min instructed individual practice with a recording manikin. Another 56 conscripts participated in a 1-h illustrated lecture on CPR, which was followed by group training with a non-recording manikin; they served as a reference group. The performance of the subjects in CPR was measured with a recording manikin before and 2 months after the training. Before training, none of the subjects passed the surprise resuscitation test. After training, the skills of 62% of the subjects in the test group were acceptable according to original criteria for lay public, and 28% passed the test according to the strict criteria for medical personnel. The less intensive training given to the reference group did not improve the acceptability of resuscitation. It is concluded that CPR training for laymen may lead to failure to attain an adequate level of skill. Proper training techniques and equipment are important, but even their use does not guarantee that an adequate level of CPR performance will be attained by all laymen if their skills are not later refreshed.

Physician education in cardiopulmonary resuscitation

Physician education in cardiopulmonary resuscitation

Cardiopulmonary resuscitation. A survey of instruction in physical therapy schools.

Sixty-two physical therapy schools were surveyed reageding their teaching of cardiopulmonary resuscitation. Eighty-two percent of the schools responded to the questions and 27 percent indicated no such instruction. Included in this report is a copy of the questionnaire and the results of the survey. The recommendation is made that all physical therapists receive adequate training in cardiopulmonary resuscitation and that their competency be confirmed by examination.

Public education in cardiopulmonary resuscitation

Public education in cardiopulmonary resuscitation

Cardiopulmonary Resuscitation Instruction

Cardiopulmonary Resuscitation Instruction